Assessing the effect of energy consumption and food production from agriculture on environmental degradation in Pakistan: Does institutional quality matter?

The nexus between food production (FP), energy consumption (EC), institutional quality (IQ), and ecological degradation (ED) has important implications for environmental sustainability. Nevertheless, environmental degradation caused by FP is widely ignored, especially in Pakistan. To fill this void, we investigated the impact of energy use, FP, and IQ on Pakistan's environmental degradation between 1990 and 2021. We also explore the moderating influence of IQ on ED. To evaluate this influence, we use the autoregressive distributed lag (ARDL) method for cointegration and the fully modified ordinary least-squares method for robustness estimation. Our empirical results demonstrate that, whereas FP and EC contribute to pollution, IQ reduces the pace of environmental degradation. Furthermore, the presence of a strong IQ mitigates the harmful ecological effects of FP and EC. Moreover, the results revealed that unbiased domestic IQ is crucial to boosting energy and agricultural efficiency while reducing CO2 emissions. Our findings might be considered while public policies to reduce carbon emissions and increase FP in a healthy environment are being developed. Integr Environ Assess Manag 2024;20:518-532. © 2023 (SETAC).

The spatial-temporal effects of energy consumption and institutional quality on CO2 emission: evidence from Belt and Road Initiative (BRI) countries.

The Belt and Road Initiative (BRI) has boosted economic development while harming the ecology. It is vital to track its CO2 emissions to guide the BRI toward a green future and low carbon. Our research contributes to these goals in two ways. First, this research examines the spatial-temporal effects of institutional quality (IQ) and renewable and non-renewable energy consumption on CO2 emissions for 75 BRI countries from 1990 to 2019. Second, geographical implications are considered when assessing the factors that affect CO2 emissions on a regional scale. Several diagnostic methods are used to determine the significant spatial impacts, and spatial panel models (SPMs) are used to analyze the phenomenon's spillover and direct consequences. The empirical findings demonstrate that increased IQ and renewable energy (RNC) harm the country's CO2 emissions. These negative consequences spread geographically to adjacent countries of the impacted country. Moreover, non-renewable energy (NC) positively affects the CO2 of the impacted nation and its neighbors. Hence, the objective of reducing CO2 emissions compels BRI to establish an effective plan to reduce non-renewable energy, enhance IQ, resolve internal and external disputes, and foster religious and ethnic harmony in BRI-affected nations. Positive direct and negative spatial impacts of economic expansion highlight the zero-sum game of nations, so high CO2-emitting countries should exercise caution when implementing economic policies.

Food security and environmental degradation: Do institutional quality and human capital make a difference?

The nexus between food security (FS), institutional quality (IQ), human capital (HC), and environmental deterioration (ED) has important implications for ecological sustainability. Yet, environmental deterioration resulting from food security activities is a widely ignored topic, particularly in BRI countries. To address this gap, we examined the influence of food security, human capital and institutional quality on the environmental deterioration of BRI countries from 1984 to 2019. Furthermore, it investigates the moderating effect of institutional quality and human capital on ED. The empirical findings revealed that food security increases ED. The research also revealed that HC and IQ lower the ED. Furthermore, food security promotes ecological sustainability through the HC channel. Additionally, institutional quality decreases the negative environmental implications of food security. Based on these results, BRI nations should enhance ecological sustainability by investing in HC and using food resources efficiently.

Green Environment-Social Protection Interaction and Food Security in Africa.

Expanding food production to commensurate with population growth has often come at a cost resulting from environmental problems. Industries generate pollutants that destroy the environment and negatively affect the level of food security. These trends threaten the sustainability of food systems and undermine the capacity to meet food security needs. Against this backdrop, this study examines how the green environment influences food security in Africa. To further articulate the novelty and contributions of the research to the extant literature, the study also examines the interaction effect of the green environment and social protection on food security. The study engaged panel data consisting of 37 African countries listed in the International Development Association (IDA) of the World Bank. The data was sourced from Food and Agricultural Organisation (FAO), Country Policy and Institutional Assessment (CPIA) and the World Development Indicators (WDI) for the period 2005 to 2019 and applied the system Generalised Method of Moments (SGMM). The result shows that a green environment and social protection are statistically significant and positively determine the level of food security in Africa. In addition, the result shows that a green environment and social protection interaction positively and significantly influence food security. The implication is that a 1% increase in the drive for a green environment may improve the level of food security by 0.8%. Also, increases in the level of social protection intervention may increase food security by 1.2%. The interaction between social protection and food security can increase food security by 0.96%. In summary, it is found that African countries under study have moderate social protection coverage and policy for environmental management and sustainability required to drive food security. The discussions of the findings and policy implications of the study are underscored in the paper.

Do BRI policy and institutional quality influence economic growth and environmental quality? An empirical analysis from South Asian countries affiliated with the Belt and Road Initiative.

The effect of quality institutions on growth-environmental nexus is a generally ignored topic, especially in South Asia economies affiliated with the belt and road initiatives (BRIs). To fill this gap, we have examined the effect of BRI policy, economic freedom (EF), and institutional quality (IQ) on growth-environmental nexus in the South Asian region from 1984 to 2019. We have used CO2 emission as a proxy for the environment in this study. To prevent variable bias, we also included energy consumption (EN) and trade openness (TO) as key factors in the model. To solve the problem of cross-sectional dependence, we have used the second-generational unit root test. The results of unit root tests indicate that the variable IQ is stationary at the level and other variables are stationary at the first difference. Furthermore, all of the variables are cointegrated, according to the panel cointegration test. Thus, we have used the panel autoregressive distributed lag (ARDL) method to estimate the long-run (LR) and short-run (SR) impact of response factors on economic growth. Furthermore, this research utilized the Granger causality test among the selected variables to inquire into the causalities. The basic findings are as follows: (i) A significantly positive interaction variable (CO2IQ) among CO2 and IQ suggests that effective and fair political institutions are critical for increasing economic development and decreasing CO2 emissions simultaneously. (ii) Economic growth is invigorated by energy consumption, trade, economic freedom, and institutional quality. (iii) Since 2013, more significant economic growth has been stimulated by BRI policy in BRI-associated countries; thus, both the SR and LR results are significantly positive. Hence, it is essential to improve the quality of institutions to reduce carbon emissions during economic growth.

Whole-Exome Sequencing Identifies Small Mutations in Pakistani Muscular Dystrophy Patients.

Background: Muscular dystrophies are a heterogeneous group of inherited disorders that cannot be diagnosed clinically due to overlapping clinical phenotypes. Whole-exome sequencing is considered as the diagnostic strategy of choice in these cases. In this study we aimed to determine the mutational spectrum of multiplex ligation-dependent probe amplification (MLPA)-negative muscular dystrophy patients in Pakistan using whole-exome sequencing. Subsequently the mutations identified via WES were used to screen additional dystrophinopathy patients by Sanger sequencing. Materials and Methods: DNA extracted from the peripheral blood of three MLPA-negative muscular dystrophy patients was sent for whole-exome sequencing. The identified variants in these 3 patients were then checked in 18 dystrophinopathy patients using Sanger sequencing. Results: Four missense variants and one nonsense variant in the Duchenne muscular dystrophy (DMD) gene were detected. WES diagnosed a DMD patient carrying a nonsense variant c.4375C>T (rs398123953) who can benefit from Ataluren therapy. The other two patients carried missense variant (c.572G>T) in the YARS2 gene (rs11539445) labeling them as patients of MLASA (myopathy, lactic acidosis, and sideroblastic anemia). The identified missense and nonsense variants in the DMD gene were detected in 18 clinically diagnosed dystrophinopathy patients using Sanger sequencing. Three missense variants were detected in our cohort of 18 dystrophinopathy patients. One missense variant c.3406A>T (rs3827462) and a nonsense variant c.4375C>T (rs398123953) were not detected in our cohort of 18 dystrophinopathy patients. Conclusions: Whole-exome sequencing identified a nonsense variant in Pakistani muscular dystrophy patients, which is amenable to treatment by Ataluren and a missense variant in YARS2 gene responsible for causing MLASA.

Episomal reprogramming of Duchenne muscular dystrophy patients derived CD3+ T cells towards induced pluripotent stem cells.

OBJECTIVE: To derive Duchenne muscular dystrophy patient specific induced pluripotent stem cells (iPSCs) from CD3+T cells of DMD patients using episomal reprogramming and characterization of these DMD-iPSCs using immunofluorescence to confirm their pluripotent state. METHODS: DMD patients were selected based upon their clinical history and examination. Peripheral blood mononuclear cells were isolated from peripheral blood of DMD patients (n=3) by density gradient centrifugation and were used to generate DMD patient specific T cells (DMD-T cells) using rhIL-2, plate bound anti CD3 antibody and T cell specific media along with specific culture conditions that promote T cell expansion. CD3+ T cells were characterized by flow cytometry and reprogrammed using episomal plasmid to generate DMD-iPSCs. These DMD-iPSCs were characterized using immunofluorescence. The study was carried out at Dow Research Institute of Biotechnology and Biomedical Sciences during August 2017- July 2018 for a period of approximately 12 months. RESULTS: The peripheral blood mononuclear cells (PBMNC) derived T cells appeared as suspended cell clumps morphologically were positive for the expression of CD3 and negative for CD31. The DMD patient specific iPSCs appeared as round, compact and flat colonies with well-defined edges morphologically and were positive for the expression of pluripotency markers OCT4, SSEA-4 and TRA-1-81 on immunofluorescence. CONCLUSION: CD3+ T cell derived DMD-iPSCs were obtained under feeder free and xeno-free culture conditions using episomal reprogramming.

Megaprepuce: A New Surgical Technique with Excellent Cosmetic and Functional Results.

Background: Congenital megaprepuce (CMP) is a malformation consisting of redundant inner foreskin, normal penile shaft, and severe phimosis. The excess inner prepuce pushes the penile shaft deeper causing the appearance of a buried penis. We describe a novel surgical technique using dartos fascial flaps to reconstruct the prepuce giving excellent cosmetic and functional results. Patients and Methods: Penile reconstruction was performed by a single surgeon in 07 cases of CMP between January 2018 and December 2019. In all cases, the described surgical technique was used. Following surgery, cosmetic and functional outcomes were reviewed as well as the incidence of complications. The patients' ages ranged from 15 to 27 months (mean = 19). Mean hospital stay was 9 hours (range = 7-12). Operating time was between 50 and 85 minutes. Results: Postoperative appearance of the penis was satisfactory for all the parents in our group. Swelling of the penile shaft was seen in all of our patients but settled within one week of surgery. Scrotal hematoma was seen in only one of our patients, but that also did not need any intervention and settled spontaneously. During the follow-up period (mean = 14.5 months, range 6-24) no patient underwent revision surgery. In all our patients, the final appearance was of a circumcised penis. The final similarity to a normal circumcised penis was excellent in all of our patients. Correction of penoscrotal transposition was done in all patients achieving an elongated penile shaft and almost invisible postoperative scarring. Conclusion: Our modified surgical procedure to correct CMP is a safe and simple technique, providing good cosmetic results with the appearance of a standard circumcised penis. This also provides a good functional outcome with complication rate quite low. This technique is also easy to reproduce and teach compared with other complex procedures.

The Satisfactory Surgical Outcome of Posterior Fossa Brain Tumors in Children at Civil Hospital, Karachi.

INTRODUCTION: Posterior fossa brain tumor is the most devastating forms of human illness, primarily because of the limited space within the posterior fossa, the potential involvement of vital brain stem nuclei, and the mass effect causes obstructive hydrocephalus. Posterior fossa tumors are more common in children than adults. THE OBJECTIVE OF THE STUDY: To find out the satisfactory surgical outcome of posterior fossa brain tumors in children at Civil hospital, Karachi. MATERIALS AND METHODS AND DURATION OF STUDY SETTING: This prospective observational, case series study was conducted from February 2015 to February 2105 in the Department of neurosurgery, Dow University of Health Sciences, Civil Hospital, Karachi, Karachi. Postoperative patients with the diagnosis of posterior fossa tumor were enrolled in the study. Detailed history, physical examination, anthropometrics, and biochemical measurements were recorded. Magnetic resonance imaging was done to determine the satisfactory surgical outcome. Patients were followed up at the third postoperative month to determine the satisfactory surgical outcome. RESULTS: Seventy-one patients fulfilling the inclusion criteria, the mean ± standard deviation age of the study population was 6.63 ± 3.181 years. 29 (40.8%) were <7 years of age and 42 (59.2%) were of age 7 years and above. 50 (70.4%) were males and 21 (29.6%) were females. 49 (69%) patients presented with vomiting. 34 (47.9%) presented with seizures. (40.8%) had papilledema. (25.4%) presented with hemiparesis. 8 (11.3%) had meningismus. On analysis of the frequency of outcome variables (80.3%) achieved the satisfactory surgical outcome. CONCLUSIONS: There has been no major study to determine satisfactory surgical outcome in postoperative patients with posterior fossa brain tumor in our population. The study was to provide local data in our population and compare it to the international data. This may help in proper patient management. Majority of the patients had satisfactory surgical outcome. The absence of papilledema, hemiparesis, and meningismus had more chances of satisfactory surgical outcome.

Comparison of Phenytoin versus Levetiracetam in Early Seizure Prophylaxis after Traumatic Brain Injury, at a Tertiary Care Hospital in Karachi, Pakistan.

AIMS: The aim of the study was to compare the efficacy of phenytoin and levetiracetam for seizure prophylaxis in patients with severe traumatic brain injury (TBI). SUBJECTS AND METHODS: A randomized controlled trial was conducted over a period of 6 months, at a tertiary health care center in Karachi, Pakistan. Patients with TBI were divided into two groups. Patients in Group A were given phenytoin, whereas Group B patients received levetiracetam. The first dose of the drugs was given within 24 h of injury and continued for 7 days. Data were collected using a predesigned pro forma. All the patients who were in a state of persistent coma, had altered mental status, or had clinical signs of seizures underwent a 1-h electroencephalographic (EEG) recording to observe the seizures, the first EEG was done on the 1st day posttrauma and a second one was done on day 7 of drug use, both the EEGs were compared for changes. We also analyzed the patients according to their duration of antiepileptic drug therapy, length of hospital stay, and complications during therapy. RESULTS: One hundred and forty (117 males and 23 females) patients who presented with TBI having a mean age of 29.48 ± 16.24 years were part of the study. The most prevalent cause of brain injury was road traffic accidents in 72.85% patients. There was no significant relationship between the antiepileptic drug used with the initial EEG (P = 0.313) and seizure activity (P = 0.502). However, a significant correlation of the antiepileptic drug used was found with EEG (P = 0.002) and seizure activity (P = 0.014) on follow-up. Patients who took levetiracetam had decreased the incidence of abnormal EEG and seizure activity on follow-up. There was not any correlation between GCS both initially (P = 0.845) and on follow-up (P = 0.104) with the antiepileptic drug used. CONCLUSION: The incidence of abnormal EEGs and seizure activity in patients with TBI is the same for both levetiracetam and phenytoin for the initial 7 days post-TBI; however, the incidence of seizures is lower for patients who used levetiracetam on the subsequent follow-up.

Robot Docking Time: Cumulative Summation Analysis of a Procedure-Independent Learning Curve in Pediatric Urology.

PURPOSE: The learning curve is an important method of assessment of progression in the use of a new technique or device and, in the field of robotic surgery, is most commonly described for individual procedures, often concentrating on console time and outcomes. We contemplated whether a learning curve of the similar nature and duration was exhibited in the procedure-independent variable of docking time. MATERIALS AND METHODS: The time from first incision to end of robot docking was found for a single surgeon's first 55 robotic cases, which encompassed a range of pediatric urological procedures. Raw and cumulative summation (CUSUM) data were found and plotted, with learning- and maintenance-phase times compared statistically. RESULTS: A classical learning curve of ∼30 cases was found with a statistically significant reduction in time between learning and maintenance phases. CONCLUSIONS: A learning curve of similar nature and duration to procedure-specific analyses was found for docking time. The variability of port placement and robot positioning for multiple procedures further increases the significance of this result.

Robotic Pyeloplasty in Children: A "Barbed" Shortcut.

INTRODUCTION: Dismembered pyeloplasty remains the gold standard for the treatment of pelviureteric junction obstruction (PUJO). Robotic approach to this procedure has proven its efficacy and is gaining popularity. The introduction of barbed sutures such as "V-Loc™" (Covidien) has provided an addition to the sutures available for pyeloplasty. This work provides our experience with the V-Loc suture for closure of pelvis in children for robotic pyeloplasty (RP). MATERIALS AND METHODS: A review of 10 pediatric RP (da Vinci Robotic System) during which the V-Loc suture was used was performed. Comparison was made with 15 cases in which 5-0 Vicryl® suture was used as an alternative. Overall median age was 4 (range 9 months to 16 years), M:F = 14:9. All had confirmed PUJO on renal ultrasound and mercaptoacetyltriglycine (mertiatide) (MAG-3). RP was done in the standard Anderson-Hynes manner with the placement of a multilength JJ ureteral stent intraoperatively. Patients had removal of the JJ stent 6 weeks postoperatively followed by renal ultrasound 3-4 months later. RESULTS: Twenty-five RPs have been performed between May 2013 and November 2015, of which 10 have had closure of the pelvis performed using the V-Loc suture and 15 with Vicryl. One patient (6.67%) in the Vicryl group underwent redo-pyeloplasty secondary to a stent-related complication. The entire V-Loc group made an eventful initial recovery; however, four (40%) developed worsening hydronephrosis and drainage on ultrasound and MAG-3 after stent removal, despite remaining completely asymptomatic. These four required either restenting and observation (n = 1) or redo-pyeloplasty (n = 3). Histology demonstrated a "plaque-like" inflammatory reaction at the pelvic suture line. CONCLUSION: Closure of the pelvis using V-Loc suture material during RP can lead to a significant hydronephrosis requiring further procedures, including redo-pyeloplasty. These children can be asymptomatic and so extra vigilance on postoperative follow-up is essential.

Single-stage urethroplasty with buccal mucosal inlay graft for stricture caused by balanitis xerotica obliterans in boys: Outcomes in the medium term.

INTRODUCTION: Balanitis xerotica obliterans (BXO) is a common condition that can affect the foreskin, glans, meatus, and urethra, and rarely can also involve urethra leading to stricture. Numerous procedures have been suggested to treat urethral stricture secondary to BXO but these have had variable results. OBJECTIVE: We describe the first prospective study of a single stage buccal mucosal inlay grafting in children with urethral strictures resistant to existing remedies. MATERIALS AND METHODS: We treated five boys with resistant urethral strictures secondary to BXO with a single stage buccal mucosal inlay graft (BMIG, Figure). Uroflowmetry was performed both pre- and post-operatively. Functional outcome was the prime measure determining success. RESULT: All the boys had a successful functional outcome and all expressed satisfaction with cosmetic outcome as well. Uroflow parameters improved remarkably, with maximum and mean urinary flow rates significantly improved from 4.2 mL/s to 26 mL/s (p = 0.0002) and from 1.6 mL/s to 12.2 mL/s (p = 0.003), respectively. Median follow-up was 34 months (range 30-42 months). DISCUSSION: This paper is the first to describe the successful use of buccal mucosal inlay grafts to treat refractory BXO stricture in children. Various surgical techniques have been proposed particularly in adults including single vs. staged procedures, preputial and post auricular grafts, circular mucosal buccal grafts, as well as double mucosal grafts placed both ventrally and dorsally. All of these procedures are not without problems, and had variable results and outcome. Most of the procedures have been described in adult urethra and are not suitable for paediatric small calibre urethra. Our technique of dorsal inlay graft gives a robust structure to the distal urethra avoiding diverticula, pooling or urine spraying and can be placed onto proximal urethra as well. We have not seen recurrence of BXO in our buccal grafts, which is reported in other grafts from prepuce and post auricular grafts. The number of patients presented in our study is limited, nonetheless an excellent result in all our cases makes this a compelling approach to manage BXO urethral strictures. An early intervention in such cases is paramount to convert a salvage operation to a pre-emptive procedure. CONCLUSION: A single stage buccal mucosal inlay grafting in children with BXO stricture can offer an excellent outcome.

Preliminary Experience with Instillation of Triamcinolone Acetonide into the Urethra for Idiopathic Urethritis: A Prospective Pilot Study.

BACKGROUND: Idiopathic bulbar urethritis (IBU) is characterized by hematuria ± dysuria without infection. Symptoms result from inflammation of the bulbar urethra, distal to external sphincter. IBU is difficult to manage and there is no recommended therapy. OBJECTIVE: To determine whether instillation of triamcinolone acetonide is a useful treatment of IBU and its associated complications. SETTING AND PARTICIPANTS: Data were prospectively collected, for 22 months, on 14 consecutive patients presenting with terminal hematuria or blood spotting ± dysuria to a pediatric urology unit. Median age was 12 years (range: 10-15). Mean symptom duration was 13 months (range: 8-24). Normal baseline laboratory blood tests, urine cultures, and ultrasound assessments were seen in all; therefore, none were excluded on the basis of a known pathology. Follow-up telephone interviews, to assess symptom persistence and side effects, were performed at 6 weeks postintervention. The mean follow-up period was 15 months (range: 4-20). INTERVENTION: Visual confirmation of IBU was obtained cystoscopically and 40 mg of triamcinolone was instilled to the inflamed area under direct vision using an open-ended ureteral catheter. OUTCOME MEASUREMENTS: Symptoms resolution was the primary outcome. Repeat cystoscopic assessment ± triamcinolone instillation was recorded, as was the occurrence of complications. RESULTS AND LIMITATIONS: Seven patients (50%) required at least one further treatment. Overall complete or partial resolution was reported in 12/14 patients (85.7%). No side effects were reported. CONCLUSIONS: This small prospective series demonstrates that intraurethral instillation of triamcinolone seems to be a promising treatment option to alleviate inflammatory symptoms in majority of cases of idiopathic urethritis. Patient Summary: Fourteen boys with inflammation of the urethra, with no identifiable cause, were treated by topically triamcinolone, directly to the inflamed area. We demonstrate an 85.7% complete/partial resolution of symptoms with no side effects seen.

Frequency of infection associated with ventriculo-peritoneal shunt placement.

OBJECTIVE: To compare the frequency of infection in protocol-based and random ventriculo-peritoneal shunt placement in patients with hydrocephalus. METHODS: The prospective, observational study was conducted at Civil Hospital, Karachi, from October 2014 to March 2015, and comprised patients having ventriculo-peritoneal shunt placement who were randomly categorised into Group A that had protocol-based procedure and Group B that had random shunt placement. All patients were followed up for six months to record final outcomes after surgery. A pre-tested questionnaire was used to document findings. SPSS 16 was used for data analysis. RESULTS: Of the 210 patients, there were 105(50%) each in the two groups, overall having 117(55.7%) boys and 93(44.3%) girls. The frequency of infection was 8(7.6%) in Group A and 19(18.1%) in Group B (p<0.05). CONCLUSIONS: With a meticulous surgical technique and modifications to the pre-, intra-, and postoperative care, it is possible to significantly reduce the incidence of shunt infection.

Computer Based Assessment (CBA): Perception of residents at Dow University of Health Sciences.

UNLABELLED: Background and objective : During the past few years, Computer-based assessment (CBA) has gained popularkity as a testing modality. This assessment offers several advantages over paper based assessment (PBA) testing. The objective of this study was to find out residents' perception of this method of assessment. Methods : The post graduate residents of Dow University of Health Sciences in the field of Surgery, Medicine, Gynecology and Obstetrics experienced their first formative Computer-based assessment (CBA) in year 2013.Immediately after formative CBA, an anonymous paper based questionnaire was distributed amongst the residents and response was sought for their self-perceived computer usage competence before starting residency, perceptions regarding CBA method and to determine their preference for PBA or CBA in future assessment preferences. RESULTS: Total 173 residents completed the questionnaire. More than half of residents, 56.1% had no prior experience of CBA. Three fourth, 76.4% of the residents were less than confident before sitting in CBA, while after completing CBA, 64.8% were either confident or extremely confident for CBA. Most common problem encountered by students was logging in 28.9%. More students (53.2%) believed that paper assessment took longer to complete than CBA. Majority of the students (61.8%) rated CBA as better than PBA despite experiencing it for the first time. CONCLUSION: Resident's perception for CBA is good and they recommend its use in future assessment as well. However, to take maximal advantage of this technology, faculty should be trained to develop questions not only with text and pictures but with audio and video support.

Pleomorphic adenoma of hard palate: an experience.

INTRODUCTION: Pleomorphic adenoma of minor salivary glands of hard palate is a rare benign tumour. It usually presents as slow growing submucosal mass on hard palate. The purpose of this study was to collect observational data regarding age, size, symptoms, CT findings and treatment of pleomorphic adenoma of hard palate. MATERIAL AND METHODS: The prospective observational study was done in the Department of ENT, Department of Oral and maxillofacial surgery at SKIMS Medical College and at Peoples Care Polyclinic for a period of 2 years. Twenty cases were enrolled in the study. After clinical suspicion, computed tomography, FNAC and core needle biopsy was done in all twenty cases before any surgical intervention was done. RESULTS: Most common age group seen to be involved was 16-30 years. Most common symptom was submucosal slow growing mass. Core biopsy was diagnostic with 100 % efficacy. On CT scan twelve patients (60 %) were seen to have intact hard palate even without minor erosions while four patients had full thickness erosion of hard palate. Surgical wide excision was done in all cases and one patient needed total maxillectomy. All treated patients were followed for one year and none showed signs of recurrence. CONCLUSION: Pleomorphic adenoma of hard palate is usually seen in adults. Definitive diagnosis lies on histopathological examination. CT is necessary for ruling out any bony erosion. Treatment is by wide local excision.

Magnetic Resonance Image findings of Spinal Tuberclosis at first presentation.

BACKGROUND: Spinal tuberculosis presents in various pathological patterns. The clinical presentation and often the management depend on exact pathological findings. Objective of study was to evaluate the Pathology of spinal tuberculosis as depicted by MRI findings in 119 consecutive cases of spinal TB. METHODOLOGY: It was a cross sectional and observational study conducted at Civil Hospital, Karachi from July 2010 to December 2012.Total numbers of participants were 119. Diagnosis was based on positive histopathology results along with the supportive evidence in MRI. A pre-structured questionnaire was constructed to record the data. Study was ethically approved by Institutional Review Board of Dow University of Health Sciences. Sample size was calculated by using Open-EPI software. All the data was entered and analyzed through SPSS 19. RESULT: There were 119 patients who participated in this study out of which 52 were males and 67 were females. Most common level was Dorso-lumbar (33.6%) and 87.5% of them had spondylodiscitis while 90% had cord compression. All 6 (100%) patients who had their upper- dorsal region affected had gibbus formation while all those patients having lumbosacral region involved had thecal compression 4 (100%). Most common mode of treatment used in patients having Spinal TB at Lumbar region was conservative (86.2%). CONCLUSION: MRI findings were mostly shadowed with features such as disc destruction and thecal or cord compression. MRI scan could be used for early detection of spinal TB which can reduce disability and deaths in patients. Major clinical findings in spinal TB were fever, Para paresis and back pain.

Role of intraoperative ultrasound in achieving complete resection of intra-axial solid brain tumours.

OBJECTIVES: To determine the frequency of completeness of resection for intra-axial solid brain tumours with the help of intra-operative ultrasound to detect residual brain tumour. METHODS: The cross-sectional study was conducted at the Department of Neurosurgery, Dow University of Health Sciences and Civil Hospital Karachi, from September 2009 to June 2010 and comprised patients with intra-axial solid brain lesion. During operation following standard craniotomy, multi-plane sonographic examination was performed using intra-operative ultrasound for tumour localisation and calculation of dimension, followed by tumour resection in the standard fashion. At the end of tumour resection ultrasound was again used for the detection of any residual tumour. Results of intra-operative ultrasound were compared with post-operative contrast magnetic resonance imaging. RESULTS: Of the 39 cases in which intra-operative ultrasound was performed, 32(82.1%) were males and 7(17.9%) were females, with an overall mean age of 42.6±19.7 years. Intra-operative ultrasonography was able to localise and delineate the tumour in all 39 (100%) cases. It showed no residual tumour in 36 (92.3%) cases, but in 3(7.7%) cases residual tumour was detected. Post-operative contrast enhancing magnetic resonance imaging showed no residual tumour in 35(89.7%) cases and in 4(10.3%) cases residual tumour was detected. The frequency of completely resected intra-axial solid brain tumour was 35(89.7%), while in 4(10.3%) cases incomplete resection was observed. CONCLUSION: The study concluded that intra-operative ultrasonography has an important role in achieving increased frequency of completely resected intra-axial solid brain tumours.

Lumbar disc degenerative disease: disc degeneration symptoms and magnetic resonance image findings.

STUDY DESIGN: Cross sectional and observational. PURPOSE: To evaluate the different aspects of lumbar disc degenerative disc disease and relate them with magnetic resonance image (MRI) findings and symptoms. OVERVIEW OF LITERATURE: Lumbar disc degenerative disease has now been proven as the most common cause of low back pain throughout the world. It may present as disc herniation, lumbar spinal stenosis, facet joint arthropathy or any combination. Presenting symptoms of lumbar disc degeneration are lower back pain and sciatica which may be aggravated by standing, walking, bending, straining and coughing. METHODS: This study was conducted from January 2012 to June 2012. Study was conducted on the diagnosed patients of lumbar disc degeneration. Diagnostic criteria were based upon abnormal findings in MRI. Patients with prior back surgery, spine fractures, sacroiliac arthritis, metabolic bone disease, spinal infection, rheumatoid arthritis, active malignancy, and pregnancy were excluded. RESULTS: During the targeted months, 163 patients of lumbar disc degeneration with mean age of 43.92±11.76 years, came into Neurosurgery department. Disc degeneration was most commonly present at the level of L4/L5 105 (64.4%).Commonest types of disc degeneration were disc herniation 109 (66.9%) and lumbar spinal stenosis 37 (22.7%). Spondylolisthesis was commonly present at L5/S1 10 (6.1%) and associated mostly with lumbar spinal stenosis 7 (18.9%). CONCLUSIONS: Results reported the frequent occurrence of lumbar disc degenerative disease in advance age. Research efforts should endeavor to reduce risk factors and improve the quality of life.