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Mucoadhesive drug delivery systems have been extensively studied to effectively reduce the limitations of conventional drug delivery systems. Zein and polyvinyl pyrrolidone (PVP) are appraised for mucoadhesive properties. This study focuses on developing a mechanically stable zein/PVP electrospun membrane for propranolol hydrochloride (PL) transport. Fourier transform infrared, Raman spectra, and swelling studies gave evidence for PVP crosslinking, whereas circular dichroism spectroscopy revealed crosslinking of zein owing to the conformational change from α-helix to β-sheet. A 10 h thermal treatment of zein/PVP imparted 3.92 ± 0.13 MPa tensile strength to the matrix. Thermally crosslinked electrospun zein/PVP matrix showed 22.1 ± 0.1 g mm work of adhesion in porcine buccal mucosa tissue. Qualitative and quantitative evaluation of cytotoxicity in RPMI 2650 has been carried out. The in vitro drug release profile of PL from thermally crosslinked zein/PVP best fitted with the Korsmeyer-Peppas model. Immunostaining of β-catenin adherens junctional protein confirmed the absence of paracellular transport through the junctional opening. Still, drug permeation was observed through the porcine buccal mucosa, attributed to the transcellular transport of PL owing to its lipophilicity. The ex vivo permeation of PL through porcine buccal mucosa was also evaluated.

Large pituitary adenomas (LPAs), which constitute ∼5%-14% of all pituitary adenomas, are considered challenging tumors owing to their locally aggressive behavior, low gross total resection rate, and high prevalence of visual deficits and hypopituitarism. We evaluated the utility of various extended endoscopic endonasal approaches in maximizing the resection of LPAs and studied the factors affecting the extent of surgical resection.A retrospective study of all LPAs (defined as a minimum diameter3 cm and tumor volume10 cmThe present study included 106 patients with LPAs. The mean extent of the resection volume was 79.18 ± 21.75 cmExtended endoscopic endonasal approaches can safely and effectively be used for gross total resection of LPAs. However, we found that the preoperative tumor volume and Knosp grade were significant factors affecting the extent of tumor resection. The use of multiple endoscopic endonasal corridors can increase the volumetric extent of resection for LPAs.

A 14-year-old girl presented with subacute onset headache, fever, and vomiting and was managed initially with antibiotics for suspected bacterial meningitis. Her symptoms further evolved over the next few weeks with systemic signs and symptoms favoring chronic meningitis with raised intracranial pressure. After the etiologic workup was unrevealing, she was started on empirical antituberculous therapy. After a period of partial improvement, symptoms recurred with a new-onset focal seizure. Her imaging findings evolved from features suggestive of focal leptomeningitis to multifocal heterogeneous enhancing cortical and subcortical lesions with hemorrhagic foci, leading to brain biopsy that confirmed diagnosis. Our case highlights the utility of diagnostic biopsy in patients with “chronic meningitis” in uncertain cases rather than confining the approach to the law of parsimony. The decision to initiate empirical therapy in chronic meningitis should be considered on a case-by-case basis and take into account factors, such as clinical examination findings, immune status, recent exposures, and potential risks of treatment. Atypical MRI features should lower the threshold for meningocortical biopsy when indicated.

Electrospun zein membranes are suitable for various biomedical applications. A UV-crosslinked electrospun membrane of a zein/PEO blend for wound healing application was explored in this work. The improvement in mechanical properties of the membrane after UV crosslinking was attributed to the change in protein conformation from an α-helix to a β-sheet. The circular dichroism (CD) spectra and FTIR spectra confirmed this conformational change. XRD analysis was shown to prove the amorphous nature of polymer blends with specific broad peaks at 2θ = 9° and 20°. The water vapor transmission rate (WVTR) of the membrane was found to be in the range of 1500-2000 g m

Supplementary Table 1 from High-Resolution Analysis of Chromosomal Breakpoints and Genomic Instability Identifies PTPRD as a Candidate Tumor Suppressor Gene in Neuroblastoma

Supplementary Table 2 from High-Resolution Analysis of Chromosomal Breakpoints and Genomic Instability Identifies PTPRD as a Candidate Tumor Suppressor Gene in Neuroblastoma

Although neuroblastoma is characterized by numerous recurrent, large-scale chromosomal imbalances, the genes targeted by such imbalances have remained elusive. We have applied whole-genome oligonucleotide array comparative genomic hybridization (median probe spacing 6 kb) to 56 neuroblastoma tumors and cell lines to identify genes involved with disease pathogenesis. This set of tumors was selected for having either 11q loss or MYCN amplification, abnormalities that define the two most common genetic subtypes of metastatic neuroblastoma. Our analyses have permitted us to map large-scale chromosomal imbalances and high-level amplifications at exon-level resolution and to identify novel microdeletions and duplications. Chromosomal breakpoints (n = 467) generating imbalances >2 Mb were mapped to intervals ranging between 6 and 50 kb in size, providing substantial information on each abnormality. For example, breakpoints leading to large-scale hemizygous loss of chromosome 11q were highly clustered and preferentially associated with segmental duplications. High-level amplifications of MYCN were extremely complex, often resulting in a series of discontinuous regions of amplification. Imbalances (n = 540) PTPRD locus, indicating a possible tumor suppressor function for this gene. (Cancer Res 2006; 66(7): 3673-80)

This study considers the multi-level research design to build on the Conservation of Resource (COR) theory to help develop a model that links authentic leadership to followers’ outcomes. Though previous studies have examined the direct effect of leadership and followers’ outcome at the individual level, findings of the impact of authentic leadership at the cross-level and multi-level are limited. Consistent with our hypotheses, the findings of the study, from a sample of 547 dyads from the financial sector in India, revealed that authentic leadership has a significant impact on authentic followership and team-level work engagement. The cross-level analysis indicated that 8.4 per cent of the variance in authentic followership is attributable to authentic leadership at the team level. Likewise, the multi-level analysis revealed that 9.4 per cent of the variance at work engagement between the teams is attributable to authentic leadership. Theoretical and managerial implications are discussed further JEL: M12

Meckel's cave dermoid cyst is an extremely rare and a technically challenging lesion. The objective of the study is to show that endoscopic endonasal approach (EEA) has recently emerged as a better alternative to transcranial approach for this formidable tumor, owing to minimal retraction-related morbidity.A 52-year-old male presented with numbness over the right side of the face and temporal area for the last 3 years. On examination, there was decreased sensation to touch, pain, and temperature over the right V1, V2, and V3 areas with an absent right corneal reflex. Imaging revealed a heterogenous extra-axial lesion in the right Meckel's cave. The tumor was resected by an extended endonasal transpterygoid approach.The patient had improvement in his symptoms with no endocrine complication.This case demonstrates the surgical techniquenof endoscopic endonasal transpterygoid resection of a Meckel's cave dermoid cyst.

Endoscopic endonasal surgery (EES) requires wide sinonasal dissection to achieve adequate visualisation of anatomical landmarks. This can also result in nasal sequelae like crusting, nasal discharge, and anosmia.To use the sinonasal outcome test (SNOT) 22 questionnaire to study the postoperative sinonasal morbidity and its recovery in patients who have undergone EES.Prospective study conducted from November 2017 to May 2018. SNOT-22 questionnaire was administered on patients operated between before EES and then re-administered during outpatient visits at 1 month, 3 months, and 6-12 months following surgery.Results of 46 patients were analyzed. The mean duration of follow-up was 11.8 months. The mean preoperative SNOT-22 score was 2.69 ± 4.95. SNOT-22 score at 1 month was 5.52 ± 6.77, at 3 months follow-up was 0.39 ± 1.02, and after 6 months was 0.30 ± 1.00. In 32 patients with a nasoseptal flap, mean preoperative score was 3.34 ± 5.68 (P = 0.18), one month following surgery it was 6.68 ± 6.88 and at 3 and 6 months following surgery it was 0.56 ± 1.19 and 0.38 ± 1.15. The mean preoperative nasal domain score was 1.022 (±2.13), the postoperative 1 month score was 2.3 ± 3.7, at 3 months following surgery was 0.22 ± 0.82 and after 6 months of surgery was 0.28 ± 0.96.Patients undergoing EES experienced transient worsening of SNOT 22 scores in the first month following surgery and recovered within 3 months of surgery. The improvement was sustained in follow-up visits beyond 6 months of surgery.

PurposeThe present study had two objectives, first objective was to examine the impact of authentic leadership on followers' well-being and work engagement. The second objective was to examine the moderating role of authentic leadership and followers' outcomes. Despite an immense amount of research on authentic leadership, how and when authentic leadership is more or less effective in promoting the well-being and work engagement of followers is little known. Drawing from the conservation of resource theory, the authors draw upon the interactionist perspective and suggest psychological capital is a dispositional boundary condition that influences the effectiveness of authentic leadership in promoting well-being and work engagement of followers.Design/methodology/approachUsing cross-sectional research design data were collected from 547 team members nested under 118 team leaders from the financial sector in India. The study used structural equation modelling and hierarchical regression analysis to examine the hypothesised relationships.FindingsThe findings from the study revealed that authentic leadership predicts followers' psychological well-being and work engagement. Also as proposed, the study found psychological capital moderates the relationship between authentic leadership and the well-being of followers. However, the study found psychological capital does not moderate the relationship between authentic leadership and followers' work engagement.Research limitations/implicationsThe study has helped expand the nomological network of authentic leadership by examining the authentic leadership model with followers' psychological well-being and work engagement. Further, the findings suggest that psychological capital being a dispositional boundary condition, it plays a contingent role in explaining the role of authentic leadership in promoting the well-being of followers.Practical implicationsThe results offer strong practical implications that can be considered as the basis for actionable strategies by the human resource management system of the organisation to enhance authentic leadership and psychological capital.Originality/valueThe study is unique in its scope and contribution, as it tries to develop an understanding of how and when authentic leadership promotes psychological well-being and work engagement by considering an interactionist approach in the Indian context.

Complex craniopharyngiomas pose a significant surgical challenge owing to its proximity to critical structures and its intrinsic nature to resist radical excision.To show that endoscopic endonasal approach (EEA) is potentially a better alternative to transcranial approach in tumors that have been operated multiple times by transcranial route for achieving radical excision with minimal morbidity.A 32-year-old male previously operated twice through interhemispheric approach for craniopharyngioma presented with blurring of vision accompanied by headache and intermittent diplopia. Imaging revealed a large lobulated suprasellar recurrence with a large calcified part adjacent to left internal carotid artery. The tumor was resected by an extended endonasal approach. The patient experienced improvement in his vision with no significant endocrine complication.This case demonstrates the surgical technique and various operative nuances of endoscopic endonasal resection of a complex craniopharyngioma.

Split cord malformations are disorders of gastrulation. Disorders of secondary neurulation occur later and are traditionally considered separate from the former. Complex split cord malformations involving both the cord and the conus and encompassing the epochs of gastrulation, primary neurulation, junctional neurulation, and secondary neurulation have not been described in literature. We present a four-year-old boy with such a malformation and postulate the embryological mechanism involved. The clinical vignette of this unique case has been described. We report a good clinical outcome in this patient with surgical management.

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

Background A persistent craniopharyngeal canal (PCC) is a rare cause of cerebrospinal fluid rhinorrhea in children. The condition often coexists with other midline facial defects, such as cleft palate. Children with PCC may also have pituitary dysfunction or neoplasms, such as craniopharyngiomas within the canal. Case Description A 5-year-old girl presented with bacterial meningitis and active cerebrospinal fluid rhinorrhea from her left nostril. Imaging showed a large nasopharyngeal meningoencephalocele, communicating with the subarachnoid space through a persistent craniopharyngeal canal. An endonasal approach was chosen to excise the PCC and meningoencephalocele and to repair the resulting skull base defect. Conclusions The extended endonasal approach can be used to treat PCC with nasopharyngeal encephaloceles in young children. The approach is suitable to address both conditions at the same time. The extended endonasal approach avoids potentially morbid transfacial approaches and can help in earlier recovery after surgery.

Ventral midbrain glioma is an extremely rare lesion in adults. The endoscopic endonasal approach is potentially a better alternative to transcranial approach for this challenging lesion and has not been described in the literature.A 22-yr-old woman previously operated through an interhemispheric approach for ventral midbrain glioma with extension in the suprasellar cistern presented with severe headache and diplopia. Imaging revealed an increase in size of the residual lesion. The tumor was resected by using an extended endonasal approach. The patient had improvement in her diplopia with no endocrine complication.This case demonstrates the surgical technique of endoscopic endonasal resection of a ventral midbrain glioma.

Background Pituitary macroadenomas occasionally disrupt the sellae diaphragma and extend directly to the third ventricle causing hydrocephalus. We present the results of a single-stage extended endoscopic approach for managing giant pituitary adenomas (GPAs) occupying the entire third ventricle. Methods A retrospective study of all GPAs occupying the entire third ventricle operated on via the endoscopic endonasal approach between January 2016 and December 2020 was performed. Results The study included 8 cases of GPA occupying the entire third ventricle, of which 2 (25%) were functioning adenomas. Of 8 patients, 4 (50%) presented with hydrocephalus, 2 underwent preoperative ventriculoperitoneal shunt, and 2 had an intraoperative external ventricular drain. No patients had postoperative cerebrospinal fluid rhinorrhea. Complete resection of the third ventricular component could be achieved in all cases radiologically; minimal residual tumor was present either in the lateral compartment of the cavernous sinus or over the anterior cerebral artery complex in 5 of 8 (62.5%) patients. Complete resolution of temporal hemianopia was seen in 8 of the 12 eyes (66.67%), and partial resolution was seen in 4 of 12 (33.3%) eyes. At a mean follow-up of 24.62 ± 10.01 months, none of the patients needed another surgical procedure. Conclusions The extended endonasal endoscopic approach can be safely and efficiently used for single-stage excision of GPAs that disrupt the diaphragm and occupy the third ventricle. Preoperative cerebrospinal fluid diversion may be used to manage associated acute hydrocephalus in these cases.

Leptospirosis is a common tropical febrile illness which may manifest with the hepatorenal syndrome and systemic hemorrhagic manifestations. Pituitary apoplexy is a rare but life-threatening condition characterized by a hemorrhage within the pituitary gland or a pituitary adenoma. Apoplexy is very rarely associated with some inducing events such as infectious diseases such as dengue hemorrhagic fever, Hantaan virus, Puumala virus have also been reported to cause pituitary apoplexy. We present the first case of pituitary apoplexy in a patient who was being treated for leptospirosis and discuss the possible mechanisms of apoplexy in the scenario presented. We also review other reports of infectious causes that may result in pituitary apoplexy.

Leadership research will benefit from bringing in the subjective realities of becoming a leader by considering the leadership journey. Generating an understanding of how leaders turn episodes in time into meaningful subjective narratives helps shed light on the meaning-making process. We seek in this inquiry to understand self-awareness with a narrative meaning-making process. In this study, we adopt a narrative research approach for analyzing the autobiography of Mahatma Gandhi, who is widely acknowledged as an authentic leader. The study explores individual experiences of becoming a leader and factors leading to the manifestation of authentic leadership behaviour as well as followers’ outcomes. The study will also contribute towards the understanding of triggering events experienced by the leader at different points in life which have led to self-awareness.

In this concise, ultra low power and high speed voltage or logic LS circuit is introduced. With the help of regulated cross coupled structure in the pull up region the power utilized by the circuit is considerably decreased and speed of the circuit is also increased. The LS can convert the input logic levels or voltages below the V TH of the transistor to the higher acceptable levels. A LS requires less area because it consists of less number of components which makes it fit for low power and high speed applications, for example implantable clinical gadgets and remote sensor organizations. Tool used for simulation is LTspice 180nm technology. The LS can shift the input voltage or logic levels as less as 80mv to higher acceptable levels. The power utilized by LS is 149.5nw and propagation delay is 23.7ns.

Since the inception of the specialty of neurosurgery, conventional teaching was that “bigger opening is better.” This statement was based on the principle that a larger opening could allow room for the swollen brain to expand adequately, resulting in lower intracranial pressure (ICP) and reducing the potential for retractor-induced ischemia to normal brain tissue. Adverse brain conditions could also be encountered due to inhalational anesthesia, vasodilatory effects of medications used to regulate blood pressure, and awkward patient positioning leading to brain swelling. Imaging techniques were not available during the early years of neurosurgery, and a large craniectomy allowed for easier localization of the lesion, easier control of bleeding, and room to perform resective surgery in cases of refractory brain bulge. Morbidity and mortality of traditional neurosurgery due to large craniotomies and subsequent brain damage during surgery were well-recognized a century ago. Over the last three decades, advancements in technology have eliminated most difficulties encountered by earlier generations of neurosurgeons. Recent imaging modalities provide accuracy within a few millimeters, and stereotactic guidance has increased the accuracy to the submillimeter level. Neuronavigation tools allow the surgeon to map the perfect trajectory to precisely target lesions while causing minimal damage to eloquent areas of the brain. Advanced micro-equipment and endoscopes allow access to deeper tissues with minimal handling of adjacent brain tissues. Advancement in anesthesia techniques and a better understanding of neurophysiology and neuropharmacology have led to improved control over ICP in the perioperative setting. Facilitation of minimally invasive neurosurgery requires preoperative planning with investigations such as computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative aids like neuroendoscope (using small burr hole/craniotomy), neuronavigation (image guidance system), or the use of robotic aided surgery. This chapter details the nunaces of anesthesia for minimally invasive neurosurgery.

The sinonasal anatomy in growing children undergoes change in size along with progressive pneumatization, this is of particular significance in endoscopic endonasal surgery. We aim to measure and quantify the sinonasal dimensions in the Indian paediatric population, which are relevant to skull base surgeons.This is a retrospective radio anatomical study of sinonasal measurements and volumetric analysis of the sphenoid sinus performed on archived CT images of children less than 18 years of age.CT scan images of 110 patients (male, 68; female, 42) were included for the study. The number of patients in each age groups was as follows [0-6 years, 17; 7-9 years, 20; 10-12 years, 27; 13-15 years, 29; 16-18 years, 17]. The distance from the nares to the sphenoid and from the sphenoid to the sella was significantly greater in children of 13-15 years (69.4 ± 5.2 mm) as compared to children less than six years (62.6 ± 6.7 mm) (P0.003). The volume of the sphenoid in children between 0 and 6 years was 4641.4 ± 1924.7 mmThe sinonasal anatomy shows progressive development between the age of 6 to 15 years after which it plateaus. The pneumatization in young children may be incomplete, which necessitates drilling in the sphenoid sinus. The intercarotid distance was not seen to be a hindrance for endoscopic endonasal surgery. None of the measurements of the skull-base, made in this study appear to restrict endoscopic endonasal surgery in children. However, a meticulous preoperative assessment of the CT scan may be needed for optimal surgical outcome.

Background and importance Cavernous malformations (CMs) are angiographically occult low-flow vascular malformations that infrequently involve the optic pathway and the hypothalamus (OPH). Clinical presentation A 23-yr-old male presented with bitemporal hemianopia due to chaismal apoplexy. Imaging revealed a CM involving the OPH. The CM was resected by an extended endonasal approach. The patient had improvement in his visual field defects, and postoperative magnetic resonance imaging (MRI) revealed a gross total resection of the CM. Conclusion This case demonstrates the surgical technique of endoscopic endonasal resection of a CM involving the optic pathway.

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 Results Seventeen (85%) patients had a Formmer's score of 1, which was an excellent surgical field quality. Two (10%) patients had a Formmer's score of 2, and one (5%) had a Formmer's score of 3. There were no statistically significant variations in heart rate and blood pressure with reduced anesthetic requirement. Conclusion Intranasal dexmedetomidine provides good surgical field conditions with the added advantage of lesser hemodynamic fluctuations.

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.

Cerebrospinal fluid (CSF) leak from the lateral recess of the sphenoid sinus is rare when compared to leaks from other sites. The extended endonasal approach along with a transpterygoid extension provides adequate exposure for repair of these defects.We retrospectively analyzed a series of seven patients who underwent eight transpterygoid approaches for repair of the CSF leak from the lateral recess of the sphenoid sinus. We analyzed the patient characteristics, site of leaks, type of repair done, and presence of increased intracranial pressure (ICP) in these individuals.Seven patients underwent eight transpterygoid approaches for CSF leaks from the lateral recess of the sphenoid sinus. The leak was bilateral in one patient. The materials used for repair consisted of fat, fascia lata, free mucosal flap or a vascularised nasoseptal flap, and fibrin glue. Evidence of increased ICP was found in five of the seven patients. CSF diversion was needed in three of the seven patients (two ventriculoperitoneal shunt and one thecoperitoneal shunt).Endoscopic endonasal transpterygoid approach provides an excellent visualization of the skull-base defect and facilitates adequate instrument manipulation within the corridor, allowing successful repair of the defect with low rates of recurrence. Increased ICP can have a role in causing spontaneous CSF rhinorrhea from this location.

AIM To study the clinical profile, imaging features, intra-operative findings, post-operative outcome at discharge and at 6 months in patients with internal carotid artery (ICA) bifurcation aneurysm. MATERIAL AND METHODS Present study is a retrospective analysis of data of patients who underwent surgery for ICA bifurcation aneurysm between the period of 1st January 2011 to 31st December 2015 at our institute. Demographic variable, clinical grade, radiological finding was assessed. Outcome was measured using modified Rankin score (mRs) at discharge and at 6 months follow up. All ICA bifurcation aneurysms were clipped using a standard pterional craniotomy. RESULTS A total of 28 patients were included in the study out of which 4 had bilateral ICA bifurcation aneurysms. Mean age was 44.15 (age range 14-65) years, with 43.75% of patient were < 40yrs. Multiple aneurysms were seen in 11 (39.28%) patients, with superior projection being the most common in 53.12%. Vasospasm was seen in 12 (42.85%) with 4 patients undergoing chemical angioplasty. At discharge good outcome (mRs < 3) was seen in 4/5 (80%) patients in the un-bled category, whereas 18/23 (78.2%) in bled category. At 6 months follow up, mRs < 3 was seen 4 (100%) patients in unbled category, and 84.21% (16 of 19) patients in bled group. CONCLUSION The findings of the present study have shown an increased incidence of bilaterality and multiplicity for ICA bifurcation aneurysms. The direction of the dome of aneurysm and temporary clipping do not affect the treatment outcomes. These aneurysms have excellent outcomes following surgery.

Over the last decade, the Philippine government and private sector have spearheaded several cashless initiatives in part to address the structural deficiencies of the country’s economy, such as its poor financial inclusion levels and its heavy reliance on remittances. This paper will provide an assessment of the non-cash payment industry in the Philippines. It will argue that while structural challenges have spurred the country’s most cutting-edge cashless initiatives, they have simultaneously impeded the full integration of cashless transactions into Philippine society. The Philippines will only achieve its goal to transition to a “cash-lite” country if the central bank, Bangko Sentral ng Pilipinas (BSP), and the private sector are able to coordinate efforts to address the financial system’s limitations.