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Abstract Introduction Transnasal transsphenoidal (TNTS) approach is preferred for surgical excision of the pituitary gland. Despite its numerous merits, the TNTS approach creates wide fluctuations in hemodynamic parameters that are attributed to the routine application of adrenaline-soaked nasal packing and the intense noxious stimulus during the surgery. Aims To evaluate the effect of dexmedetomidine for preoperative nasal passage preparation on the surgical field visualization and hemodynamic profile of patients during TNTS surgery. Material and Methods Cotton strips soaked in dexmedetomidine were used for nasal preparation. The primary outcomes studied were the quality of surgical field visualization through the endoscope and the amount of bleeding that occurred while raising the nasal mucosal flap. The secondary outcomes assessed were the intraoperative anesthetic and analgesic requirement and the hemodynamic profile. Statistical Analysis Data from the study were summarized as mean and SD. Associations were tested using chi-square test for nonparametric data and for continuous variables ANOVA for repeated measures. A p-value

Background: Ventral brainstem compression secondary to complex craniovertebral junction abnormality is an infrequent cause of neurologic deterioration in pediatric patients. However, in cases of symptomatic, irreducible ventral compression, 360° decompression of the brainstem supported by posterior stabilization may provide the best opportunity for improvement in symptoms. More recently, the endoscopic endonasal corridor has been proposed as an alternative method of odontoidectomy associated with less morbidity. We report the largest single case series of pediatric patients using this dual-intervention surgical technique. The purpose of this study was to evaluate the surgical outcomes of pediatric patients who underwent posterior occipitocervical decompression and instrumentation followed by endoscopic endonasal odontoidectomy performed to relieve neurologic impingement involving the ventral brainstem and craniocervical junction. Methods: Between January 2011 and February 2017, 7 patients underwent posterior instrumented fusion followed by endonasal endoscopic odontoidectomy at our unit. Standardized clinical and radiological parameters were assessed before and after surgery. A univariate analysis was performed to assess clinical and radiologic improvement after surgery. Results: A total of 14 operations were performed on 7 pediatric patients. One patient had Ehlers-Danlos syndrome, 1 patient had a Chiari 1 malformation, and the remaining 5 patients had Chiari 1.5 malformations. Average extubation day was postoperative day 0.9. Average day of initiation of postoperative feeds was postoperative day 1.0. Conclusions: The combined endoscopic endonasal odontoidectomy and posterior decompression and fusion for complex craniovertebral compression is a safe and effective procedure that appears to be well tolerated in the pediatric population. Key words: Axis, Basilar invagination, Chiari, Endonasal, Endoscopic, Odontoidectomy, Pediatric

Aim The aim of the following study is to study the incidence, clinical presentations, risk factors and management modalities in deep vein thrombosis (DVT) affecting patients undergoing cranial or spinal surgery in neurosurgical intensive care unit (ICU). Materials and Methods Retrospective review of patients who developed DVT in the course of prolonged ICU stay (>7 days), following cranial or spinal surgery between September 2009 and November 2011. Results A total of 260 patients were reviewed in the study period between September 2009 and November 2011. Eight patients (3.7%) were diagnosed with DVT by color Doppler during this period. The average age of the group was 47 years (range 36-70 years). 3 patients had DVT limited to the popliteal vein, 2 patients had an extension to the femoral vein and in 3 patients to the common iliac vein. Risk factors associated with DVT seen in our series included poor neurological status with immobilization in 2 patients, delayed ambulation in 3 patients, surgery in the prone position in 3 patients and old age in 1 patient. Conclusion Prolong intraoperative time; post-operative long immobilization and old age are significant contributory risk factor for DVT. However, this complication can be averted by prophylactic measures like compression stockings and intermittent compression devices used in conjunction with low molecular weight heparin and low-dose unfractionated heparin.

Aim The aim of the following study is to analyze the outcome following surgery in 169 patients with large vestibular schwannoma (VS) and to evaluate hydrocephalus as a prognostic factor in patients of the VSs. Subjects and Methods Retrospective analysis of all cases of VSs admitted to our tertiary neurosurgical center from January 2005 to December 2010 was performed. Comparison of patients who underwent pre-operative cerebrospinal fluid (CSF) diversion and those who underwent primary surgery was carried out for post-operative complications and delayed hydrocephalus. Results A total of 169 patients of VS were seen. The mean age at presentation was 39.03 years (12-72 years). The most common symptom was hearing loss seen in 161 (95.2%) cases. Giant VS was seen in 130 (75.5%) and hydrocephalus was present in 110 (63.9%). Pre-operative CSF diversion was done in 23 (13.1%) patients; 8 (4.6%) patients developed gradually symptomatic hydrocephalus following surgery and underwent ventriculoperitoneal shunt. Total surgical excision was done in 92.9% patients and subtotal excision was done in 7% patients. Conclusions Hydrocephalus occurs in longstanding untreated cases of VS. Hydrocephalus causes no statistically significant increase in post-operative complications like CSF leak and post-operative hematoma. Patients with hydrocephalus presenting with acute symptoms of raised intracranial pressure benefit from CSF diversion. In most patients, tumor resection will restore patency of the CSF pathway and CSF diversion can be avoided.

The uncontrolled utilization of organophosphate pesticides (OPPs) has resulted in substantial environmental issues globally, that pose significant threat to human health. As a result, effective sequestration of these OPPs has taken into consideration by several researchers and environmental scientists. In this context, metal‐organic frameworks (MOFs) have attracted a lot of attention in the field of adsorption due to their superabundant attachment sites, easy functionalization process, strong stability, tunable pore size, and rich topology. Therefore, the present review critically summarizes MOF based adsorbents such as pristine, functionalized, composites, and MOF‐derived materials along with the choice of precise linkers for the preparation of MOFs. Functionalizing agent used to achieve maximum adsorption by MOF is extensively explored. Possible mechanism, major interaction pathway for the mitigation of OPPs has also been focused. Finally, development of effective MOFs for successful implementation is recommended, along with future prospects for large‐scale applications. [ABSTRACT FROM AUTHOR]

The study aimed to deprescribe inappropriate consumption among Proton Pump Inhibitor (PPI) users and assess the clinical consequences of deprescribing. This is a prospective interventional study carried out among patients aged >18 years and consuming PPI. The “potentially inappropriate” patients were counselled on harms of inappropriate PPI usage, impact of healthy dietary and lifestyle habits employing a Patient Information Leaflet (PIL). The patients deprescribed were followed up through telephonic communication. Global Overall Symptom scale (GOS) was utilized to assess gastric discomfort before and after deprescribing. From 745 patients recruited, 226 (30.33%) were classified under “potentially inappropriate”, out of which 113 (15.16%) were deprescribed. When paired t-test was applied, GOS scale indicated significant difference in symptoms before and after deprescribing (P- value