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The objective of this study is to further patient-physician discussion regarding postoperative quality of life expectations after surgical acoustic neuroma resection.This study is retrospective prospective. Qualifying patients were identified and administered Penn Acoustic Neuroma Quality-of-Life (PANQOL) Scale.The setting was Loyola University Chicago Health System.Three hundred twenty-six patients at our center with surgically resected acoustic neuroma between January 1990 and July 2021 completed the PANQOL.During postresection follow-up visits, patients were administered the PANQOL survey.The total PANQOL is comprised of questions addressing quality of life in seven domains of hearing, balance, face, energy, pain, health, and anxiety. Univariate and multivariable analyses were performed to test for associations between surgical approach and/or patient characteristics.Patients who were treated with retrosigmoid approach reported slightly higher PANQOL pain scores when compared with translabyrinthine approach. No association was found between responses on hearing PANQOL and surgical approach. No association was found between approach and total PANQOL score. However, on average female patients reported lower total PANQOL compared with male patients.The lack of association between patient response on hearing PANQOL and surgical approach illustrates the impact of preoperative patient counseling in appropriately setting patient expectations. The difference in pain PANQOL response may be due to a higher rate of occipital neuralgia due to incision placement and soft tissue retraction in the retrosigmoid patient group. Surgeons may consider alternative surgical incisions and soft tissue dissection to improve patient's quality of life with respect to postoperative pain.

Metsihet Mohammed Nuru,1 Temesgen Bizuayehu Wube,2 Demissie Assegu Fenta2 1Comprehensive Specialized Hospital, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; 2School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, EthiopiaCorrespondence: Metsihet Mohammed Nuru, Tel +2519-39-80-82-06, Email m.metsihet2006@gmail.comBackground: The most common abnormality in HIV-infected children is cytopenia, a hematological complication characterized by a decline in any of the blood cell lines. It is associated with a higher risk of morbidity and mortality. Therefore, this study aimed to assess the prevalence and associated factors of cytopenia among HIV-positive children on highly active antiretroviral therapy (HAART).Methods: Hospital-based cross-sectional study design was conducted on HIV-positive children on HAART from July to September 2020. Socio-demographic and clinical characteristics of the study participants’ data were collected using a structured questionnaire. Hematological parameters from the blood sample were analyzed using Ruby Cell-Dyne 300 hematology auto-analyzer. The data were analyzed using SPSS version 20. Logistic regression was used to assess the predictors of cytopenia among the study participants. P-values of less than 0.05 are considered statistically significant.Results: Two hundred seventy-three HAART-experienced children were enrolled in this study, and 50.9% were females. At baseline, 40.7% of children were anemic. The overall magnitude of cytopenia among the study participants was 26.7%. The prevalence of anemia, thrombocytopenia, leucopenia and neutropenia among children was 11.4%, 4.0%, 14.3%, and 18.3%, respectively. Patients with an undetectable viral load (AOR = 0.5, CI = 0.3– 0.9) are 50% less likely to report cytopenia. HAART-experienced children living in rural areas are more likely to develop cytopenia (AOR = 2.6, CI = 1.3– 5.2) than those living in urban areas.Conclusion: Hematologic abnormalities are common problems among children on highly active antiretroviral therapy. Therefore, routine investigation of hematological and immunological changes following appropriate therapeutic interventions is recommended.Keywords: HIV, cytopenia, HAART, children, Ethiopia

Objective The evolution of acoustic neuroma (AN) care continues to shift focus on balancing optimized tumor resection and control with preservation of neurological function. Prior learning curve analyses of AN resection have demonstrated a plateau between 20 and 100 surgeries. In this study of 860 consecutive AN surgeries, we investigate the presence of an extended learning curve tail for AN resection. Methods A retrospective cohort study of AN resections by a single interdisciplinary team between 1988 and 2018 was performed. Proportional odds models and restricted cubic splines were used to determine the association between the timing of surgery and odds of improved postoperative outcomes. Results The likelihood of improved postoperative House-Brackmann (HB) scores increased in the first 400 procedures, with HB 1 at 36% in 1988 compared with 79% in 2004. While the probability of a better HB score increased over time, there was a temporary decrease in slope of the cubic spline between 2005 and 2009. The last 400 cases continued to see improvement in optimal HB outcomes: adjusted odds of HB 1 score were twofold higher in both 2005 to 2009 (adjusted odds ratio [aOR]: 2.11, 95% confidence interval [CI]: 1.38–3.22, p Conclusion In contrast to prior studies, our study demonstrates the steepest growth for learning, as measured by rates of preservation of facial function outcomes (HB 1), occurs in the first 400 AN resections. Additionally, improvements in patient outcomes continued even 30 years into practice, underlining the importance of lifelong learning.

Political behaviour encompasses a combination of democratic attitudes and orientations that shows people as an essential part of a democratic development in the society. Political behavior literatures that exist are narrow and rely mostly on the traditionally drives and impulses to the analysis of political behavior such as socio-cultural cleavages determined lines. However, this study presents an academically comprehensive, and empirically well-explanation of the concept of political behavior. Significant for its practical understanding and adoption in political behavior discourse and analysis that is base on the most pressing issues and demands of the people. The study uses a qualitative method of data collection. Findings revealed that political behavior component include formal political participation and extra parliamentary activism. Formal political participation: involves citizens to take part in voting, enjoys right to contest in any office or position at the state or national levels, membership in political parties, pressure groups, civil societies, labour unions, market unions, and humanitarian advocacy groups. And extra parliamentary activism : involves protests or unconventional political engagement such as strike, demonstrations, petitions, or rallies, in order to attract attention and concerns to portray the electorates’ most pressing demands and needs towards government policies for the benefit of the general public.

Behaviouralism views individual as the main focus in the analysis of political behaviour and set of orientations within the political system for political inquiry. Studies that adopt behaviouralism exist but mostly are limited to in cooperating boths it’s quantitative and qualitative techniques in the analysis of political inquiry. This work demonstrates the effectiveness of the theory of behaviouralism in the study of political behavioural change in Bauchi state Nigeria, aiming at the theory’s contribution in moving the study of political system and political behaviour from qualitative to include quantitative studies. The work utilized a qualitative method in its data collection and analysis. Findings concludes that variables such as formal political participation and extra parliamentary activism that forms major part of the theoretical assumptions of political behaviour component in the theory of behaviouralism are practical in the empirical and academic analyses of political inquiry by using both quantitative and qualitative techniques. Thus, behaviouralism method is effective and has changed the perspective of political inquiry by introducing a scientific innovative technique that is strengthened with confirmable evidences.

Regional imitation is a propensity aimed at neighbouring nations to meet toward a common level of democratic political development. One can understand how such a propensity exists by concentrating on a diffusion element that analyses the hypothetically anticipated outcome of electoral management policies in these neighbouring nations. Research on Nigeria’s democracy exist however, concentrated exclusively on domestic phenomenon and factors such as socio-cultural cleavages, overlooking the likely external influence of international norms, and regional diffusion of democratic strategies from neighbouring African states. This study examines the influences of regional diffusion of democratic strategies on Nigeria’s democratic development, through a qualitative process of data collection and analysis. The study concludes that, regional diffusion of democratic strategies from successful wave of democratic transition to opposition parties against the then incumbent ruling political parties in African countries, such as Senegal, Mauritius, Ghana, Uganda, Malawi and Mali has motivated people and institutions in Nigeria to emulate the development there. Particularly, strong adherence to the rule of law by political actors, independence and integrity of the legal system, and provision of efficient civic and voter education have greatly motivated and influenced the change in Nigeria’s democratic development strategies.

The major challenges connected to Nigeria’s political party politics includes ideology, corruption, money politics, ethno religious fragmentations, violence and a dominant ruling party with some opposition parties challenging each other. Studies on Nigerian political parties are narrow in advocating for practical solutions to the challenges of party politics in Nigeria, particularly considering the emerging shift in the voting choices of the citizens during the 2007 and 2019 general elections in Bauchi State. This indicates that the influence of political parties on voters appears to be in decline, or at the very least experiencing significant change. Thus, the nature of this evidence of decline and what it means for the future of parties and representative democracy needs to be investigated with realistic way out, which this study aims at through a qualitative method of data collection and analysis. The study concludes that, while political parties are reasonably and normatively important to the process of representative democracy, party politics in Nigeria should embrace a collective viewpoint and common ideology of serving and developing the welfare of the electorates as well as to aggregate, articulate, and stimulate the electorates interests in the form of policy alternatives. In addition, Nigerian political party system must be is a system of connections consequential from inter-party competition. This imply that each party as a component affects and is influenced in turn by the performance of the other parties within Nigeria’s political system.

The notable challenges that Nigeria’s democratic processes and development suffer from includes cases of electoral misconduct such as rigging, use of thugs to interrupt the election process and use of money to bargain the votes of the poor hungry Nigerian. Inter and intra party conflicts, ethno religious violence, inequality, pandemics, along with others. Studies on Nigeria’s democracy exist but are limited to providing a ground breaking approach to mitigating the challenges of Nigerian democracy. This article presents an innovative approach from the political behavioural change theoretical and practical insight to mitigating the challenges of Nigerian democracy through a qualitative method of data collection and analysis. Findings concludes that challenges of Nigeria’s democracy can be mitigated through an innovative political behavioural change approach that centers on meeting the most pressing issues and demands of the electorates. And in the manner democratic process and practices of the Nigerian political system is handling generally. This would ultimately help to connect democratic values with democratic attitude, democratic attitude with electorates’ electorates and leaders’ democratic behaviour with most pressing issues and demands. Issues and demands with democratic policies and institutions, local or international significant for democratic development.

International advocacy groups such as DFID, CIDA, EU, UNDP, USAID and IFES are considered external actors of national development process. Reports on international advocacy groups exist but are limited to academic orientation. This paper focus on the role of these international advocacy groups on Nigeria’s INEC capacity building through a qualitative method of data collection and analysis. Findings conclude that the contributions of these organizations have differed both in their approaches and so is the kind of assistance they rendered to Nigeria’s electoral process since inception of the new democratic transition in 1999. They organised programmes on capacity building for INEC staff, and civic education programmes for the electorates, they enhanced political participation by women, youths and other marginalized groups; improved democratic quality of political commitment; strengthened channels of civic engagement; and promoted credible, transparent and sustainable elections. They also provide funding/ grant sponsorship of pre-election and post-election workshops for accredited observers and training for security officials. This is indeed significant to the prospect’s democratic development, and individual well-being of the citizenry which these international advocacy groups and norms advocate.

Background: Moringa oleifera plant parts extract have been utilized tremendously in traditional medicine, having various pharmaceutical activities such as antifungal, antibacterial and antiviral properties. Aim: This study was carried out to evaluate antiviral activity of aqueous extract of Moringa leaves, seeds and flowers against Polio virus isolates (Vaccine Strains P1&P3), MDG-17-04852; MDG-17-04881. Study Design: This is a baseline study carried out to determine the efficacy of Moringa oleifera in the treatment of poliomyelitis. Place and Duration of Study: This study was carried out at the University of Maiduguri Teaching Hospital Maiduguri and Abubakar Tafawa Balewa University, Bauchi from September 2018 to October, 2019. Methods: Phytochemical substances was extracted and screened from the Moringa using standard laboratory techniques. Continuous cell line L20B cells was used to isolate polio virus. Polio virus stock was prepared and titration was carried out to determine TCID50 by Kerber’s formula, L-d(S - 0.5). Cytotoxicity of the extracts was evaluated using the end-point cytopathic effect assay. Antiviral assay and Polio virus Intratypic Differentiation (ITD) was performed using Real-Time PCR. Results: The results revealed present of Tannins in leaves and flowers, Alkaloids and Saponins in all the extracts, Glycosides and Steroids in leaves and Flavonoids in flowers only. Cytotoxicity of the extracts shows 50% effects in 100mg and 50mg concentrations, while 33.3% and 16.7% was observed in 25mg and 12.5mg (P>.05). The titration of the tissue culture infective dose 50% (TCID50) shows that Polio virus type 1and 3 had a titre value of 106.5 and 106.25 respectively. The ITD results observed presence of Sl1 and Sl3 from the extracts. Conclusion: This study found that the Moringa extracts did not neutralized the Polio virus strains studied, as the phytochemicals show no antiviral activity. Therefore further study is needed in this area to ascertain its antiviral potentials against poliomyelitis.

Introduction The petroclival region is an integral part of the skull base. It can harbor different pathologies and provides access to the petroclival junction and cerebellopontine angle. We present the results of the morphometric analysis of the posterior fossa and a prediction model to enable skull base surgeons to choose an optimal surgical corridor considering patient's bony anatomy. Methods Ninety patients (14 to assess interobserver reliability) with temporal bone computed tomography were selected. Exclusion criteria included patients Results The average age was 49.5 years (55%) for males. The mean clival length and surface areas were 44.2 mm (standard deviation [SD] ± 4.1) and 8.1 cm2 (SD ± 1.3). The mean petrous apex and translabyrinthine corridors volumes were 2.2 cm3 (SD ± 0.6) and 10.1 cm3 (SD ± 3.7). The mean petroclival angle at the internal auditory canal (IAC) was 154.9 degrees (SD ± 9). The clival length correlated positively with clival surface area (rho = 0.6, p Conclusion The petroclival region is complex and with high variability of surgical significance. The use of preoperative measurements of the clival length and petroclival angle as part of surgical planning that could help the surgeon to choose an optimal surgical corridor by overcoming the anatomical variability elements.

The increasing competitiveness of the neurosurgical residency match has made it progressively difficult for foreign medical graduates (FMGs) to match in neurosurgery. We compared FMG to U.S. medical graduate (USMG) match rates in neurosurgery and identified factors associated with match outcomes for FMGs in neurosurgery.Retrospective review of American Association of Neurological Surgeons membership data and Association of American Medical Colleges Charting the Outcomes match reports (2007-2017).Across 1857 neurosurgical residents (USMG: 91.1%, FMG: 8.9%), average FMG match rates were 24% (range, 15%-35%) versus 83% (range, 75%-94%; P0.001) for USMG. FMGs were more male (89.5% vs. 82.0%, P = 0.016), older (33.9 vs. 31.8 years, P = 0.008), and more likely to take research year(s) before matching (95.8% vs. 78.5%, P0.001). FMGs had greater publications (5 vs. 2, P0.001) and H-indices (3 vs. 1, P0.001). The number of matched USMGs increased by 3.3 annually, whereas that of matched FMGs remained unchanged (β = 0.07). Compared with USMGs, FMGs were less likely to match to National Institutes of Health (NIH) Top 40 (32.7% vs. 47.5%, P0.001) and Doximity Top 20 (20.0% vs. 29.0%, P = 0.014) programs. FMGs with prior U.S. neurosurgery program affiliation were more likely to match at NIH and Doximity Top 20 programs (P0.05). For NIH programs, FMGs were older (35.3 vs. 32.0, P = 0.011), had higher H-indices (5 vs. 2, P0.001), publications (7 vs. 2, P0.001), and were more likely to take research year(s) (94.4% vs. 76.0%, P = 0.002) than USMGs. FMGs had similar patterns for matching into Doximity Top 20 programs.Although FMGs have lower match rates into U.S. neurosurgery residencies than USMGs, several demographic, professional, and academic factors could increase the chances of successful FMG neurosurgical match.

Intrathecal baclofen (ITB) is a treatment modality used to improve the quality of life of patients with intractable spasticity and dystonia. Although it is an effective solution in patients failing oral interventions, it is associated with potential infectious complications. It is known that pediatric patients with ITB have significantly higher infection rates compared with adult patients. The cause of these higher rates in pediatric patients remains unclear. In the present study, we performed a meta-analysis focusing on the incidence of infection, and clarification of potential risk factors for infection in pediatric patients with ITB.This meta-analysis was performed in accordance with the PRISMA guidelines. An electronic database search was performed through PubMed, Web of Science, Embase, and Cochrane Library databases. Eligibility criteria and bias assessment were applied before statistical analysis.The 17 studies identified yielded 2238 pediatric patients treated with implanted ITB pumps between 1994 and 2014. Infection comprised 34% of observed complications, second only to catheter malfunction. Pediatric ITB primary infection ranged between 0% and 44% among included studies (interquartile range, 4.85%-18.85%). A linear mixed-effects regression model showed that subfascial implantation had 12% lower primary infection rates compared with subcutaneous implantations across the literature. The relative risk of infection was 56% lower in pediatric patients with subfascially implanted ITB pumps.Surgeons and clinicians should use these data to better assess patient risk-benefit when considering ITB pump implantation.

Primary encephaloceles (PEs) present only rarely in the temporal region; in the rare instance that they project through the floor of the middle fossa they are secondary. In this case report the authors report on the management of a giant PE extending through the floor of the middle fossa.An 8-month-old boy presented to the authors’ service with a large PE projecting into his neck through a missing left middle fossa floor; the lesion was causing significant meta-, dys-, and hypoplasia of the structures of the anterolateral neck on that side. Surgical goals for this patient included the following: 1) removal of potentially epileptogenic and dysfunctional tissue; 2) preservation of cranial nerves; 3) prevention of cognitive decline or iatrogenic deficit; 4) prevention of CSF leak; 5) reconstruction of skull base; 6) prevention of airway and swallowing compromise; and 7) cosmesis. After a multidisciplinary evaluation with ENT, plastic surgery, and neurology, an operation was performed using a preauricular infratemporal approach when the patient was 3 years old. Gliotic tissue was resected and amygdala, hippocampus, and middle cerebral artery were preserved.The immediate results of the operation showed good immediate outcome. Seizure freedom and neurodevelopment outcomes remain to be seen at follow-up.

Temesgen Bizuayehu Wube,1 Metsihet Mohammed Nuru,2 Adane Tesfaye Anbese3 1School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; 2Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia; 3Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, EthiopiaCorrespondence: Temesgen Bizuayehu WubeSchool of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, P.O. Box:1560, Hawassa, EthiopiaTel +251 916604551Email temesgenbizuayehu2@gmail.comBackground: Recognition of MetS in type two diabetic patients is important in starting the appropriate preventive and therapeutic measures. The commonly used definitions of MetS have similarities and discrepancies. Different definitions defined metabolic syndrome differently. IDF, WHO, NCEP-ATP III, and the harmonized definitions were used frequently to determine the prevalence of metabolic syndrome.Objectives: This study was aimed to investigate the prevalence of MetS and its associated factors among patients with type 2 Diabetes Mellitus using four definitions and to identify the concordance and the difference of these four definitions.Methods: A cross-sectional study was conducted from February 28 to May 30/2017 at Hawassa university comprehensive specialized hospital. The study involved 314 study participants selected by simple random sampling technique. Logistic regression was used to determine associated factors of metabolic syndrome, and kappa statistics was used to determine the concordance between different definitions of metabolic syndrome. In any cases, a p-value of

Introduction The transcribriform and transclival corridors are endoscopic endonasal approaches used to treat pathologies of the skull base. We present a predictive model that uses the clival length and ethmoidal width to predict the size and surgical freedom (SF) of these corridors. Methods Adult facial computed tomography scans were reviewed. Exclusion criteria included patients Results A total of 103 patients were included with an average age of 44.9 years and 47% males. Females had a smaller clival surface area (8 vs. 9.2 cm2, p = 0.001). For transclival corridor, clival length correlated positively with SF in the sagittal plane (rho = 0.44, p Conclusion A significant variability of the bony anatomy of the anterior and central skull base was found. The use of clival length and ethmoidal width as part of preoperative surgical planning might help to overcome the anatomical variability which could affect the adequacy of surgical corridors.

Purpose. To determine immunological and virological failure and associated factors among children infected with human immunodeficiency virus receiving antiretroviral treatments at Hawassa University Hospital, Southern Ethiopia. Methods. A hospital-based cross-sectional study was conducted among 273 HIV-infected children from July 1 to December 1, 2019. Data were collected using a structured questionnaire and review of patient records. Blood samples for viral load and CD4 count were collected. Data were analyzed using SPSS version 20. Significance group comparison was done by the Kaplan-Meier log-rank test. The Cox proportional hazard model was used to select significant factors of the variability between groups. Results. A total of 273 children, between the age ranges of 1 to 14 years, were included. Of these, 139 (50.9%) and 134 (49.1%) were males and females, respectively. Children from the rural area were almost five times more vulnerable for virological and immunological failure than those children from the urban area ( AOR = 4.912 , (1.276-8.815), P = 0.032 ). The overall viral load suppression was 196 (71.8%) with a good adherence of 226 (82.9%). Nonsuppressed HIV viral load was found to be 77 (28.2%) which had two times more viral load copies ( AOR = 2.01 , (1.21–2.66), P = 0.001 ) when compared to those who had suppressed viral load copies. The proportions of children who had immunological nonresponse were 45.6% (21 out of 46), 30.4% (14 out of 46), and 23.9% (11 out of 46) among children with baseline CD4 of 500 cells/μl, respectively. Unimproved outcomes among females were noted for immunological and virological failure in this study ( AOR = 1.901 , (1.038-3.481), P = 0.038 ). Conclusion. In conclusion, the highly active antiretroviral treatment appeared highly effective in terms of immunological and virological long-term outcomes. However, viral suppression (71.8%) in our study was far apart from the UNAIDS target of 90% in 2020. For that reason, strengthening adherence counseling and early initiation of HAART is important.

Posterior vault distraction osteogenesis (DO) is an emerging treatment option for craniosynostosis. Operative nuances detailing surgical management are being described with increasing use and experience. In this article, we discuss the surgical management of an 8-month-old male with a ventriculoperitoneal shunt (VPS) diagnosed with bilateral lambdoid craniosynostosis and Chiari I malformation. The patient underwent successful bilateral posterior fossa DO without surgical re-implantation of the shunt. Pre- and post-operative imaging confirmed no migration of the VPS. Intracranial volume increased by 20.1% and posterior fossa volume increased by 39.9%. Our experience illustrates that posterior vault DO can be done safely in the setting of a parieto-occipital VPS, in a single operative setting, without the need of additional procedures.

Tenosynovial giant cell tumor (TGCT) is a rare entity that is not well described in the neurosurgical literature. We present a case of a 37-year-old woman with a diffuse subtype TGCT of the cervical spine, affecting the left cervical 6-7 facet joint, with co-incidental cervical trauma. Initial management consisted of subtotal resection and cervical stabilization with cervical 6 to 7 laminectomy, and cervical 4 to thoracic 2 posterior instrumented fusion. Gross total resection was achieved at a later date with a plan for postoperative radiation to prevent a recurrence. The patient was lost to follow-up for radiation treatment and returned 2.5 years later with minor symptoms and recurrence at the surgical site.

Background: Plasminogen activator inhibitor type I (PAI-1) is important for balancing the fibrinolytic effect of plasmin, and deficiency can result in increased risk of bleeding. We report a case of a patient with PAI-1 deficiency who presented with delayed spontaneous recurrence of an acute subdural hematoma (aSDH) after evacuation. Case Description: A 29-year-old male presented with altered mental status (AMS) after a fall at a construction site with Glasgow Coma Scale (GCS 4T). His coagulation profile was normal, and brain computed tomography (CT) showed a left-sided aSDH. He underwent emergent evacuation of the hematoma. On postoperative day 2, he was started on heparin for venous thromboembolism (VTE) prophylaxis. His neurological examination improved and was discharged with no focal deficits. Three days later, he presented with sudden AMS (GCS 7T); CT head showed a large hematoma at the site of original surgery. The hematoma was evacuated emergently. On readmission, the family informed providers that the patient had a history of PAI-1 deficiency. Postoperatively, only mechanical VTE prophylaxis was used and the patient was started on oral TXA per hematology recommendation. The patient improved and was discharged with no focal deficit. On follow-up, he remained neurologically stable. Conclusion: PAI-1 deficiency should be suspected in patients with delayed posttraumatic/surgical bleeding and a normal coagulation profile. If PAI-1 deficiency is evident or suspected, then a trial of antifibrinolytic agent should be used to treat and prevent recurrence of bleeding. Furthermore, chemical VTE prophylaxis should be avoided as it increases the risk for bleeding.

Background: The human immunodeficiency virus (HIV) epidemic remains a serious challenge and continues to take its roll, on vulnerable populations such as children. Hematological and immunological abnormalities are common complications in children infected with human immunodeficiency virus. They are associated with an increased risk of disease progression and death. Hence; specific diagnosis and determination of these parameters are required for monitoring of treatment to avert disease progression. Therefore, this study was aimed to determine hematological and immunological parameters among HAART-experienced children at Hawassa University comprehensive specialized Hospital. METHODS A hospital-based cross-sectional study was conducted among 273 HIV-infected children from July to December 2019. Data were collected using a structured questionnaire that included variables related to sociodemographic characteristics and clinical conditions of the study individuals. Blood samples for hematological and immunological parameters were collected and analyzed using SPSS version 20. P-Value < 0.05 considered statistically significant.RESULTSA total of 273 HAART-experienced children were enrolled. Of whom 139 (50.9%) and 134 (49.1%) were females and males respectively. The baseline means hemoglobin level of the study participants was 12mg/dl and 40.7% of children were anemic. A baseline CD4+ T-cell median percentage was 18.4% and increased to 29.2% and the mean hemoglobin level at baseline was 12 mg/dl and increased to 13.1mg/dl after treatment. The prevalence of anemia, thrombocytopenia, Leucopenia, Pancytopenia, and neutropenia was 11.4, 4%, 14.3%, 2.9%, and 18.3%, respectively. All forms of hematological abnormalities were highly prevalent in children with a CD4-cell percentage CONCLUSION:Hematologic and immunological abnormalities were common problems among children taking highly active antiretroviral therapy. Therefore, clinicians need to routinely investigate for hematological and immunological changes with appropriate therapeutic interventions for hematological and immunological abnormalities after treatment. Furthermore, large scale and longitudinal studies are recommended to strengthen and explore the problem in-depth

Glycerol rhizotomy was originally described as an initial surgical treatment for trigeminal neuralgia after the failure of medical therapy. Here we describe its use as a salvage procedure, typically after failure of multiple other modalities including microvascular decompression, stereotactic radiosurgery, and/or other percutaneous procedures. Foramen ovale cannulation as a "salvage procedure" may be complicated by lack of cerebrospinal fluid (CSF) return despite adequate cannulation of the foramen ovale, making conventional fluoroscopic confirmation of adequate needle placement less certain. In this article, we describe the application of intraoperative CT, fused with high-resolution preoperative CT/MRI for neuronavigation to accurately cannulate the foramen ovale and Meckel's cave for glycerol rhizotomy. Intraoperative CT, again fused with high-resolution preoperative CT and MRI studies, was then used to confirm accurate trajectory through the foramen ovale and the adequate location of the needle tip in Meckel's cave before injecting glycerol. We present our initial experience with 14 patients who underwent glycerol rhizotomy by these techniques depending on intraoperative CT. It appears that intraoperative CT-guided neuronavigation provides a practical, reliable, and accurate route to the foramen ovale and aids in the confirmation of adequate needle placement even when there is a lack of CSF return. These methods may be especially useful for difficult cannulations typical in salvage procedures. In an era of feasible intraoperative guidance, with advanced stereotactic planning software allowing the fusion of intraoperative CT with high-resolution preoperative CT and MRI datasets, these techniques can be applied to foramen ovale cannulation for glycerol rhizotomy without major modification.