bluuebunny/crossref_metadata_2025 huggingface dataset:
Marconi Redux: Small-Footprint High-Frequency Antenna System Design
Authors: Durham Dr. Marcus O. , Durham Pruitt R. , Durham Dr. Robert A.
Published: May 2024

The objective is to develop high-frequency (HF) antenna systems that are
small, unobtrusive, usable in limited space, indoor or portable, not
exposed to lightning, easily configurable for alternate patterns,
requiring only simple tools, minimum-skill install, without climbing,
and inexpensive. Construction, tests, and measurements clearly
illustrate an HF antenna system can be greatly reduced in size to a
couple of meters.

Ten circuit design implementations condense HF antennas to a miniscule
space, resulting in dramatically lessened environmental impact. A key
consideration is changing every antenna element to a tunable, loaded
inductor (TLI). Add inductor elements for wider bandwidth and
multi-band. SWR, impedance, and frequency evaluations illustrate the
performance.

Most contemporary antennas are variations of the balanced dipole used by
Hertz in 1888 or the unbalanced monopole advocated by Marconi in 1895.
Little has changed in high frequency antennas since those early two
designs. Below 30 MHz, antennas are still largely long-wires with
distributed electrical and magnetic properties. All antenna circuits
have two electrical connections: 1) the radiator and 2) the return,
comprised of the monopole counterpoise or the dipole non-radiating side.
More creativity is on the return side of the circuit than on the
radiator. This article summarizes the NM0D triad HF antenna system,
which fits all the objectives.
On Fermat's Last Theorem
Authors: Villacres Carlos
Published: May 2024

Here we approach the problem of FLT using the Binomial Theorem and two
cases: n even or odd. In this paper we will show that the polynomial (a
+ b − c) can be factored iff a +
b = c . Using this factored form
we attain a general solution for FLT.
Equivalence of Electro-optic Modulator Electrical and Optical Sidebands via Neumann's Addition Theorem for Bessel Functions
Authors: Cole David B
Published: May 2024

In photonic circuits and optical communications links, the electro-optic
modulator (EOM) can be considered the heart of the entire system,
allowing analog and digital data in the RF or microwave domain to be
modulated onto an optical carrier for transmission over low-loss,
high-bandwidth optical links. EOMs can be fabricated in a number of
material systems and operated in various modes that optimize some
measure of performance depending on the application. One common
configuration is the push-pull configuration, where a phase modulator in
each arm of a Mach-Zehnder interferometer is modulated with equal
amplitude but opposite phase. The resulting optical fields of the EOM,
and most importantly, the photodetected currents generated from those
fields, are well-characterized in the literature. Here, we explicitly
demonstrate how the complex optical fields, represented by a sinusoidal
series with Bessel function amplitudes, are combined by the detector
nonlinearity into RF and microwave currents, also represented by a
sinusoidal series with Bessel function amplitudes, and extracted at the
end of the optical link.
GRAMSCI E O FASCISMO: UM MAPA DA QUESTÃO
Authors: Secco Lincoln
Published: May 2024

O presente artigo pretende mapear nos escritos políticos e nos Cadernos do Cárcere de Antonio Gramsci o fascismo. O fascismo é aqui considerado enquanto mobilização oportunista e permanente, contrarrevolucionária e racional da irracionalidade das massas durante a crise do entreguerras. Essa abordagem não fecha o conceito, mas propõe um eixo para mapear as fronteiras imprecisas dos regimes fascistas, os contornos dos movimentos históricos e suas etapas. A vantagem dessa abordagem é que ela lida com a historicidade dos fenômenos fascistas sem abandonar a construção de um conceito abrangente. Como veremos, Antonio Gramsci foi pioneiro nessa metodologia.
RELAÇÕES BRASIL-CHINA: IMPERIALISMO, DEPENDÊNCIA E DESCONEXÃO
Authors: Souza Angelita Matos
Published: May 2024

Neste texto, o objetivo é apresentar uma reflexão breve sobre as relações Brasil-China, orientadas por duas perguntas:1. As relações entre os dois países podem ser apreendidas a partir do par imperialismo e dependência? 2. Seria possível vislumbrar uma nova rodada de dependência com desenvolvimento via relações com o país asiático? Em linhas gerais, argumentaremos contra a caracterização das relações Brasil-China como de dependência; tampouco abordaremos a China como potência imperialista, indicaremos apenas que práticas imperialistas, certamente, caracterizam o expansionismo chinês. Além disso, defenderemos que as relações com o país asiático estão inseridas na fase atual da dependência, marcada pela dissociação entre dependência e desenvolvimento (industrial). Por fim, a possibilidade de reversão dessa situação será considerada por meio da ideia de desconexão.
QUARENTA ANOS DE TEATRO NO DEPARTAMENTO DE FILOSOFIA DA UNESP
Authors: Portich Ana
Published: May 2024

Este texto divide-se em duas frentes, a primeira sobre a forte presença, no Departamento de Filosofia da UNESP, de docentes e alunos que nos últimos 40 anos dedicaram-se à pesquisa sobre teatro no Brasil e no mundo. Desde 1982 vários projetos voltados para a prática teatral foram realizados neste departamento, com destaque para o Ciclo de Leituras Dramáticas, que celebra em 2022 dez anos de atividades ininterruptas sob coordenação da professora Ana Portich. A segunda parte do artigo consiste em uma experiência de criação de texto realizada de 2020 a 2022 por pesquisadores que tiveram sua formação em filosofia na UNESP. Como amostra dos exercícios de dramaturgia que surgiram dessa iniciativa, publicamos aqui a Cena 1, de Danieli Gervazio Magdaleno; A vanguarda no campo, de Manoela Paiva Menezes; A questão da terra e outras coisinhas mais, de Ernesto Ferro Jr.
FOI BOGDÁNOV A RESPOSTA PARA GRAMSCI?
Authors: Sochor Zenovia A.
Published: May 2024

As particularidades epistemológicas e táticas que distinguem o marxismo ortodoxo soviético das diversas vertentes do marxismo ocidental foram objetos de inúmeros debates, tanto entre acadêmicos quanto no interior de movimentos políticos e sociais. No contrapelo dessa tendência que privilegia as diferenças, Zenovia Sochor apresenta nesse artigo possíveis pontos de contato entre tais tradições, através das obras de dois de seus principais expoentes: Antonio Gramsci, um dos mais importantes pensadores do marxismo ocidental; e Aleksandr Bogdánov, importante líder da fração bolchevique nos anos primevos do POSDR. Utilizando-se das posições de Lenin como referencial comparativo, Sochor apresenta as ideias de Bogdánov e Gramsci acerca das condições necessárias para a revolução a partir de três aspectos do problema: (1) o papel dos intelectuais; (2) as organizações propostas para o trabalho cultural-educacional; e em um nível mais amplo, (3) a relação entre mudança cultural e transição para o socialismo.
Pelatihan Keterampilan Teknik Dasar Permainan Bulu Tangkis di Desa Pandan Wangi Kabupaten Lombok Timur
Authors: Azis Abdul
Published: May 2024

Badminton is a sport that is the pride of the Indonesian nation. Almost every region has the facilities and infrastructure to do this sport. The popularity of badminton has resulted in badminton players being able to compete at the international level. This should be maintained and developed in order to make the nation proud. There are five categories of badminton played, including men's singles, women's singles, men's doubles, women's doubles and mixed doubles. The game of badminton can not only be played on an open court (outdoor), but can also be played on a closed court (indoor). The shape of a badminton court is rectangular and there is a net in the middle that divides the area between two players or pairs. The aim of this activity is to train basic technical skills for playing badminton in Pandan Wangi Village, Jerowaru District, East Lombok Regency. The results achieved in training on basic techniques for playing badminton in Pandan Wangi Village within ± one and a half months include: 1) children know what the basic techniques for playing badminton are; 2) children already understand how to perform the basic technical movements of playing badminton; 3) develop players' abilities in playing badminton; 4) improve children's ability to perform basic badminton techniques; 5) improve brain cognition; 6) strengthen the muscles and joints of the body; 7) prevent a number of diseases; 8) make children interested in sports from previously often playing online games; 9) develop the quality of children in Pandan Wangi Village in playing badminton; and 10) maintaining body health by exercising, especially playing badminton.
Selective Arterial Embolization for the Management of Large Multinodular Cervicomediastinal Goiter
Authors: Coello-Vergara Jonathan , Montalván-Lalama Dannia , Albuja-Delgado Kevin , Oñate Gabriela Paredes , Gonzaga-Granja Rosa , Jarro-Villavicencio Iván , Villarreal-Juris Andrea
Published: May 2024

In the surgical treatment of thyroid disease, surgery of cervicomediastinal goiters has always been a challenge, due to the high risk of intraoperative and postoperative complications, especially excessive bleeding. Case report Fifty-one-year-old female patient with multiple underlying diseases, presenting a large cervical mass resulting to be a large multinodular cervicomediastinal goiter. Underwent selective arterial embolization of vascular branches supplying irrigation to the mass and later a total thyroidectomy with minimum blood loss during the intraoperative time. Conclusion Even if preoperative selective artery embolization is far from being a routine technique in cervicomediastinal goiter surgery, in selected patients who have many underlying medical problems, very voluminous goiter, high bleeding risk or high intraoperative risk, it can be considered a useful and safe procedure.
Faktor-Faktor yang Memengaruhi Penerimaan Vaksin Human Papillomavirus (HPV) di Negara-Negara ASEAN: Literature Review
Authors: Varian Almerridho  , Butsainah Putri Rahmah  , Muhammad Faris Naufal  , Robiana Modjo
Published: May 2024

Human papillomavirus (HPV) adalah virus yang menjadi penyebab infeksi menular seksual (IMS) paling umum dan penyebab utama dari kanker serviks. Kanker serviks merupakan kanker yang menempati urutan kedua terbanyak di Indonesia. Salah satu upaya pencegahan terjadinya kanker serviks adalah melalui vaksinasi human papillomavirus (HPV). Penelitian sebelumnya membuktikan bahwa penerimaan terhadap vaksinasi HPV di ASEAN dipengaruhi oleh pengetahuan rendah tentang vaksin, harga tinggi, dan kepercayaan masyarakat yang kontradiktif. Tujuan dari penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi penerimaan vaksin HPV di negara-negara ASEAN. Literature review dilakukan pada tiga database untuk penelitian kualitatif dan kuantitatif yang diterbitkan hingga Agustus 2023. Artikel disertakan jika dalam bahasa Inggris atau Indonesia, tersedia dalam teks lengkap, dan memiliki fokus pada pengetahuan, biaya, keyakinan, penerimaan vaksin HPV. Dari 23 studi, ditemukan bahwa faktor- faktor penerimaan vaksin HPV yang paling sering disinggung adalah faktor pengetahuan, biaya, dan kepercayaan. Walau menjadi faktor yang kerap muncul, pengetahuan tidak selalu mencerminkan angka penerimaan vaksin.Tidak ditemukan adanya kontradiksi terkait faktor biaya di antara kumpulan studi tersebut. Biaya vaksinasi menjadi faktor utama dalam penerimaan vaksin HPV. Pengetahuan dapat berpengaruh tetapi tidak selalu mencerminkan angka penerimaan vaksin HPV. Faktor lain seperti kepercayaan masyarakat juga menjadi kontributor yang cukup besar terhadap penerimaan vaksin HPV di negara-negara ASEAN.
Endoscopic Fenestration of an Intra-ventricular Arachnoid Cyst in a Young Male – A Rare Entity
Authors: Muhammad Assad Javed  , Niaz Ahmad Khan  , Ain-us-Saba
Published: May 2024

Introduction:  Among intracranial space-occupying lesions, arachnoid cysts compromise 1% only. Abnormal collection of cerebrospinal fluid occurs in these types of cysts leading to pressure symptoms. Developmental abnormalities of cerebrospinal structures in early fetal life lead to the primary type of arachnoid cysts, while the second type of arachnoid cyst is formed after some neurological insult like head injury, tumor, meningitis, or brain surgery. In 60 – 90% of cases, the primary type predominates and presents with pressure symptoms before the age of 20 years. The adjudged incidence is 1.4% in adults, the least frequent being intraventricular location.
Clinical Case:  A 23-year-old male presented with a long-standing left-sided cranial vault headache, right-sided focal seizures, and progressive right- hemiparesis. Neurological evaluation revealed upper motor neuron signs on the right side of the body. A computerized axial tomography raised the suspicion of an arachnoid cyst for which magnetic resonance imaging was done which revealed a large intraventricular cyst of lateral ventricles causing mass effect over the ipsilateral hemisphere and mild obstructive hydrocephalous. Surgical intervention was required as per symptomology (intractable headache, seizures, and hemiparesis) and large cyst size.
Conclusion:  Cerebrospinal fluid accumulation in the brain's arachnoid layer causes non-cancerous arachnoid cysts. Larger cysts may push on brain tissue and cause neurological difficulties. MRI may diagnose arachnoid cysts, and treatment options include cystoperitoneal shunt, craniotomy, and neuro-endoscopic fenestration, the least invasive. Cyst size and location determine therapy. In this example, endoscopic treatment reduced symptoms and consequences.
The Swirl Sign and Its Relationship to Patient Outcomes in Extradural Hematomas: A Retrospective Investigation
Authors: Ul Haq Muhammad Ammad , Muhammad Jazib Ijaz  , Anam Ali  , Sania Bhatti  , Maheen Sabah  , Eesha Yaqoob  , Saad Javed
Published: May 2024

Introduction:" Swirl sign" is a relatively uncommon sign, seen on non-contrast CT scans in patients with head trauma who develop extradural hematoma the prognostic significance of which is controversial. This research aims to evaluate the predictive significance of the swirl sign in patients with an extradural hemorrhage.
Material and Methods:  It was a retrospective study and included 145 patients, with traumatic brain injury, who underwent surgical treatment at the Department of Neurosurgery Holy Family Hospital, Rawalpindi, Pakistan, between January 2022 and January 2023 and had traumatic EDH identified by computed tomography scan. Patients who did not undergo surgery or had combined or open craniocerebral injuries were eliminated. A Glasgow Outcome Scale score was used to evaluate outcomes after three months of traumatic brain injury. Mann-Whitney U test, the Chi-square test, and multivariate logistic regression were applied for descriptive and inferential analysis.
Results:  A total of 145 cases were evaluated, 19 (13.1%) demonstrated the sign on a CT scan of the brain. Analysis displayed a notable association between the incidence of the swirl sign and pupillary size, preoperative Glasgow Coma Scale score, time between trauma and first CT scan, and volume of hematoma measured intraoperatively. Patients displaying the swirl sign showed an increased mortality rate (25%) compared to patients without the swirl sign (5%) and worse outcomes at 3 months.
Conclusion:  The presence of the swirl sign on the CT scan had a significant association with worse outcomes. Early detection and prompt surgical evacuation are important for patients with this sign.
PET-CT Guided Gamma Knife Radiosurgery for Recurrent Glioblastoma Multiforme Recurrent Cases in Pakistan
Authors: Zaheen Shibli  , Aurangzeb Kalhoro  , Kashif Ahmed  , Abdul Sattar M. Hashim
Published: May 2024

Objective:  The treatment of recurrent Glioblastoma Multiforme (r-GBM) poses a significant confronts to neurosurgeons. This study was conducted to assess the effectiveness of PET-CT-guided Gamma Knife radiosurgery (GKRS) in treating r-GBM. The purpose of the study is to determine the outcome of this treatment approach.
Materials and Methods:  Retrospective descriptive research was supervised at the Neurospinal and Cancer Care Institute, Karachi Pakistan between June 2017 to August 2022. The study comprised patients with biopsy-confirmed Grade IV Glioblastoma Multiforme who experienced recurrence during follow-up. PET-CT and MRI brain with contrast were performed to determine the target volume of the tumor, and GKRS was carried out based on the scan findings.
Results:  A total of 24 patients, ranging in age from 47 to 77 years with a median age of 50 years, were included in the study. The tumor recurrence occurred within a median interval of 10 months after diagnosis, ranging from 1 to 16 months. The median time for progression-free survival from GKRS was 5 months, ranging from 2 to 6 months. The median overall survival from GKRS was 11 months, ranging from 5 to 12 months.
Conclusion:  GKRS is a tool in the multimodal treatment of r-GBM. By co-registering PET-CT-MRI, it becomes possible to plan the treatment more effectively by targeting the active tumor while preserving healthy brain tissue. This approach has the potential to improve overall survival rates and patient outcomes.
Management and Outcome of Severe Traumatic Brain Injury
Authors: Arfa Qasim  , Lal Rehman  , Iram Bokhari  , Farrukh Javeed  , Haris Hamid  , Rubab Qadir
Published: May 2024

Objective:  To assess the management of patients with severe traumatic brain injury and their outcomes.
Materials and Methods:  A prospective observational study was conducted at the Department of Neurosurgery of a tertiary care hospital. Our study included 279 patients in total. After meeting the requirements for inclusion, the patient's baseline information, such as age, gender, arrival GCS, and outcome, were noted. Three months of post-trauma observation were employed to assess the outcome. SPSS version 22.0 was used to evaluate the data obtained.
Results:  According to our study out of the total, 118 (42.3%) patients with severe TBI showed good outcomes while 161 (57.7%) showed poor outcomes at 3 months. In our study, the arrival GCS and arrival pupillary reactivity were statistically significant outcome factors (p = 0.040 and 0.010 respectively). Overall mortality was 35.13% (98) at 3 months.
Conclusion:  Patients presenting with severe TBI have high morbidity and mortality. Arrival GCS and pupillary reaction were important factors to significantly alter the outcome.
Keywords:  Traumatic Brain Injury, Glasgow Coma Score, Head Trauma, Glasgow Outcome Score, Outcome.
Clinical Outcomes of Dexmedetomidine As An Anesthetic Adjuvant in Intracranial Surgery, An Experience from Irfan General Hospital Peshawar: A Prospective Case Series Study
Authors: Mabood Shahid , Khan Asad , Iqbal Javed , Mehmood Fahad , Sahibzada Abdul Haseeb
Published: May 2024

Objective:  Neuro anesthesia (most commonly general) is indicated in intracranial surgery, the goal of which is to maintain a stable hemodynamic environment. This study aimed at evaluating the effectiveness of Dexmedetomidine (DEX) when used as an adjuvant in intracranial surgery.
Materials And Methods:  A prospective design was utilized and the data was collected at the Department of Neurosurgery Irfan General Hospital Peshawar in patients undergoing intracranial. All those patients having a score of 14 or 15 on the Glasgow Coma Scale, and I and II on the American Society of Anesthesiologists (ASA) undergoing intracranial surgery under general anesthesia were included in the study.
Results:  The majority of patients were males 35 (66%) while 18 (34%) were females. 29(55%) patients were categorized as grade I while 24 (45%) as grade II according to the American Society of Anesthesiologists-Physical status. mean extubation time of our sample of patients undergoing craniotomy was 6.21 ± 2.16 minutes while the time for rescue analgesia was 41.23 ± 23.15 minutes. The heart rate values decreased significantly when noted at different intervals from the baseline.
Conclusion:  Dexmedetomidine is an effective and safe anesthetic adjuvant when used in intracranial surgery and provides stable hemodynamics both intra and post-operatively. The neuro anesthetic drug also reduces the requirements of other opioids and rescue drugs.
Comparative Study on the Effectiveness of Posterolateral Fusion vs. Interbody Fusion in Isthmic/Degenerative Spondylolisthesis
Authors: Syed Ahmad Faizan  , Mudassir Masaud  , Zubair Mustafa Khan  , Tariq Imran  , Asif Bashir
Published: May 2024

Objective:  To compare the effectiveness of posterolateral fusion versus transforaminal lumbar interbody fusion in degenerative/isthmic spondylolisthesis in terms of postoperative pain and postoperative complications.
Materials & Methods:  A quasi-experimental study was conducted and 74 patients were included. Group A (n=37) patients underwent PLF, whereas Group B (n = 37) patients underwent TLIF. The pain was assessed with a visual analog scale (VAS), and for disability, the Oswestry Disability Index (ODI) was used.
Results:  In Group-A, pre- and post-op back pain mean scores were 3.86 & 0.78, leg pain mean scores were 1.32 & 0.54 while ODI mean scores were 22.51 & 8.59, respectively(P ? 0.05). In Group B, pre- and post-op back pain mean scores were 3.41 & 0.46, leg pain mean scores were 0.84 & 0.30 and ODI mean scores were 19.89 & 6.59, respectively (P > 0.05). The prevalence of minimal disabilities in the TLIF (73%, 78%, 81%, 86%, & 91%) group was relatively more than in the PSF (70%, 75%, 78%, 81%, & 86%) group during pre-op, and post-op phases (2 & 6 weeks, 3 & 6 months). Relatively more patients (8.1% vs. 5.4%) with moderate disability were found in the PSF group as compared to the TLIF group. 
Conclusion:  The study concluded that TLIF is a safe and more effective procedure than PLF for isthmic/degenerative spondylolisthesis. It is a better surgical procedure for post-operative back pain, leg pain, complications, and disability.
Efficacy of Electromagnetic Based Neuronavigation-Guided Biopsy of Supratentorial Lesions of the Brain at Jinnah Hospital Lahore
Authors: Usman Ahmad Kamboh  , Mehwish Manzoor  , Hafiza Arisha Fayyaz  , Zaid Sami  , Mehreen Mehboob  , Manzoor Ahmad
Published: May 2024

Objective:  The study aims to establish the efficacy of electromagnetic-based neuro navigation-guided biopsy of supratentorial lesions (including deep-seated, multiple, and suspicious lesions) in selected patients.
Materials & Methods:  After being admitted to the neurosurgery department, all patients who satisfied the inclusion criteria were recruited for the research. Patients received neuroimaging in the form of CT/MRI brain with contrast using the neuronavigation protocol, and the data was uploaded to the Medtronic neuronavigation system. Under general anesthesia, all patients had a biopsy. On the console, the surgical trajectory for the biopsy was planned. Following the AxiEM system's usual operating protocols, a Sedan needle was used to biopsy lesions after its stylet was replaced with an EM stylet.
Results:  Out of 19 patients, 11 (60%) were male and 8 (40%) female while age ranged from 13 to 70 years. Out of 19 patients, 4 patients (21%) had parietal, occipital, and thalamic lesions respectively. 4 patients (21%) had low-grade glioma (grade 2) and 3 (15.7%) patients had Burkitt lymphoma, adenocarcinoma (likely from lungs), and blue cell tumor respectively. As regards complications, 2 patients (10.5%) developed hemorrhage, 1 patient (5.26%) developed postoperative cerebral edema, and 1 patient (5.26%) expired.
Conclusion:  Electromagnetic neuronavigation using the biopsy needle (Sedan needle) is a safe and effective neuronavigation system. It offers a high degree of accuracy required for the establishment of a definitive diagnosis and adequate treatment.
A Rare Presentation of Triplegia Resulting from Penetrating Brain Trauma by a Hand-Held Dagger
Authors: Tassadaq Ali , Shah Motsim , Akhtar Nadeem , Khan Munema , Gondal Soban , Rana Mohsin
Published: May 2024

Penetrating brain trauma is a devastating injury mode mostly seen in military settings. Its low-velocity counterpart resulting from objects such as knives, drills, daggers, etc. is relatively less common & rarely seen present mostly in isolated case reports. The neuropathological outcome can be disproportionately morbid in these cases with a varied clinical spectrum ranging from occult deficits to grave debilities reported. It is an anatomical insult whose course is free of clinical constraints & determined by the trajectory & velocity of the object. In this case report, an 18-year-old male ordeal is reported who suffered the injury from a hand-held dagger that involved both parietal cortices via midline traversing. GCS on presentation was 15/15 but the patient had triplegia in the form of paraplegia & contralateral upper limb monoplegia. The object was retrieved via craniectomy & cortectomy although no clinical recovery was seen post-up or on follow-up. It is a case intriguing & indicative of the unpredictable course of such injuries.
Radiological Verses Histological Evaluation of Spinal Space Occupying Lesions
Authors: Sabika aftab  , Rabail Akbar  , Tanweer Ahmed  , Lal Rehman  , Iram Bokhari  , Sana Akbar
Published: May 2024

Objective:  This study set out to evaluate radiology's diagnostic capacity in accurately establishing a preliminary working diagnosis for various spine tumor types.
Materials and Methods:  This is a prospective study carried out and examined patients who had surgical resection with the collection of histopathology samples, regardless of age or gender. A full MRI examination from every angle and contrast-enhanced pictures were required. Inclusion criteria consisted of Patients of all ages of both genders, who underwent surgery a tissue sample was collected for histopathological diagnoses, and a complete MRI study with all views and contrast-enhanced images was available to give a preliminary diagnosis.
Results:  Based on the evaluation by the senior radiologists, the lesions were most commonly intradural-extramedullary (50%) in position according to the dura, followed by intramedullary in 14 (26.9%) patients. Despite our series having a total of 16 misdiagnosed cases, the overall diagnostic accuracy of the MRI remained high at 69.2%.
Conclusion:  MRI has superior diagnostic accuracy in diagnosing meningiomas as compared to nerve sheath tumors such as meningiomas. It also has good predictive accuracy of intramedullary lesions such as ependymomas.
Effectiveness and Safety of Burr Hole Evacuation in Chronic Subdural Hematoma Patients – Experience from a Low-Income Country
Authors: Filza Faiqa , Almas Fasih Khattak  , Leena Ayesha  , Khial Jalal  , Wajid Ali  , Majid Ayaz  , Zahid Khan
Published: May 2024

Background: In contemporary neurosurgery, burr holes are fundamental in cranial procedures, primarily for the evacuation of chronic subdural hematomas (CSDH). CSDH is prevalent, and its clinical course, though not life-threatening, carries morbidity and mortality risks. This study evaluates the effectiveness and safety of Burr Hole Evacuation (BHE) for CSDH, aiming to assess clinical outcomes, immediate postoperative complications, and patient satisfaction.
Methodology: This retrospective cohort study analyzed data from patients who underwent BHE for CSDH between March 2015 and August 2023. Inclusion criteria encompassed well-documented CSDH diagnoses, comprehensive medical records, and primary BHE cases, excluding previous neurosurgical interventions and pediatric cases. Data included patient demographics, clinical presentation, imaging findings, surgical details, post-operative outcomes, and patient satisfaction. Analysis was performed using SPSS version 25.
Results: The study included 86 patients, predominantly male (85%) with a mean age of 54 years. Clinical presentations varied, with headaches (85%) being the most common symptom. CT scans were pivotal for diagnosis, revealing hypodensities primarily over the convexity. BHE was performed without complications, resulting in favorable post-operative outcomes (93% significant recovery, 7% extended hospital stays). No intraoperative or post-operative mortality occurred, and there were no recurrent hematomas. Patient satisfaction with BHE was high (97%).
Conclusion: BHE is a viable primary surgical intervention for CSDH in low-income settings, with positive outcomes, safety, and patient satisfaction. Further studies and collaborative efforts are essential to enhance neurosurgical treatment in these settings and explore long-term outcomes.
incidence of cervical spine injuries in paediatric patients and their outcome in tertiary care hospital
Authors: Ahmed Sahibzada haseeb , Abbas khan
Published: May 2024

Objective:  The incidence of mortality after cervical trauma in the pediatric population is very high. The purpose of this study was to determine the treatment given, morbidity and mortality of patients with cervical spine injuries, and their outcome after 6 months of management which includes both surgical and conservative treatment.
Materials & Methods:  A prospective study was conducted at Lady Reading Hospital, Peshawar with a total number of patients n = 187 included in our study. Patients were stratified according to their age, mortality, mechanism of injury (fall, motor vehicle accident, bicycle injuries, &sports-related injuries), level of cervical spine injury, presence of neurologic deficit, presence of bony injury (fractures, &dislocations), ligamentous injuries & SCIWORA. The primary outcome was the functional status at 6 months following treatment.
Results:  There were 78 females and 109 males. In comparison to the lower cervical spine (C3 – C7), which was involved in 86 patients (46%), the higher cervical spine level (C0 – C2) was involved in 101 patients (or 54%). The most frequent cause of cervical spine injuries in the older age range was a history of a fall, followed by a motor vehicle accident. Among the treatment groups, mortality was highest in patients who underwent surgery. 
Conclusion:  Younger age groups, higher cervical spine levels, and mechanisms of injury such as high energy impact trauma were independent risk factors for increased mortality. Compared to incomplete neurological abnormalities, a complete neurological disability increases mortality.
The Outcome of Prolactinoma in the Postpartum Period: a Study from a Tertiary Care Hospital in Pakistan
Authors: Shirin Gul Suhail  , Omair Afzal  , Zahra Safdar  , Rizwan Ahmad Khan  , Uzma Zia
Published: May 2024

Objective:  Prolactin is an essential hormone secreted by the pituitary gland of pregnant women. The pituitary gland undergoes growth, due to lactotroph hyperplasia in response to placental estrogen during pregnancy. Research on the postpartum outcomes of prolactinomas is less. This study evaluates the prevalence of Prolactinoma and the occurrence of spontaneous resolution of Prolactinomas after pregnancy.
Materials and Methods:  A cross-section study was conducted at the Punjab Institute of Neurosciences, Lahore. 200 pregnant women were recruited; their blood samples were collected to evaluate serum prolactin levels. Women diagnosed with prolactinomas exhibiting positive symptoms were given dopamine agonists. The administration of dopamine agonist was discontinued at the 24th week of gestation. All participants were monitored till birth, at 40 days after delivery, and throughout breastfeeding. Their prolactin levels were evaluated, and magnetic resonance imaging (MRI) was conducted to verify the resolution of prolactinoma.
Results:  The mean age of females in the study was 29.03 ± 7.20 years. Out of 200, 40 (20%) females had prolactinoma. Out of 40, 13 (32.5%) were given Bromocriptine while 27 (67.5%) were given Cabergoline. At presentation, the mean serum prolactin level was 138.91 ± 149.02 ng/ml, which reduced to 21.38 ± 9.80 ng/ml. The mean tumor size at presentation was 7.23 ± 2.07 mm, which reduced to 0.79 ± 0.66 mm after delivery. Out of 40, 30 (75.0%) had spontaneous resolution.
Conclusion:  The occurrence of prolactinoma is low in symptomatic patients and can resolve spontaneously after delivery in the majority of cases.
Recurrence Rate After Using Subdural Drain in Patients with Chronic Subdural Hematoma
Authors: Hameed Ullah  , Amer Zaman  , Waseef Ullah  , Junaid Alam  , Atta Ullah  , Bilal Ahmad
Published: May 2024

Objective:  One of the most often carried out procedures in the neurosurgical field is the drainage of chronic subdural hematomas (CSDHs). According to Scotti, subdural hematoma was identified radiologically as a subdural collection that was hypodense to parenchyma and manifested 21 days following trauma. This definition was based on the CT scan. In this study, we want to find the effectiveness of subdural drain in managing chronic subdural hematoma from the perspective of recurrence in our setup.
Materials and Methods:  After the procedure, the patients were admitted to the ward for 48 hours and the drain was removed after 48 hours. Then the patients were discharged and follow-up was taken one month for diagnosis of recurrence. Recurrence was labeled positive if postoperative symptomatic recurrence of hematoma that needs re-operation of any type within one month of primary surgery.
Results:  Among 85 patients mean age was 51 years with a standard deviation ± 7.55. 60(71%) patients were male and 25(29%) patients were female. Moreover s10 (12%) patients had recurrence while 75(88%) patients didn’t have recurrence.
Conclusion:  According to our research, patients with Chronic Subdural Hematoma (CSDH) had a 12% recurrence incidence following the placement of a subdural drain.
Depressed Skull Fracture Surgical Management and Outcome among Head Injury Patients: Experience at Tertiary Care Hospital
Authors: Aurangzeb Kalhoro  , Muhammad Hamid Ali  , Vashdev Khimani  , Raiz Ahmed Raja  , Mahesh Kumar Luhano
Published: May 2024

Objective:  To evaluate outcomes in patients with managed depressed skull fractures operatively having head injuries.
Methods:  This study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro. We analyzed 76 patients who underwent operative management for skull fractures. Patient selection included both children and adults with skull fractures evident on CT brain scans using bone windows.
Results:  Our study included 76 patients, with 48 males and 28 females, and a mean age of 28.68 ± 10.33 years. Among them, 45 (59.21%) were under 30 years old, and the highest incidence of depressed skull fractures occurred in the 21 – 30 age group. Road traffic accidents were the leading cause, accounting for 42 (55.25%) cases, while falls from heights contributed to 24 (31.57%) cases, and 7 (9.21%) resulted from objects falling on the patients.
Conclusion:  Patients with head injuries can be fatal if not managed promptly. Neglecting the management of a depressed fracture can also impact the outcome in these cases and lead to a series of complications.
Complications of Post-Traumatic Spinal Surgery
Authors: Mohammad Daniyal Mumtaz  , Iram Bokhari  , Tanweer Ahmed  , Raheel Gohar  , Sanam Daniyal  , Sehrish Altaf
Published: May 2024

Objective:  The study aimed to evaluate the frequency and complications of post-traumatic spinal surgeries.
Materials and Methods:  A prospective observational study was conducted at JPMC for six months and included 55 patients presenting with post-traumatic spinal injuries who were operated on. Information on the patient’s demographics, clinical findings, radiological findings, type of surgical procedure, and postoperative complications were recorded. A chi-square test was employed to compare difficulties with demographic characteristics.
Results:  Our study comprised of patients with an age of 39.55+/-6.19 years; of them, 72.7 percent were males, and overall complications occurred in 30.9 percent of patients, which included wound infection (10.9%), CSF fistula (3.6%), wound dehiscence (1.8%), pneumonia (3.6%), heart arrhythmia (1.8%), lung congestion (1.8%), instrumental loosening (1.8%), postoperative visual loss (1.8%), and diathermy burns (3.6%).
Conclusion:  30.9 percent of patients operated for spinal traumatic injuries developed complications. A few of these complications are dreaded and need to be communicated to patients/attendants and necessary steps should be taken to prevent them.
Evaluation of Outcomes and Complications of Sphenoid Wing Meningiomas in Tertiary Care Hospital of KPK
Authors: Ahmad Qarnain Aafaq , Mumtaz Ali  , Akramullah  , Sajid Khan  , Zubair Bashir
Published: May 2024

Objective:  The objective of this study is to evaluate the outcomes and complications associated with pterional craniotomy and extended pterional craniotomy for the resection of Sphenoid Wing Meningiomas.
Material and Methods:  A prospective study was conducted on 34 patients at the Neurosurgery department, Prime Teaching Hospital, Pakistan, and Ali Institute of Neurosciences. We examined 34 recently diagnosed cases of sphenoid wing meningiomas, selected through a total enumerative sampling method. Diagnosis of these meningiomas was confirmed by comprehensive neurological assessment and imaging studies. Various surgical techniques, such as Pterional and Extended Pterional approaches, were employed in the procedures. Assessment of clinical outcomes and complications was conducted during follow-up evaluations. A total of 34 patients diagnosed with sphenoid wing meningiomas were covered as the study’s target population. All patients met certain criteria to be included in the study.
Results:  25 (73.6%) of the total number of patients were females and 9 (26.4%) were males. The mean age at diagnosis was 47 ± 5 years. Presenting symptoms included headache, seizures, visual loss, motor deficit, and cognitive decline. Surgical techniques used in tumor resection were pterional craniotomy and extended pterional craniotomy. Post-operative evaluation after follow-up studies showed that the symptoms reversed, including a reduction in headache, vision restoration, seizure control, and motor and cognitive function improvement.
Conclusion:  Pterional approach and extended Pterional approaches related to SWM removal are satisfactory rates of an acceptable and safe surgical treatment with satisfactory results concerning the total resection rate and related clinical improvement.
Coccydynia: Do Corticosteroid Injections Hit the Mark Over NSAIDs?
Authors: Naveed Gul  , Kashif Ramooz  , Yasir Shehzad  , Shafiq ur Rehman Jamil  , Faraz Mehmood  , Sania Bhatti  , Eesha Yaqoob  , Saad Javed
Published: May 2024

Objective:  Coccydynia is a medical ailment that causes discomfort at the coccyx, or tailbone, which can make it difficult for a person to go about their regular business. Nonsteroidal anti-inflammatory medications taken orally, and corticosteroid injections are two potential treatments for Coccydynia. However, the most effective and appropriate course of treatment for this condition must be identified. The study aimed to compare the effectiveness of Corticosteroid Injection vs. NSAID for pain relief in Coccydynia patients.
Materials & Methods:  A total of 47 patients with idiopathic coccydynia were allocated to receive either oral NSAIDs plus a tailbone cushion (n=24) or fluoroscopic corticosteroid injection (n=23). Pain levels were measured by a visual analog scale at baseline and 2-, 3-, and 4-months post-treatment. Chi-square and t-tests were used to compare treatment efficacy.
Results:  The two treatment groups showed no significant differences. Both groups demonstrated reduced pain over time, with no significant difference between injections and NSAIDs (p=0.209). While injections provided more relief for mild pain, NSAIDs showed better results for no-pain patients. Overall mean pain scores were similar between groups. The treatments differed in effectiveness for certain pain levels but exhibited comparable efficacy in reducing overall coccyx pain. The hypothesis of differing treatment efficacy was not supported.
Conclusion:  As a result, it can be considered a viable alternative therapy for patients who have difficulty adhering to oral medication regimens due to its one-time administration and affordable cost. To achieve optimal therapeutic outcomes, it is critical to choose the appropriate patients.
Analyzing Spondylolisthesis in Patients with Proven Spinal Stenosis Using Plain X-Rays and Supine MRI: A Retrospective Study of Five Years
Authors: Mumtaz Ali  , Akram Ullah  , Ramzan Hussain  , Hanif Ur Rahman  , Sajid Khan  , Amjad Ali  , Abdul Haseeb Sahibzada
Published: May 2024

Objective:  This study aimed to evaluate the frequency of cases in which patients were diagnosed with lumber spinal stenosis using MRI and later were categorized as having spondylolisthesis when evaluated through plain X-rays.
Material and Methods:  This retrospective study was conducted at the Ali Institute of Neurosciences, Irfan General Hospital from 2017 to 2022. All those patients were included in the study who underwent lumbar spine MRI between 2017 and 2022 with evident findings of spinal stenosis, patients who subsequently underwent plain X-rays of the lumbar spine, and patients with available medical records and imaging data for review. While all those were excluded who did not undergo plain X-rays following MRI. Data was analyzed using SPSS version 22. Descriptive statistics, such as frequencies and percentages, were used to summarize the categorical data while mean and standard deviation were reported for numerical data.
Results:  The mean age of the study population was 45 years, with a range from 26 to 65. Among the patients included in the study (1156), 380 were the cases missed initially on MRI and later diagnosed with spondylolisthesis on plain X-rays. This corresponds to a frequency of 33% of misdiagnosed spondylolisthesis cases based on MRI.
Conclusion:  This study highlights that the frequency of missed spondylolisthesis cases on lumbar spine MRI was one-third of the cases and the importance of additional imaging modalities, such as plain X-rays, for accurate diagnosis.
The Prevalence of Post-operative Complications Following Meningomyelocele Repair
Authors: Sahibzada Haseeb Ahmed  , Adnan Khan  , Muhammad Hassan Abid  , Muhammad Daud  , Maria Nisar  , Muhammad Kashif Jamal
Published: May 2024

Objective:  To assess the incidence of post-operative complications after meningomyelocele repair in patients presenting with Meningocele.
Materials & Methods:  All the patients presenting with meningocele and myelomeningocele, age between 1 day to 5 years, both genders and patients with ASA grade I and II were included. All the baseline /routine hospital investigation was done, the lesions were assessed for age, size duration of symptoms, and location and were checked for cerebrospinal fluid leaks. The presence of associated abnormalities was evaluated. The patients were given antibiotics as per protocol before and after surgery to prevent infection. All patients were observed closely in the post-operative period for development and timely management of any complications.
Results:  Among 145 children, 9% of children had defects in the cranio cervical and 91% of children had defects in the lumbosacral. 15% children had myelomeningocele size ?3 cm while 85% of children had myelomeningocele size >3 cm. 83% of children were male and 17% of children were female. 18% of children had wound infection, 6% of children had wound dehiscence and 26% of children had CSF Leak. Stratification of postoperative complications concerning age, gender, location of NTD (cranio cervical/lumbo sacral), size (? 3 cm & > 3 cm), duration of symptoms (? 1 month & 1 month), malnourished (yes/no) showed the insignificant differences.
Conclusion:  The frequency of post-operative complications i.e. wound infection was 18%, wound dehiscence was 6% and CSF Leak was 26% after meningomyelocele repair in patients presenting with Meningocele.
Navigating Peril: Unraveling the Consequences of violation of Lane by bike riders on Traumatic Brain Injury Outcomes in a Developing Country's Neurosurgical department
Authors: Usman Ahmed Kamboh  , Muhammad Irfan Sheikh  , Syed Shahzad Hussain Shah  , Muhammad Rizwan  , Atiqa Arif  , Mehwish Manzoor  , Zaid Sami Ullah
Published: May 2024

Objective:
To infer the impact of violation of lane by the bike riders on the severity of injury and clinical outcome.
Materials & Methods:
prospective observational study conducted from 1st January 2023 to 30th June 2023.50 patients who met inclusion criteria were studied for impact of violation of lane on the severity of injury and clinical outcome. Data was analyzed for gender distribution, valid driving license, helmet wearing, trauma scene violation of lane, duration of stay in ward, severity of injury, mode of injury and outcome was assessed by Glasgow outcome scale extended after 1 month.
Results:
In our study 49(98%) patients were male and 1(2%) female. 37 (74%) patients had documented evidence by 1122 regarding lane violation group while 13(26%) patients of lane non violation group. 14(28%) patients had STBI, and 18(36%) patients were categorized in moderate and mild traumatic brain injury each. Neuro monitoring was done in 14(28%) patients. Operative intervention was done in 31(62%) patients and 9(64%) patients were those who had STBI.11(78%) out of 14 patients with severe injury were from lane violation group. Patients of lane violation group were having higher disability i.e. 12 (32.4%).
Conclusion:
Violation of lane is an aberrant driving behavior. It has emerged as a common cause of bike related road traffic accidents leading to mortality. A prevailing disregard for traffic norms adds fuel to this perilous fire, paving the way for grave outcome.
 
Key words: Severe Traumatic brain injury (STBI), Road traffic accident (RTA), Violation of lane, Bike rider, Intracranial pressure (ICP), Glasgow outcome scale extended.
Chat GPT Develops Multiple Choice Questions (MCQs) for Postgraduate Specialty Assessment – A Reality or a Myth?
Authors: Faridah Amir Ali  , Sharif Salman Yousuf , Madiha Ata  , Nirali Patel  , Muhammad Rafay  , Hasan Raza Syed  , Saima Perwaiz Iqbal
Published: May 2024

Objective:  Multiple Choice Questions (MCQs) are a valuable assessment tool, but creating them to match learning goals needs experts. AI, like ChatGPT, might offer an alternative. A study showed MCQs made for medical programs by ChatGPT and the faculty. This study compares faculty-made MCQs to ChatGPT-made ones for a post-grad program.
Material & Methods:  Specific learning objectives of a module from a medical and surgical program were extracted. One mid-level faculty and the AI software developed MCQ from each learning objective with a clinical scenario. Two subject and medical education experts from each specialty were blinded and given a standardized online tool to rate the technical and content quality of the MCQs in five domains; the item, vignette, question stem, response options, and overall quality.
Results:  For the medicine and allied specialty, 23 MCQs in each set were assessed. There was no significant difference between each variable, the overall quality of MCQs, or the odds of the decision to accept the questionnaire. Two sets of 24 MCQs were assessed for the surgical and allied specialty. There was no difference between the domains for “Item” and “Vignette”. For the domain “question stem”, MCQs developed by faculty were more grammatically correct (p-value 0.02). There was no difference in the quality or odds of the decision to accept.
Conclusions:  AI's impact on education is undeniable. Our findings indicate that in specific areas, faculty outperformed ChatGPT, though overall question quality was comparable. More research is necessary, but ChatGPT could potentially streamline assessment development, saving faculty substantial time.