Efficacy Of Prophylactic Intrawound Application Of Vancomycin Powder In Preventing Surgical Site Infections In Spinal Instrumentation Surgery.

BACKGROUND: Surgical site infection (SSI) is always a matter of utmost concern in cases of spinal instrumentation in low-income countries. This study was conducted to determine the efficacy of local intrawound application of vancomycin powder in reducing postoperative SSI following Thoracolumbar-Sacral spinal instrumentation. METHODS: This randomized controlled trial was done in the Department of Neurosurgery, Ayub Teaching Hospital Abbottabad from 1st July 2019 to 31st December 2021. Seventy-eight patients of either gender with an age range from 15 to 65 years, who were planned for posterior spinal instrumentation surgery (transpedicular screw fixation), were included in the study. Patients were divided into two equal groups, A (Vanco group) and B (control group). In addition to standard systemic prophylaxis, 1 gm of Vancomycin powder was applied over the implant in Group A patients. RESULTS: The mean age of the patients in Group A was 36±16.6 while the mean age of patients in the group was 33.7±15.9 years. A statistically significant reduction of surgical site infection was observed in those who received a prophylactic intra-wound application of vancomycin powder (Vanco group) (5.2%) compared to the control group (20.5%). CONCLUSIONS: Intrawound vancomycin powder administration significantly decreases SSI following spinal instrumentation surgeries. Patients at high risk of infection are highly recommended as a candidate for this technique.

Correlation of brain-derived neurotrophic factor with severity of depression and treatment response.

Background: Brain-derived neurotrophic factor (BDNF) is a modulator of neuroplasticity in the brain. It plays an important role in the pathophysiology of depression through the stress pathway. The information about correlation of BDNF levels with depression severity and treatment response in Indian population is scarce. Methods: Consecutive 60 never treated cases with depression reporting to a large tertiary care psychiatry unit and 60 healthy matched controls from 01 January 2016 to 31 December 2016 were enrolled for study. Sociodemographic data were collected. Diagnosis of depression was carried out as per International Classification of Diseases-10th revision (ICD-10) diagnostic criteria for research. The Hamilton Rating Scale for Depression (HRSD) was administered and accordingly scored. Venous blood for BDNF levels was collected from all cases and controls. Cases were reassessed after 04 weeks of treatment with HRSD and BDNF levels. Results: The mean level of serum BDNF among cases (18.56 ng/ml) was found to be reduced significantly as compared with healthy controls (32.41 ng/ml). The mean serum BDNF level (18.56 ng/ml) in never treated cases was significantly negatively correlated with the median clinical HRSD score (18.5). There was a significant increase in the mean level of serum BDNF after antidepressant treatment. Conclusion: The study has revealed statistically significant low levels of serum BDNF in cases not exposed to treatment with depression compared with healthy controls. There was significant negative correlation of levels of serum BDNF with depression severity. The levels of serum BDNF significantly increased after four weeks of treatment.

Mortality And Prognostic Factors In Patients Operated For Acute Epidural Hematoma.

Background: Epidural hematoma is one of the most common surgical emergencies encountered in neurosurgery. This study was conducted to determine the mortality and prognostic factors in patients operated for traumatic intracranial epidural hematoma in a resource-constrained setting from a developing country. Methods: This retrospective study was conducted in the Department of Neurosurgery at Ayub Teaching Hospital Abbottabad from 1st January 2019 to 31st Dec 2021. Inclusion and exclusion criteria were created. The medical record of 116 patients admitted and operated on for traumatic extradural hematoma was retrospectively reviewed. Information was recorded using a standardized structured questionnaire. The outcome was measured in terms of the Glasgow coma outcome score. Results: Out of 116 patients, 93 were male and 23 were female.19 (16.4%) patients were in the age range 0-5 years, 42 (36.2%) were in the age range 6-15, 35(31.0%) were in the age range 16-30, 11 (9.5%) were in the age range 31-45 years, 7 (6.0%) were in the age range 46-60 years while only one patient included in this study was above 60 years. Overall mortality was 4.3%. Mortality was higher in females and in those aged less than 5 years (3.4%). 4 out of 16 patients died with GCS less than 8, while none of the patients died when GCS was above 12. Mortality was significantly higher in the presence of associated lesions (4.4% vs. 0%) and anisocoria (2.6% vs.1.7%). Patients who operated within 6 hours of trauma resulted in better outcomes with a mortality rate of 0.0% and functional recovery of 57.8 % while for those who operated after 6 hours, mortality was significantly higher (4.3%) and functional recovery was significantly low (15.5%). Conclusion: Good surgical outcomes can be achieved with early operative intervention if indicated. Female gender, low preoperative GCS score, presence of pupillary dilatation, presence of associated lesions, delayed surgical intervention and age less than 5 years are significant predictors for poor outcomes.

Comparison Of Cvd Risk Assessment Via Qrisk®2 Vs Reynolds Risk Score In Inflammatory Joint Diseases.

BACKGROUND: The risk of cardiovascular disease in patients with inflammatory joint diseases is very high and rheumatologists need to screen their patients for this risk. A number of screening tools have been used in this patient population. Objective was to compare the cardiovascular risk assessment in patients with inflammatory joint diseases using QRISK®2 and Reynolds Risk Score. METHODS: Four hundred and one patients with inflammatory joint diseases were enrolled via consecutive non probability sampling. Their future cardiovascular disease risk was calculated via the QRISK®2 and Reynolds Risk Scores. The resulting scores were analyzed for any correlation. RESULTS: There was no significant correlation between the scores obtain via both risk assessment tools (p>0.05).

Efficacy Of Conservative Management Of Early Post Traumatic Cerebrospinal Fluid Rhinorrhoea.

Background: The incidence of Post-traumatic Cerebrospinal Fluid Rhinorrhoea (PCSFR) has been decreased due to advanced therapeutic measures. The current investigative study has been arranged to assess the efficacy of conservative management of early PCSFR. Method: This cross-sectional study was conducted at departmental of Neurosurgery, Ayub Medical Institute, Abbottabad. Patients with traumatic brain injury having Cerebrospinal fluid rhinorrhoea with either gender having age 5-50 year and presenting within seven days of traumatic brain injury were included. Moreover, those with nasal fractures, penetrating head injuries having fever and neck stiffness were also included in the study. Results: A total number of 120 patients having male dominancy, i.e., 86 (72%) were included in the study with the mean age of 27 years ± 8.741 in which 77 (92%) patients were in the age range of 2nd to 4th decades. The commonest cause was trauma due to Road Traffic Accidents (RTA) having 65 (54%) patients. Conservative treatment was effective in 62 (52%) patients predominantly in the patients of 3rd decade, i.e., 31 (50%), in which the effectiveness in male gender was revealed to be 52.32% (45) and effectiveness in RTA patients was recorded to be 54.83%. Similarly, the Chi-Square value was calculated for the PCSFR patients for four groups of patients (5-20, 21-30, 31-40, 41-50) to be 48.27 having critical value of 7.81 with the p-value of 1.87e-10, which completely rejects the Null-hypothesis for the patients of various ages. Conclusion: Based on the current investigative study, it may be concluded that PCSFR is common in middle age population with slight male dominancy. It may also be inferred that RTA is the leading cause of PCSFR in our set up and majority of the patients shows improvement after conservative management. Moreover, the effectiveness of conservative management of PCSFR could be predominantly observed in the patients of 3rd decade.

Surgical Treatment Options For Chronic Subdural Haematoma.

Subdural hematoma is an encapsulated collection of blood under the dura matter. This commonly encountered neurosurgical disorder is best managed by surgical evacuation; however, contemporary neurosurgery lacks a consensus regarding surgical technique of choice. Due to high incidence of the condition and associated complications, vast amount of literature is available on the subject; including studies comparing efficacy of various available treatment modalities. Herein, literature on surgical techniques employed for management of Chronic Subdural Hematoma (CSDH) has been reviewed to provide an evidence-based review on best surgical practices. Following conclusions can be made on basis of evidence of various levels provided in the studied literature: (1) Twist-drill craniostomy is a relatively safe technique that can be employed under local anaesthesia, thus can be considered as first line treatment in high risk surgical candidates. (2) Single and double burr-hole craniostomies have shown comparable results. (3) Intraoperative irrigation during burr-hole craniostomy doesn't affect outcome. (4) Drain insertion after hematoma evacuation lowers recurrence risk. (5) Position of drain is not significant but early drain removal is associated with higher recurrence rates. (6) Craniotomy is associated with high morbidity and mortality, hence should be reserved for recurrent and large septate hematoma cases. (7) Head elevation in postoperative period reduces recurrence. (8) Embolization of middle meningeal artery (EMMA): A novel treatment modality, is promising but requires further approval in terms of large sample sized multicenter randomized control trials. In conclusion further research is required on the subject to formulate guidelines regarding management of this common neurosurgical emergency.

Aspergillus niger-mediated release of phosphates from fish bone char reduces Pb phytoavailability in Pb-acid batteries polluted soil, and accumulation in fenugreek.

Soil receiving discharges from Pb-acid batteries dismantling and restoring units (PBS) can have a high concentration of phytoavailable Pb. Reducing Pb phytoavailability in PBS can decline Pb uptake in food crops and minimize the risks to humans and the environment. This pot study aimed to reduce the concentration of phytoavailable Pb in PBS through Aspergillus niger (A. niger)-mediated release of PO43- from fish bone [Apatite II (APII)] products. The PBS (Pb = 639 mg kg-1 soil) was amended with APII powder (APII-P), APII char (APII-C), and A. niger inoculum as separate doses, and combining A. niger with APII-P (APII-P + A. niger) and APII-C (APII-C + A. niger). The effects of these treatments on reducing the phytoavailability of Pb in PBS and its uptake in fenugreek were examined. Additionally, enzymatic activities and microbial biomass carbon (MBC) in the PBS and the indices of plant physiology, nutrition, and antioxidant defense machinery were scoped. Results revealed that the APII-C + A. niger treatment was the most efficient one. Compared to the control, it significantly reduced the Pb phytoavailability (DTPA-extractable Pb fraction) in soil and its uptake in plant shoots, roots, and grain, up to 61%, 83%, 74%, and 92%. The grain produced under APII-C + A. niger were safe for human consumption as Pb concentration in grain was 4.01 mg kg-1 DW, remaining within the permissible limit set by WHO/FAO (2007). The APII-C + A. niger treatment also improved soil pH, EC, CEC, MBC, available P content and enzymatic activities, and the fenugreek quality parameters. A. niger played a significant role in solubilizing PO43- from APII-C, which reacted with Pb and formed insoluble Pb-phosphates, thereby reducing Pb phytoavailability in PBS and its uptake in plants. This study suggests APII-C + A. niger can remediate Pb-polluted soils via reducing Pb phytoavailability in them.

Level Of Pre-Tertiary Care Hospital Management Of Traumatic Spinal Cord Injured Patients; Where Do We Stand?

BACKGROUND: Traumatic spinal cord injury is a debilitating condition that may cause long term disabilities with tremendous socioeconomic impact on affected individuals and their families. Secondary injuries can best prevent or minimized by appropriate pre hospital management and proper referral and transfer. This study was conducted to assess the clinical profile of traumatic spinal cord injuries and level of pre-hospital care provided to patients either at the site of injury or at other healthcare facilities. METHODS: This prospective study was conducted in the Department of Neurosurgery Ayub Teaching Hospital Abbottabad, from January 2012 to January 2017. All patients with suspected spinal injury were included in the study. Age, gender, mode of injuries and the pre-tertiary care provided were recorded. RESULTS: Out of 4464 patients with suspected spinal cord injury, 3685 (82.5%) were male, 779 (17.4%) were female. Age ranged from 10-70 years. 1685 (37.8%) were diagnosed as having spinal injury. Cervical spine was the most common affected level 743 (44.09%), followed by thoracic spine 135 (8.01%). 1441 (85.5%) were incomplete while 224(14.5%) were complete spinal cord injuries. Road traffic accident was the most common mechanism of injury 884 (52.4%). Only 4 (0.23%) patients directly received in our unit were properly transported, 66 (3.91%) were brought after proper spinal immobilization, intravenous line was maintained in 584 (34.66%) patients, 410 (24.3%) patients received some fluid resuscitation, parenteral analgesia was given to 441 (26.17%) patients while urinary catheterization was done in 195 (11.75%) patients. Those received from other healthcare facilities only 4 (0.23%) were brought by properly equipped ambulance, intravenous access was maintained in 438 (25.99%),320 (18.99%) received some fluid resuscitation, urinary catheterization was done in 229(13.59%) while proper parenteral analgesia was given to 988 (58.63%) patients. CONCLUSIONS: There is a complete lack of proper transport and referral of trauma patients in our area which reflects almost non-existent emergency medical (rescue) services, deficient health care facilities.

Intradiploic Epidermoid Cyst Of The Skull.

Intradiploic epidermoid cyst is an uncommon, benign, slow growing neoplasm that occurs between two tables of cranial bones and constitute 0.4% of all cranial epidermoid. It usually occurs due to the entrapped ectodermal embyronal remnants within the skull bones or rarely secondary to trauma. Pre-operative diagnosis on the basis of radiologic investigations is difficult. Complete surgically excision is usually required in order to prevent complications like super infection, intracranial rupture with pneumocephalus and rarely malignant degeneration. We are presenting a case of incompletely resected and chronically infected intradiploic epidermoid cyst of right parietal bone operated inadvertently by a general surgeon elsewhere without doing any radiological investigations.

Time-restricted feeding regulates molecular mechanisms with involvement of circadian rhythm to prevent metabolic diseases.

Lifestyle and genetic perturbation of circadian rhythm can trigger the incidence and severity of metabolic diseases. Time-restricted feeding (TRF) regulates the circadian rhythm of food intake that protects against metabolic disorders induced by adverse nutrient intake. TRF also executes host metabolism from nutrient availability to optimize nutrient utilization. Circadian clock and nutrient-sensing pathways coordinate to regulate metabolic health through the feeding/fasting cycle. Concurrently, TRF imposes diurnal rhythm in nutrient utilization, thereby preserving cellular homeostasis. However, modulation of daily feeding and fasting periods calibrates the circadian clock, which protects against the lethal effects of nutrient imbalance on metabolism. Therefore, TRF also improves and restores metabolic rhythms that ultimately lead to better fitness by reversing the alteration in genotype-specific gene expression. The aim of this review was to summarize that TRF is an emerging dietary approach that maintains robust circadian rhythms in support of a steady daily feeding and fasting cycle. TRF also encourages the coordination between circadian clock components and nutrient-sensing pathways via molecular effectors that exert a protective role in the prevention of metabolic diseases.

Impacts of oxalic acid-activated phosphate rock and root-induced changes on Pb bioavailability in the rhizosphere and its distribution in mung bean plant.

Rhizosphere acidification in leguminous plants can release P from the dissolution of phosphate compounds which can reduce Pb bioavailability to them via the formation of insoluble Pb compounds in their rhizosphere. A soil polluted from Pb-acid batteries effluent (SPBE), having total Pb = 639 mg kg-1, was amended with six different rates (0, 0.5, 1, 2, 4 and 6%) of oxalic acid-activated phosphate rock (OAPR) and their effects on pH, available P and bioavailable Pb concentrations in the rhizosphere and bulk soils of mung bean plant were evaluated. Furthermore, the effects of these variant OAPR rates on Pb concentrations in plant parts, bioaccumulation factor (BAF) and translocation factor (TF) for Pb in grain and traits like productivity, the activities of antioxidant enzymes, and grain biochemistry were investigated. Results revealed that increasing rates of OAPR significantly increased pH values and available P while decreased bioavailable Pb concentrations in the rhizosphere over control. The highest dissolution of P in the rhizosphere was with 4 and 6% OAPR rates. As a result, the formation of insoluble Pb compounds affected on reduced Pb concentrations in shoots, roots, and grain in addition to lower grain BAF and TF values for Pb over control. Likewise, the highest plant productivity, improved grain biochemistry, high Ca and Mg concentrations, least oxidative stress, and enhanced soil alkaline phosphatase activity were found with 4 and 6% OAPR rates. The OAPR 4% rate is suggested for reducing grain Pb concentration, cell oxidative injury, and improving grain biochemistry in mung bean.

Efficacy of chitosan-coated textile waste biochar applied to Cd-polluted soil for reducing Cd mobility in soil and its distribution in moringa (Moringa oleifera L.).

Soil pollution with Cd has promoted serious concerns for medicinal plant quality. Amending Cd-polluted soils with textile waste biochar (TWB) coated with natural polymers can lower Cd bioavailability in them and reduce associated environmental and human health risks. In this study, we explored the impacts of solely applied TWB, chitosan (CH), their mix (TWB + CH) and TWB coated with CH (TBC) in Cd-polluted soil on Cd distribution in moringa (Moringa oleifera L.) shoots and roots as well as plant-available Cd in soil. Moreover, amendments effects on plant growth, dietary quality, and antioxidative defense responses were also assessed. Results revealed that the addition of TWB, CH, and TWB + CH in Cd-polluted soil reduced Cd distribution in shoots (56%, 66%, and 63%), roots (41%, 48%, and 45%), and plant-available Cd in soil (38%, 52%, and 49%), compared to control. Interestingly, the TBC showed significantly the topmost response for reducing Cd concentrations in shoots, roots, and soil by 73%, 54%, and 58%, respectively, relative to control. Moreover, amending Cd-polluted soil with TWB, CH, and TWB + CH depicted significantly better effects on plant growth, dietary quality, and activities of soil enzymes but the topmost response was observed with TBC treatment. Compared with control, TBC improved plant growth parameters: shoot length (81%), root length (90%), shoot fresh weight (60%), root fresh weight (76%), shoot dry weight (75%), root dry weight (68%) contents of chlorophyll-a (42%) and chlorophyll-b (74%), and soil enzyme activities: urease (130%), catalase (138%), protease (71%), cellobiohydrolase (45%), acid phosphatase (34%), peroxidase (60%), ß-glucosidase (152%), chitinase (62%), and phosphomonoesterase (139%). Furthermore, TBC treatment arrested Cd-induced oxidative stress via escalating the activities of antioxidant enzymes as well as improved moringa dietary parameters (protein, tannins, lipids, alkaloids, saponins, terpenoids, flavonoids, and tocopherols contents). Such findings suggest that the TBC has an immense perspective to remediate Cd-polluted soils and prevent human health risks associated with Cd exposure through the diet.

Fahr's Disease In A Patient Presenting With Status Epilepticus.

Fahr's disease is a rare disease in which there is symmetrical bilateral intracranial calcification. We are presenting a 50-year-old female patient who presented with status epilepticus. She had history of generalized tonic clonic fits for the last fifteen years. Her CT scan revealed widespread bilateral and symmetrical intracranial calcification in cerebellum, thalamus, basal ganglia and in white matter of the cerebral hemisphere Most of the secondary causes were ruled out to make the clinical diagnosis of Fahr's disease.

Surgical Outcome Of Intradural Spinal Tumours.

BACKGROUND: This study was conducted to determine the short-term outcome of surgical procedure in patients having spinal intradural tumours. METHODS: This cross-sectional study was conducted from 26 April 2016 to 25 March 2019 on 56 patients after approval from hospitals ethical and research committee. MRI spine were studied in detail for all patients to know about the site, size, shape, extent and nature of the tumour. History, examination, pre-operative MRI findings, post-operative findings were documented in patient's pro forma. Short term as well as long term post-operative results were documented after surgery, during stay at hospital and followup visits till 6 months. RESULTS: In this study, 56 patients with spinal intradural tumours were observed. Male to female ratio was 1.33:1. Age ranged from 5-65 years (32.5±14.6). Paraparesis, hypesthesia, sphincter dysfunction were the presenting symptoms in most of the patients. 47% (21) patients improved according to MRC Grading system 46% (20) patients remained static 7% (3) patients deteriorated. Wound infection was found in 7 (12.5%) patients, followed by Neurological Deficit in 5 (8.9%) cases, Meningitis was found in 2 (3.57%), CSF leak was noted in 4 (7.14%) patients and mortality in 1 (1.7%) of the case. CONCLUSIONS: Surgery of the intradural spinal tumours carry good neurological outcome with acceptable complication rates.

Associative effects of lignin-derived biochar and arbuscular mycorrhizal fungi applied to soil polluted from Pb-acid batteries effluents on barley grain safety.

While disobeying environmental regulations of Pakistan, several Pb-acid batteries recycling and repairing units discharge their effluents into water canals that irrigate arable fields. Resultantly, serious ecological risks, as well as human health hazards through consumption of edible crops grown on such Pb-polluted soils have been reported. In this experiment, we observed associative effects of amending a soil polluted from Pb-acid batteries effluents (SPB) with arbuscular mycorrhizal fungi (AMF) and lignin-derived biochar (LBC) on barley grain safety to human health. The SPB was treated with AMF inoculum (a consortium of four AMF species), lignin (LN), and LBC, as sole treatments and AMF inoculum with LN and LBC. Barley parameters involving Pb distribution in grain and other parts, grain biochemistry, and nutrition were assessed. Likewise, Pb bioavailability in SPB, AMF root colonization, soil enzymes, microbial biomass carbon (MBC), and AMF produced total glomalin related soil protein (TGSP) were also scoped. Additionally, human renal cells (HEK 293) cytotoxicity test was performed by opting barley grain-related Pb concentrations. Results show that LBC + AMF significantly reduced grain Pb concentrations below the critical limit [4.67 mg kg-1 (WHO/FAO standard)], AMF colonization, MBC, soil enzymology, and TGSP, compared to control. Likewise, rest barley parameters were also improved in this treatment. Contrary to other treatments, grain produced on LBC + AMF did not result in (a) cell apoptosis, (b) cell distortion and (c) cohesion loss. Immobilization of Pb in SPB was due to the dilution effect of Pb adsorption on LBC, AMF mycelium and TGSP which resulted in a significant drop of grain Pb concentrations below the critical limit and ultimately no harm to HEK 293 cells. Our findings endorse that grain produced at LBC + AMF treatment are safer for human consumption and will not pose health risks. The LBC + AMF application can remediate SPB for safer cereal production.

Estimating The Possible Role Of Testing Capacity And Social Distancing In Predicting The Growth Rate Of Daily Covid-19 Cases.

BACKGROUND: The purpose of this study was to estimate the effect of social distancing (days since the imposition of a lock-down) and the number of daily tests conducted per million population on the daily growth rate of COVID-19 cases. METHODS: After excluding the first 30 days since the announcement of an index case in a country, relevant data for the next forty days was collected from four countries: Belgium, Italy, South Korea and United Kingdom. Two online databases: Our World in Data and worldometer were used for the collection of data which included the number of new COVID-19 cases and the number of tests conducted on a given day. The acquired figures were transformed into per million population of the given country. The growth rate of daily COVID-19 cases was derived and was used as the regress and in a multiple linear regression with the number of tests per million population per day and the number of days since a lock-down was imposed as the regressors. RESULTS: It was found that the growth rate of daily COVID-19 cases decreased by .051% when the number of daily tests conducted per million population increased by 1. A .532% decrease in the growth rate of daily COVID-19 cases was observed with each passing day of a lock-down, which essentially represented the most effective form of social distancing. A significant regression was calculated (F (2, 155) = 35.191, p=.014), with an R2 of .054. Neither the daily number of tests conducted per million population nor the number of days of maintaining social distancing (lock-down) was individually significant contributors to the prediction of the growth rate of daily COVID-19 cases (p=.267 and p=.554 respectively). CONCLUSION: An extensive and rapid increase in the daily number of testing capacity and maintaining social distancing can decrease the growth rate of daily COVID-19 cases. Depending on the availability of the required resources, timely implementation of these measures can lead to better outcomes for a given population.

Efficacy Of Phenytoin In Prevention Of Early Posttraumatic Seizures.

BACKGROUND: The use of anti-epileptic drugs for prophylaxis of early post-traumatic seizures after traumatic brain injury has been very promising. The objective of this study was to determine the outcome of phenytoin in prevention of early post-traumatic seizures in moderate to severe traumatic brain injuries and to compare the frequency of seizures in moderate to severe traumatic brain injury, with phenytoin started within 12 hours and after 12 hours of injury. METHODS: This cross-sectional study was conducted at Department of Neurosurgery, Ayub Medical Institute, Abbottabad from April to October, 2015. All the patients with moderate to severe head injury presenting within 48 hours of injury were included in this study in consecutive manner. Patients were started on phenytoin and observed for early post-traumatic seizures. RESULTS: A total of 163 patients were included in this study with a mean age of 24.69±10.186 years. One hundred and twenty-two (74.8%) were males and rest of 41 (25.2%) were females. A total of 26 (16%) patients had early post-traumatic seizures. 9.89% patients in whom phenytoin was started within 12 hours had seizures, while 23.11% patients in whom phenytoin was started after 12 hours of injury had seizures, the difference being statistically significant (p-value .018).. CONCLUSIONS: Frequency of early post-traumatic seizures is high in patients with moderate to severe head injured patients. Anti-epileptics like phenytoin should be started within 12 hours for seizure prophylaxis.

Promoting the productivity and quality of brinjal aligned with heavy metals immobilization in a wastewater irrigated heavy metal polluted soil with biochar and chitosan.

Depleting aquifers, lack of planning and low socioeconomic status of Pakistani farmers have led them to use wastewater (WW) for irrigating their crops causing food contamination with heavy metals and ultimately negative effects on human health. This study evaluates the effects of chitosan (CH) and biochar (BC) on growth and nutritional quality of brinjal plant together with in situ immobilization of heavy metals in a soil polluted with heavy metals due to irrigation with wastewater (SPHIW) and further irrigated with the same WW. Both CH and BC were applied at three different rates i.e. low rate [(LR), BC0.5%, CH0.5% and BC0.25%+CH0.25%], medium rate [(MR), BC1%, CH1% and BC0.5%+CH0.5%] and high rate [(HR), BC1.5%, CH1.5% and BC0.75%+CH0.75%]. Result revealed that brinjal growth, antioxidant enzymes, and fruit nutritional quality significantly improved from LR to HR for each amendment, relative to control. However, these results were more prominent with BC alone and BC+CH, compared with CH alone at each rate. Similarly, with few exceptions, significant reduction in Ni, Cd, Co, Cr and Pb concentrations in the root, shoot and fruit were found in sole CH treatment both at LR and MR but in both CH and BC+CH treatments at HR, relative to control. Interestingly, the concentrations of Fe in the roots, shoots and fruit were more pronounced at BC treatments relative to CH and BC+CH treatments at each rate, compared to control. Overall, the BC+CH treatment at HR was the most effective treatment for in situ immobilization of heavy metals in SPHIW and further irrigated with the same WW, compared to rest of the treatments. This study indicates that BC0.75%+CH0.75% treatment can be used to reduce mobility and bioavailability of heavy metals in SPHIW and facilitates plant growth by improving the antioxidant system. However, the feasibility of BC0.75%+CH0.75% treatment should also be tested at the field scale.

Comparison Of Simultaneous Versus Delayed Ventriculoperitoneal Shunting In Patients Undergoing Meningocoele Repair In Terms Of Infection.

BACKGROUND: Myelomeningocele is a congenital anomaly of Central Nervous System (CNS) leading to serious sequels related to various systems and organs of the affected patient. Hydrocephalus is a common condition associated with myelomeningocele. Hydrocephalus is seen in 11.8% of children with Myelomeningocele (MMC). This study was conducted to compare the simultaneous vs delayed ventriculoperitoneal shunting in children undergoing myelomeningocele in terms of infection. METHODS: This Randomized Control Trial was conducted at department of Neurosurgery, Ayub Medical College, Abbottabad from 7th March to 7th June 2016. In this study a total of 98 patients with MMC and hydrocephalus were randomly divided into two equal groups. In group A simultaneous MMC repair and VP shunting was performed while in group B MMC repair was done in first and VP shunting was done two weeks postoperatively.. RESULTS: In this study mean age in Group A was 1 years with SD±2.77 while mean age in Group B was 1 years with SD±3.12. In Group A (12%) patients had infection and (88%) whereas in Group B (20%) patients had infection and (80%) patients didn't had infection.. CONCLUSIONS: Simultaneous VP shunting was more effective than delayed VP shunting in children undergoing myelomeningocele in terms of infection.

Potential of miscanthus biochar to improve sandy soil health, in situ nickel immobilization in soil and nutritional quality of spinach.

The complex interaction of biochar (BC) with soil health reflecting properties, the feedstock used to prepare BC and application rate of BC in sandy soil is still a question for the researchers. An incubation study was conducted where nine different sorts of BC, each prepared from the different feedstock, were applied at 2% rate to evaluate their relative suitability to improve sandy soil health. Results revealed that BC prepared from miscanthus (MIB) significantly increased soil medium and fine pores, available water content (AWC), electrical conductivity (EC), and cation exchange capacity (CEC) while decreased soil wide pores, pH, bulk density (BD) and particle density (PD) compared to the rest sorts of BC. Later, spinach was grown in pots containing same soil but spiked with 50 ppm nickel (Ni) and amended with 1, 2, 3, 4 and 5% rates of MIB. The results showed a significant increment in spinach biomass, reduction in the concentrations of Ni in spinach tissues and DTPA-extractable Ni with the increasing rate of MIB till 3% and later, no significant changes with 4 and 5% rates thereafter. However, significant improvement in the activities of antioxidant enzymes, chemical and biochemical attributes of spinach were observed at 5% MIB when compared to lower rates. Similarly, post-harvest soil physicochemical and enzymatic parameters were also significantly (P < 0.05) improved with increasing rates of MIB. This study implies that application of MIB at 5% rate can improve the nutritional quality of spinach, sandy soil health and can reduce Ni concentrations in spinach tissues.