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Menna G, Kolias A, Esene IN, Barthélemy EJ, Hoz S, Laeke T, Veiga Silva AC, Longo-Calderón GM, Baticulon RE, Zabala JP, Hassani FD, El Abbadi N, Khan MM, Robertson FC, Thango N, Cheresem B, Ogando-Rivas E, Roumy LG, Karekezi C, Alamri A, Spena G, Cenzato M, Servadei F, Giussani CG, Nicolosi F. Reducing the Gap in Neurosurgical Education in LMICs: A Report of a Non-Profit Educational Program. World Neurosurg 2024; 182:e792-e797. [PMID: 38101536 DOI: 10.1016/j.wneu.2023.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Central to neurosurgical care, neurosurgical education is particularly needed in low- and middle-income countries (LMICs), where opportunities for neurosurgical training are limited due to social and economic constraints and an inadequate workforce. The present paper aims (1) to evaluate the validity and usability of a cadaver-free hybrid system in the context of LMICs and (2) to report their learning needs and whether the courses meet those needs via a comprehensive survey. METHODS From April to November 2021, a non-profit initiative consisting of a series of innovative cadaver-free courses based on virtual and practical training was organized. This project emerged from a collaboration between the Young Neurosurgeons Forum of the World Federation of Neurological Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and UpSurgeOn, an Italian hi-tech company specialized in simulation technologies, creator of the UpSurgeOn Box, a hyper-realistic simulator of cranial approaches fused with augmented reality. Over that period, 11 cadaver-free courses were held in LMICs using remote hands-on Box simulators. RESULTS One hundred sixty-eight participants completed an online survey after course completion of the course. The anatomical accuracy of simulators was overall rated high by the participant. The simulator provided a challenging but manageable learning curve, and 86% of participants found the Box to be very intuitive to use. When asked if the sequence of mental training (app), hybrid training (Augmented Reality), and manual training (the Box) was an effective method of training to fill the gap between theoretical knowledge and practice on a real patient/cadaver, 83% of participants agreed. Overall, the hands-on activities on the simulators have been satisfactory, as well as the integration between physical and digital simulation. CONCLUSIONS This project demonstrated that a cadaver-free hybrid (virtual/hands-on) training system could potentially participate in accelerating the learning curve of neurosurgical residents, especially in the setting of limited training possibilities such as LMICs, which were only worsened during the COVID-19 pandemic.
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Affiliation(s)
- Grazia Menna
- Neurosurgery Unit, Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; NIHR Global Health Research Group on Acquired Brain and Spine Injury (ABSI), University of Cambridge, Cambridge, UK.
| | - Angelos Kolias
- Clinical Senior Lecturer and Hon. Consultant Neurosurgeon, Addenbrooke's Hospital & University of Cambridge, Cambridge, United Kingdom
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Ernest J Barthélemy
- Division of Neurosurgery, Global Neurosurgery Laboratory, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Samer Hoz
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tsegazeab Laeke
- Neurosurgery Units, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ana Cristina Veiga Silva
- Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Neurosurgery, Hospital of Restauraçao, Recife, Pernambuco, Brazil
| | | | - Ronnie E Baticulon
- Division of Neurosurgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | | | - Naija El Abbadi
- Department of Neurosurgery, International Cheikh Zaid Hospital, Abulcassis University of Health Sciences, Rabat, Morocco
| | - Muhammad Mukhtar Khan
- Specialist Neurosurgeon Northwest General Hospital & Research Centre, Peshawar, Pakistan
| | - Faith C Robertson
- Global Health & Global Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
| | - Nqobile Thango
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Beverly Cheresem
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Elizabeth Ogando-Rivas
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA; Brain Tumor Immunotherapy Program, University of Florida, Gainesville, Florida, USA
| | - Louis-Georges Roumy
- Department of Neurosurgery, Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Giannantonio Spena
- Neurosurgery Unit, Department of Neuroscience, Alessandro Manzoni Hospital, Lecco, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, Milan, Italy
| | - Franco Servadei
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Carlo Giorgio Giussani
- Department of Neurosurgery, Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Federico Nicolosi
- Department of Neurosurgery, Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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Yordanov S, Yang X, Mowforth O, K Demetriades A, Ivanov M, Vergara P, Gardner A, Pereira E, Bateman A, Alamri A, Francis J, Trivedi R, Kotter M, Davies B, Budu A. Factors Influencing Surgical Decision-Making in the Posterior Laminectomy With Fixation for Degenerative Cervical Myelopathy (POLYFIX-DCM) Trial: Survey Study. JMIR Form Res 2023; 7:e48321. [PMID: 37698903 PMCID: PMC10523224 DOI: 10.2196/48321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is estimated to affect 2% of the adult population. DCM occurs when degenerative processes cause compression and injure the spinal cord. Surgery to remove the stress caused by the compression of the spinal cord is the mainstay of treatment, with a range of techniques in use. Although various factors are described to inform the selection of these techniques, there needs to be more consensus and limited comparative evidence. OBJECTIVE The main objective of this survey was to explore the variation of practice and decision-making, with a focus on laminectomy versus laminectomy and fusion in posterior surgery of the cervical spine. We present the results of a survey conducted among the principal investigators (PIs) of the National Institute for Health and Care Research (NIHR) randomized controlled trial on posterior laminectomy with fixation for degenerative cervical myelopathy (POLYFIX-DCM). METHODS A series of 7 cases were shared with 24 PIs using SurveyMonkey. Each case consisted of a midsagittal T2-weighted magnetic resonance imaging and lateral cervical x-rays in flexion and extension. Surgeons were asked if their preferred approach was anterior or posterior. If posterior, they were asked whether they preferred to instrument and whether they had the equipoise to randomize in the NIHR POLYFIX-DCM trial. Variability in decision-making was then explored using factors reported to inform decision-making, such as alignment, location of compression, number of levels operated, presence of mobile spondylolisthesis, and patient age. RESULTS The majority of PIs (16/30, 53%) completed the survey. Overall, PIs favored a posterior approach (12/16, 75%) with instrumentation (75/112, average 66%) and would randomize (67/112, average 62%) most cases. Factors reported to inform decision-making poorly explained variability in responses in both univariate testing and with a multivariate model (R2=0.1). Only surgeon experience of more than 5 years and orthopedic specialty training background were significant predictors, both associated with an anterior approach (odds ratio [OR] 1.255; P=.02 and OR 1.344; P=.007, respectively) and fusion for posterior procedures (OR 0.628; P<.001 and OR 1.344; P<.001, respectively). Surgeon experience also significantly affected the openness to randomize, with those with more than 5 years of experience less likely to randomize (OR -0.68; P<.001). CONCLUSIONS In this representative sample of spine surgeons participating in the POLYFIX-DCM trial as investigators, there is no consensus on surgical strategy, including the role of instrumented fusion following posterior decompression. Overall, this study supports the view that there appears to be a clinical equipoise, and conceptually, a randomized controlled trial appears feasible, which sets the scene for the NIHR POLYFIX-DCM trial.
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Affiliation(s)
- Stefan Yordanov
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Xiaoyu Yang
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Oliver Mowforth
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | | | - Marcel Ivanov
- Neurosurgery Department, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Pierluigi Vergara
- Department of Spinal Surgery, East Suffolk and North Essex NHS Foundation Trust, Ipswich, United Kingdom
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Erlick Pereira
- Department of Neurosurgery, St Georges University Hospital NHS Foundation Trust, London, United Kingdom
| | - Antony Bateman
- Royal Derby Spinal Centre, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Alexander Alamri
- Department of Neurosurgery, St Georges University Hospital NHS Foundation Trust, London, United Kingdom
| | - Jibin Francis
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Rikin Trivedi
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Mark Kotter
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Benjamin Davies
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Alexandru Budu
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Alamri A, Mostofi A, Pereira EAC. Neurosurgical interventions for cancer pain. Curr Opin Support Palliat Care 2023; 17:85-89. [PMID: 37039569 DOI: 10.1097/spc.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
PURPOSE OF REVIEW Half of all cancer patients will develop cancer-related pain, and a fifth of these patients will continue to experience pain refractory to maximal pharmacological therapy. This, together with the opioid crisis, has prompted a resurgence in neurosurgical treatments. Neuromodulatory or neuroablative procedures are largely used for various nonmalignant, chronic pain conditions, but there is growing evidence to support their use in cancer pain. This review aims to cover the main neurosurgical treatments that may prove useful in the changing sphere of cancer pain treatment. RECENT FINDINGS Neuromodulation techniques for pain have largely replaced neuroablation in neurosurgical practice due to the higher risk of inadvertent permanent neurological deficits from the latter. When compared to neuroablative approaches for severe treatment-refractory cancer pain, neuromodulation is more expensive (largely due to implant cost) and requires more follow-up, with greater engagement needed from the health service, the patient and their carers. Furthermore, neuroablation has a more rapid onset of effect. SUMMARY Neuromodulation techniques for pain have largely replaced neuroablation in neurosurgical practice due to the higher risk of inadvertent permanent neurological deficits from the latter. Whilst this approach is beneficial when treating nonmalignant pain, neuromodulation in patients with pain related to advanced cancer still has a limited role. Neuroablative procedures are less expensive, require less follow-up, and can have a lower burden on health services, patients and their carers.
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Affiliation(s)
- Alexander Alamri
- Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, UK
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Alamri A, Mostofi A, Aziz T, Pereira E. Intrathecal baclofen overdose mimicking brainstem death during deep brain stimulation surgery for pain. Ann R Coll Surg Engl 2022; 104:e232-e235. [PMID: 35616338 PMCID: PMC9433185 DOI: 10.1308/rcsann.2021.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 09/03/2023] Open
Abstract
We describe a unique case of intrathecal baclofen overdose mimicking brainstem death, during bilateral anterior cingulate cortex deep brain stimulation (DBS) for pain. A 37-year-old man with chronic regional pain syndrome requiring an intrathecal baclofen pump underwent DBS under general anaesthesia and experienced an intraoperative generalised tonic-clonic seizure on dural opening. Once the operation was completed, the patient was noted to have fixed, dilated pupils bilaterally and was transferred for an emergency computed tomography scan of the head, which did not reveal any acute intracranial pathology. The patient was transferred to the intensive care unit for management of concurrent hypotension, bradycardia and supportive management of his low Glasgow Coma Scale (GCS) score. A trial of atropine to counter the bradycardia was unsuccessful. Intrathecal baclofen toxicity was suspected as a diagnosis of exclusion, necessitating urgent aspiration of the baclofen pump. The patient's GCS score improved after pump aspiration and he was discharged home several days later. It was noted that the intrathecal baclofen pump had been refilled several days previously and the patient had reported intermittent episodes of somnolence. In perioperative patients with intrathecal baclofen pumps in situ, baclofen toxicity should always be considered as a differential in perioperative complications, even if it is considered a rare event.
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Affiliation(s)
- A Alamri
- St George’s University of London, UK
| | - A Mostofi
- St George’s University of London, UK
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Mohamed M, Alamri A, Mohamed M, Khalid N, O'Halloran P, Staartjes V, Uff C. Prognosticating outcome using magnetic resonance imaging in patients with moderate to severe traumatic brain injury: a machine learning approach. Brain Inj 2022; 36:353-358. [PMID: 35129403 DOI: 10.1080/02699052.2022.2034184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Over the last decade advancements in computer processing have enabled the application of machine learning (ML) to complex medical problems. Convolutional neural networks (CNN), a type of ML, have been used to interrogate medical images for variety of purposes. In this study, we aimed to investigate the potential application of CNN in prognosticating patients with traumatic brain injury (TBI). METHODS Patients with moderate to severe TBI and evidence of diffuse axonal injury (DAI) were selected retrospectively. A CNN model was developed using a training subgroup and a holdout subgroup was used as a testing dataset. We reported the model characteristics including area under the receiver operating characteristic curve (AUC). RESULTS We included a total of 38 patient, of which we generated 725 MRI sections. We developed a CNN model based on a modified AlexNet architecture that interpreted the brain stem injury to generate outcome predictions. The model was able to predict GOS outcomes with a specificity of 0.43 and a sensitivity of 0.997. It showed an AUC of 0.917. CONCLUSION The utilization of machine learning MRI analysis for prognosticating patients with TBI is a valued method that require further investigation. This will require multicentre collaboration to generate large datasets.
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Affiliation(s)
- Moumin Mohamed
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
| | - A Alamri
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
| | - M Mohamed
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
| | - N Khalid
- Department of Neurosurgery, Royal London Hospital, London, UK
| | - Pj O'Halloran
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK.,Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Ireland
| | - Ve Staartjes
- Clinical Neuroscience Department, Machine Intelligence in Clinical Neuroscience (Micn) Laboratory, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - C Uff
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
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Usher I, Hellyer P, Lee KS, Leech R, Hampshire A, Alamri A, Chari A. "It's not rocket science" and "It's not brain surgery"-"It's a walk in the park": prospective comparative study. BMJ 2021; 375:e067883. [PMID: 34903556 PMCID: PMC8667323 DOI: 10.1136/bmj-2021-067883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare cognitive testing scores in neurosurgeons and aerospace engineers to help settle the age old argument of which phrase-"It's not brain surgery" or "It's not rocket science"-is most deserved. DESIGN International prospective comparative study. SETTING United Kingdom, Europe, the United States, and Canada. PARTICIPANTS 748 people (600 aerospace engineers and 148 neurosurgeons). After data cleaning, 401 complete datasets were included in the final analysis (329 aerospace engineers and 72 neurosurgeons). MAIN OUTCOME MEASURES Validated online test (Cognitron's Great British Intelligence Test) measuring distinct aspects of cognition, spanning planning and reasoning, working memory, attention, and emotion processing abilities. RESULTS The neurosurgeons showed significantly higher scores than the aerospace engineers in semantic problem solving (difference 0.33, 95% confidence interval 0.13 to 0.52). Aerospace engineers showed significantly higher scores in mental manipulation and attention (-0.29, -0.48 to -0.09). No difference was found between groups in domain scores for memory (-0.18, -0.40 to 0.03), spatial problem solving (-0.19, -0.39 to 0.01), problem solving speed (0.03, -0.20 to 0.25), and memory recall speed (0.12, -0.10 to 0.35). When each group's scores for the six domains were compared with those in the general population, only two differences were significant: the neurosurgeons' problem solving speed was quicker (mean z score 0.24, 95% confidence interval 0.07 to 0.41) and their memory recall speed was slower (-0.19, -0.34 to -0.04). CONCLUSIONS In situations that do not require rapid problem solving, it might be more correct to use the phrase "It's not brain surgery." It is possible that both neurosurgeons and aerospace engineers are unnecessarily placed on a pedestal and that "It's a walk in the park" or another phrase unrelated to careers might be more appropriate. Other specialties might deserve to be on that pedestal, and future work should aim to determine the most deserving profession.
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Affiliation(s)
- Inga Usher
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Cancer Institute, University College London, London, UK
- Brainbook, London, UK
| | - Peter Hellyer
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Keng Siang Lee
- Brainbook, London, UK
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Robert Leech
- Department of Neuroimaging, Kings College London, London, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Alexander Alamri
- Brainbook, London, UK
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Aswin Chari
- Brainbook, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, WC1N 3JH, UK
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
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Mohamed MAK, Alamri A, Smith B, Uff C. Applying Convolutional Neural Networks to Neuroimaging Classification Tasks: A Practical Guide in Python. Acta Neurochir Suppl 2021; 134:161-169. [PMID: 34862540 DOI: 10.1007/978-3-030-85292-4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this chapter, we describe the process of obtaining medical imaging data and its storage protocol. The authors also explain in a step-by-step approach how to extract and prepare the medical imaging data for machine learning algorithms. And finally, the process of building and assessing a convolutional neural network for medical imaging data is illustrated.
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Affiliation(s)
- Moumin A K Mohamed
- Department of Neurosurgery, Royal London Hospital, London, UK. .,The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK.
| | - Alexander Alamri
- Department of Neurosurgery, Royal London Hospital, London, UK. .,The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK.
| | - Brandon Smith
- The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
| | - Christopher Uff
- Department of Neurosurgery, Royal London Hospital, London, UK.,The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
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Newall N, Smith BG, Burton O, Chari A, Kolias AG, Hutchinson PJ, Alamri A, Uff C. Improving Neurosurgery Education Using Social Media Case-Based Discussions: A Pilot Study. World Neurosurg X 2021; 11:100103. [PMID: 33997763 PMCID: PMC8095172 DOI: 10.1016/j.wnsx.2021.100103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The increasing shift toward a more generalized medical undergraduate curriculum has led to limited exposure to subspecialties, including neurosurgery. The lack of standardized teaching may result in insufficient coverage of core learning outcomes. Social media (SoMe) in medical education are becoming an increasingly accepted and popular way for students to meet learning objectives outside formal medical school teaching. We delivered a series of case-based discussions (CbDs) over SoMe to attempt to meet core learning needs in neurosurgery and determine whether SoMe-based CbDs were an acceptable method of education. METHODS Twitter was used as a medium to host 9 CbDs pertaining to common neurosurgical conditions in practice. A sequence of informative and interactive tweets were formulated before live CbDs and tweeted in progressive order. Demographic data and participant feedback were collected. RESULTS A total of 277 participants were recorded across 9 CbDs, with 654,584 impressions generated. Feedback responses were received from 135 participants (48.7%). Participants indicated an increase of 77% in their level of knowledge after participating. Of participants, 57% (n = 77) had previous CbD experience as part of traditional medical education, with 62% (n = 84) receiving a form of medical education previously through SoMe. All participants believed that the CbDs objectives were met and would attend future sessions. Of participants, 99% (n = 134) indicated that their expectations were met. CONCLUSIONS SoMe has been shown to be a favorable and feasible medium to host live, text-based interactive CbDs. SoMe is a useful tool for teaching undergraduate neurosurgery and is easily translatable to all domains of medicine and surgery.
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Key Words
- Brainbook
- CES, Cauda equina syndrome
- CM, Cervical myelopathy
- COVID-19, Coronavirus disease 2019
- CbD, Case-based discussion
- EDH, Extradural hematoma
- GBM, Glioblastoma
- HCP, Hydrocephalus
- LMICs, Low- and middle-income countries
- Medical education
- Neurosurgery
- Public engagement
- SAH, Subarachnoid hemorrhage
- SDH, Subdural hematoma
- Science dissemination
- SoMe, Social media
- Social media
- TBI, Traumatic brain injury
- TBI-CM, Traumatic brain injury–clinical management
- TBI-P, Traumatic brain injury–pathophysiology
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Affiliation(s)
- Nicola Newall
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom
- Brainbook, London, United Kingdom
| | - Brandon G. Smith
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Brainbook, London, United Kingdom
| | - Oliver Burton
- Warwick Medical School, University of Warwick, Warwick, United Kingdom
- Brainbook, London, United Kingdom
| | - Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Brainbook, London, United Kingdom
| | - Angelos G. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Brainbook, London, United Kingdom
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Brainbook, London, United Kingdom
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- Queen Mary University of London, London, United Kingdom
- Brainbook, London, United Kingdom
| | - Chris Uff
- Department of Neurosurgery, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- Queen Mary University of London, London, United Kingdom
- Brainbook, London, United Kingdom
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Lee KS, Zhang JJY, Alamri A, Chari A. 133 Neurosurgery Education in The Medical School Curriculum: A Scoping Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Worldwide, there is no specific medical school curriculum in neurosurgery despite a high burden of neurosurgical disease that is often assessed, investigated and managed by generalists. This scoping review was carried out to map available evidence pertaining to the provision of neurosurgery education in the medical school curriculum across the world.
Method
This review was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.
Results
Ten studies were included. Six were from the United Kingdom, two from the United States, and one each from Canada and Ireland. Two studies evaluated perceptions of both medical students and practicing clinicians, five studies evaluated the perceptions of medical students and three studies reported perceptions of clinicians only. Three main themes were identified. Neurosurgery was perceived as an important part of the general medical student curriculum. Exposure to neurosurgery teaching was varied but when received, deemed useful and students were keen to receive more. Interest in a neurosurgical career amongst medical students was high.
Conclusions
There is a lack of a specialty-specific medical school curriculum and variability of medical students’ exposure to neurosurgery teaching exists. Our findings highlight the need to systematically assess specialty-specific teaching and determine adequacy.
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Affiliation(s)
- K S Lee
- Bristol Medical School, University of Bristol, Bristol, UK., Bristol, United Kingdom
| | - J J Y Zhang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Singapore, Singapore
| | - A Alamri
- Department of Neurosurgery, Royal London Hospital, Barts Health NHS Trust, London, UK., London, United Kingdom
- Barts Health Education Academy, Royal London Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom
| | - A Chari
- Great Ormond Street Institute of Child Health, University College London, London, UK, London, United Kingdom
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK, London, United Kingdom
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Ota HCU, Smith BG, Alamri A, Robertson FC, Marcus H, Hirst A, Broekman M, Hutchinson P, McCulloch P, Kolias A. The IDEAL framework in neurosurgery: a bibliometric analysis. Acta Neurochir (Wien) 2020; 162:2939-2947. [PMID: 32651707 PMCID: PMC7593304 DOI: 10.1007/s00701-020-04477-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Idea, Development, Exploration, Assessment and Long-term study (IDEAL) framework was created to provide a structured way for assessing and evaluating novel surgical techniques and devices. OBJECTIVES The aim of this paper was to investigate the utilization of the IDEAL framework within neurosurgery, and to identify factors influencing implementation. METHODS A bibliometric analysis of the 7 key IDEAL papers on Scopus, PubMed, Embase, Web of Science, and Google Scholar databases (2009-2019) was performed. A second journal-specific search then identified additional papers citing the IDEAL framework. Publications identified were screened by two independent reviewers to select neurosurgery-specific articles. RESULTS The citation search identified 1336 articles. The journal search identified another 16 articles. Following deduplication and review, 51 relevant articles remained; 14 primary papers (27%) and 37 secondary papers (73%). Of the primary papers, 5 (36%) papers applied the IDEAL framework to their research correctly; two were aligned to the pre-IDEAL stage, one to the Idea and Development stages, and two to the Exploration stage. Of the secondary papers, 21 (57%) explicitly discussed the IDEAL framework. Eighteen (86%) of these were supportive of implementing the framework, while one was not, and two were neutral. CONCLUSION The adoption of the IDEAL framework in neurosurgery has been slow, particularly for early-stage neurosurgical techniques and inventions. However, the largely positive reviews in secondary literature suggest potential for increased use that may be achieved with education and publicity.
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Affiliation(s)
| | - Brandon G Smith
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Faith C Robertson
- Department. of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hani Marcus
- The Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Allison Hirst
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
| | - Marike Broekman
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
- Department of Neurosurgery, Haaglanden Medical Center/Leiden University Medical Center, The Hague, Netherlands
| | - Peter Hutchinson
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Peter McCulloch
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
| | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK.
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK.
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Lee KS, Zhang JJ, Alamri A, Chari A. Neurosurgery Education in the Medical School Curriculum: A Scoping Review. World Neurosurg 2020; 144:e631-e642. [DOI: 10.1016/j.wneu.2020.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
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Robertson FC, Gnanakumar S, Karekezi C, Vaughan K, Garcia RM, Abou El Ela Bourquin B, Derkaoui Hassani F, Alamri A, Mentri N, Höhne J, Laeke T, Al-Jehani H, Moscote-Salazar LR, Al-Ahmari AN, Samprón N, Stienen MN, Nicolosi F, Fontoura Solla DJ, Adelson PD, Servadei F, Al-Habib A, Esene I, Kolias AG. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part II): Barriers to Professional Development and Service Delivery in Neurosurgery. World Neurosurg X 2020; 8:100084. [PMID: 33103110 PMCID: PMC7573643 DOI: 10.1016/j.wnsx.2020.100084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strengthening health systems requires attention to workforce, training needs, and barriers to service delivery. The World Federation of Neurosurgical Societies Young Neurosurgeons Committee survey sought to identify challenges for residents, fellows, and consultants within 10 years of training. METHODS An online survey was distributed to various neurosurgical societies, personal contacts, and social media platforms (April-November 2018). Responses were grouped by World Bank income classification into high-income countries (HICs), upper middle-income countries (UMICs), low-middle-income countries (LMICs), and low-income countries (LICs). Descriptive statistical analysis was performed. RESULTS In total, 953 individuals completed the survey. For service delivery, the limited number of trained neurosurgeons was seen as a barrier for 12.5%, 29.8%, 69.2%, and 23.9% of respondents from HICs, UMICs, LMICs, and LICs, respectively (P < 0.0001). The most reported personal challenge was the lack of opportunities for research (HICs, 34.6%; UMICs, 57.5%; LMICs, 61.6%; and LICs, 61.5%; P = 0.03). Other differences by income class included limited access to advice from experienced/senior colleagues (P < 0.001), neurosurgical journals (P < 0.0001), and textbooks (P = 0.02). Assessing how the World Federation of Neurosurgical Societies could best help young neurosurgeons, the most frequent requests (n = 953; 1673 requests) were research (n = 384), education (n = 296), and subspecialty/fellowship training (n = 232). Skills courses and access to cadaver dissection laboratories were also heavily requested. CONCLUSIONS Young neurosurgeons perceived that additional neurosurgeons are needed globally, especially in LICs and LMICs, and primarily requested additional resources for research and subspecialty training.
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Affiliation(s)
- Faith C. Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sujit Gnanakumar
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Claire Karekezi
- Department of Neurosurgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Kerry Vaughan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanna M. Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Bilal Abou El Ela Bourquin
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Nesrine Mentri
- Department of Neurosurgery, Bejaia University Hospital, Bejaia, Algeria
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Tsegazeab Laeke
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Department of Surgery, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Hosam Al-Jehani
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Al-Khobar, Saudi Arabia
- Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | | | - Ahmed Nasser Al-Ahmari
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - Martin N. Stienen
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Federico Nicolosi
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | | | - P. David Adelson
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ignatius Esene
- Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon
| | - Angelos G. Kolias
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke’s Hospital, Cambridge, United Kingdom
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Gnanakumar S, Abou El Ela Bourquin B, Robertson FC, Solla DJF, Karekezi C, Vaughan K, Garcia RM, Hassani FD, Alamri A, Höhne J, Mentri N, Stienen M, Laeke T, Moscote-Salazar LR, Al-Ahmari AN, Al-Jehani H, Nicolosi F, Samprón N, Adelson PD, Servadei F, Esene IN, Al-Habib A, Kolias AG. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part I): Demographics, Resources, and Education. World Neurosurg X 2020; 8:100083. [PMID: 33103109 PMCID: PMC7573644 DOI: 10.1016/j.wnsx.2020.100083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Providing a comprehensive and effective neurosurgical service requires adequate numbers of well-trained, resourced, and motivated neurosurgeons. The survey aims to better understand 1) the demographics of young neurosurgeons worldwide; 2) the challenges in training and resources that they face; 3) perceived barriers; and 4) needs for development. METHODS This was a cross-sectional study in which a widely disseminated online survey (April 2018-November 2019) was used to procure a nonprobabilistic sample from current neurosurgical trainees and those within 10 years of training. Data were grouped by World Bank income classifications and analyzed using χ2 tests because of its categorical nature. RESULTS There were 1294 respondents, with 953 completed responses included in the analysis. Of respondents, 45.2% were from high-income countries (HICs), 23.2% from upper-middle-income countries, 26.8% lower-middle-income countries, and 4.1% from low-income countries. Most respondents (79.8%) were male, a figure more pronounced in lower-income groups. Neuro-oncology was the most popular in HICs and spinal surgery in all other groups. Although access to computed tomography scanning was near universal (98.64%), magnetic resonance imaging access decreased to 66.67% in low-income countries, compared with 98.61% in HICs. Similar patterns were noted with access to operating microscopes, image guidance systems, and high-speed drills. Of respondents, 71.4% had dedicated time for neurosurgical education. CONCLUSIONS These data confirm and quantify disparities in the equipment and training opportunities among young neurosurgeons practicing in different income groups. We hope that this study will act as a guide to further understand these differences and target resources to remedy them.
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Affiliation(s)
- Sujit Gnanakumar
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Bilal Abou El Ela Bourquin
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Faith C. Robertson
- Department. of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Claire Karekezi
- Department of Neurosurgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Kerry Vaughan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanna M. Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Nesrine Mentri
- Department of Neurosurgery, Bejaia University Hospital, Bejaia, Algeria
| | - Martin Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Tsegazeab Laeke
- Department of Surgery, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | | | - Ahmed Nasser Al-Ahmari
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hosam Al-Jehani
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi Arabia
- Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Federico Nicolosi
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - P. David Adelson
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Ignatius N. Esene
- Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Angelos G. Kolias
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
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de Jesus VC, Shikder R, Oryniak D, Mann K, Alamri A, Mittermuller B, Duan K, Hu P, Schroth RJ, Chelikani P. Sex-Based Diverse Plaque Microbiota in Children with Severe Caries. J Dent Res 2020; 99:703-712. [PMID: 32109360 DOI: 10.1177/0022034520908595] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Severe early childhood caries (S-ECC) is a multifactorial disease that can lead to suffering and reduced oral health-related quality of life in young children. The bacterial and fungal composition of dental plaque and how children's sex is associated with S-ECC are largely unknown. In this study, V4-16S rRNA and ITS1 rRNA gene amplicon sequencing was used to compare the plaque bacteriome and mycobiome of children <72 mo of age: 40 with S-ECC (15 males, 25 females) and 40 caries-free (19 males, 21 females). Health- and nutrition-related questionnaire data were also investigated. This study aimed to analyze potential sex-based differences in the supragingival plaque microbiota of young children with S-ECC and those caries-free. Behavioral and nutritional habit differences were observed between children with S-ECC and those caries-free and between male and female children. Overall, higher levels of Veillonella dispar, Streptococcus mutans, and other bacterial species were found in the S-ECC group as compared with caries-free controls (P < 0.05). A significant difference in the abundance of Neisseria was observed between males and females with S-ECC (P < .05). Fungal taxonomic analysis showed significantly higher levels of Candida dubliniensis in the plaque of children with S-ECC as compared with those caries-free (P < 0.05), but no differences were observed with Candida albicans (P > 0.05). Significant differences in the relative abundance of Mycosphaerella, Cyberlindnera, and Trichosporon fungal species were also observed between the caries-free and S-ECC groups (P < 0.05). Machine learning analysis revealed the most important bacterial and fungal species for classifying S-ECC versus caries-free. Different patterns of crosstalk between microbial species were observed between male and female children. Our work demonstrates that plaque microbiota and sex may be important determinants for S-ECC and could be factors to consider for inclusion in caries risk assessment tools.
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Affiliation(s)
- V C de Jesus
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - R Shikder
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Computer Science, Faculty of Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - D Oryniak
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - K Mann
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - A Alamri
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - B Mittermuller
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - K Duan
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - P Hu
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Computer Science, Faculty of Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - R J Schroth
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - P Chelikani
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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15
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Oesman C, Alamri A, Khalil S, Wareing M, Saeed S, Bradford R, Paraskevopoulos D. P41 Endoscopy in cerebellopontine angle lesions: feasibility and technical considerations. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesTo define selection criteria and describe technique nuances for the use of endoscopy in surgery for cerebello-pontine angle (CPA) lesions.DesignProspective observational study.SubjectsPatients undergoing CPA lesion resection were selected for endoscope-assisted and/or endoscope-guided lesion resection.MethodsCPA interventions without mass lesions were excluded. 10 CPA lesions were identified pre-operatively for intra-operative endoscopic use across two neurosurgical centres. We describe equipment and technique selection.Results10 cases were selected over a one year period. Histology revealed 3 vestibular schwannomas (VS) (30%), 1 cyst (10%), 3 epidermoids (30%), 3 meningiomata (30%). Three cases were planned and carried out fully endoscopically (including two VS and the cyst) based on patient factors and favourable anatomy. Four cases were carried out with endoscopic assistance. The endoscope was used in three cases for anatomical orientation ‘around the corner’ only. Techniques and equipment vary depending on surgical aims, surgical anatomy and working area. Tips and pitfalls are identified and described.ConclusionsEndoscopy can be applied safely in CPA pathologies, as an alternative to the operating microscope for highly selected cases, or as an adjunct for specific surgical steps, especially when microscope optics do not allow angled visualisation. It is particularly useful in identifying lesion residuum and ‘working around the corner’. High level training is required before applying endoscopy to the CPA.
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16
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Graham J, Gingerich J, Lambert P, Alamri A, Czaykowski P. Baseline Edmonton Symptom Assessment System and survival in metastatic renal cell carcinoma. ACTA ACUST UNITED AC 2018; 25:e319-e323. [PMID: 30111978 DOI: 10.3747/co.25.3935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Baseline symptom burden as measured using the Edmonton Symptom Assessment System (esas), a patient-reported, validated, and reliable tool measuring symptom severity in 9 separate domains, might yield prognostic information in patients receiving treatment for metastatic renal cell carcinoma (mrcc) and might add to the existing prognostic models. Methods In this retrospective single-centre cohort study, we included patients receiving first-line sunitinib therapy for mrcc between 2008 and 2012. Baseline variables included information relevant to the pre-existing prognostic models and pre-treatment esas summation scores (added together across all 9 domains), with higher scores representing greater symptom burden. We used Kaplan-Meier curves and Cox regression modelling to determine if symptom burden can provide prognostic information with respect to overall survival. Results We identified 68 patients receiving first-line therapy for mrcc. Most had intermediate- or poor-risk disease based on both the Memorial Sloan Kettering Cancer Center (mskcc) and the International Metastatic Renal Cell Carcinoma Database Consortium (imdc) models. The median baseline esas summation score was 16 (range: 6-57). In univariable analysis, the hazard ratio for overall survival was 1.270 (p = 0.0047) per 10-unit increase in summation esas. In multivariable analysis, the hazard ratio was 1.208 (p = 0.0362) when controlling for mskcc risk group and 1.240 (p = 0.019) when controlling for imdc risk group. Conclusions Baseline symptom burden as measured by esas score appears to provide prognostic information for survival in patients with mrcc. Those results should encourage the investigation of patient-reported symptom scales as potential prognostic indicators for patients with advanced cancer.
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Affiliation(s)
- J Graham
- University of Manitoba and.,CancerCare Manitoba, Winnipeg, MB
| | - J Gingerich
- University of Manitoba and.,CancerCare Manitoba, Winnipeg, MB
| | | | - A Alamri
- Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - P Czaykowski
- University of Manitoba and.,CancerCare Manitoba, Winnipeg, MB
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McKenna G, Alamri A, Whitfield P. Perceptions of Study Leave amongst Neurosurgical Trainees. MedEdPublish 2018. [DOI: 10.15694/mep.2018.0000118.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was not marked as recommended. BackgroundThere is a paucity of studies in medical education literature addressing the educational value of study leave to doctors in training. The aims of this study were to establish the utilisation of study leave by neurosurgical trainees, to explore the perceived benefits and barriers to taking study leave, and to evaluate to what extent trainees support a more standardised approach to study leave allocation.MethodsIndividual interviews were conducted with 10 neurosurgical trainees, selected from each stage of training - Early (ST1-3), Intermediate (ST4-6) and Final (ST7-8). Qualitative data were coded and an inductive approach was used for thematic analysis.ResultsNeurosurgical trainees at all stages of training perceive study leave offers a wealth of opportunities for learning and professional development. However, there is a striking mismatch between the utility of study leave and the practical uptake, which is partly due to the reported opportunity cost of sacrificing clinical training.There was consensus that combining standardised courses with flexible opportunities for trainees to pursue individual interests and educational needs could enhance the potential educational value of study leave.ConclusionsThe findings demonstrate the critical value of study leave and support the role of standardised national training programme "boot camps", mapped to the curriculum. These can deliver knowledge and technical skills using high fidelity simulation models, thereby increasing educational yield from study leave.
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Alamri A, Hever P, Cheserem J, Gradil C, Bassi S, Tolias CM. Encephaloduroateriosynangiosis (EDAS) in the management of Moyamoya syndrome in children with sickle cell disease. Br J Neurosurg 2017; 33:161-164. [PMID: 28616936 DOI: 10.1080/02688697.2017.1339227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Encephalo-duro-arterio-synangiosis (EDAS) in Moyamoya syndrome (MMS) treatment has been well described in the literature, however in MMS caused by sickle cell anaemia (SCA), EDAS use remains controversial with poor long-term follow-up. We present a case-series of SCA patients who have undergone EDAS for SCA-related MMS and describe their post-operative course as well as provide a literature review of the role of EDAS in the treatment of sickle cell anaemia. METHODS A retrospective review of all the paediatric EDAS procedures conducted in our institution for SCA from 2007 to 2015. Two patients underwent behavioural screening. RESULTS A total of eight patients with MMS secondary to SCA underwent EDAS. Unilateral EDAS was performed without complication in seven patients. One patient underwent bilateral EDAS but with a two-year gap in between procedures. Follow-up magnetic resonance angiography demonstrated no progression of Moyamoya collaterals or further ischaemic events with regression of collaterals clearly visible in one patient. All patients have demonstrated a return to normal school activities. CONCLUSIONS EDAS is a well-tolerated revascularisation procedure for children with MMS. The prevention of further infarcts in our group with sickle cell disease has allowed these children to resume normal school activities.
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Affiliation(s)
- Alexander Alamri
- a Department of Neurosurgery , King's College Hospital , London , UK
| | - Pennylouise Hever
- a Department of Neurosurgery , King's College Hospital , London , UK
| | - Jebet Cheserem
- a Department of Neurosurgery , King's College Hospital , London , UK
| | - Catia Gradil
- a Department of Neurosurgery , King's College Hospital , London , UK
| | - Sanj Bassi
- a Department of Neurosurgery , King's College Hospital , London , UK
| | - Christos M Tolias
- a Department of Neurosurgery , King's College Hospital , London , UK
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AlQahtani A, Alshaikh N, Alzarei A, Musleh A, Alamri A, Alqahtani A, Alfawwaz F, Alshammari F, Aloulah M, Marglani O, Alsaleh S, Alandejani T, Mokarbesh H. Contralateral sinus involvement of surgically treated unilateral allergic fungal rhinosinusitis. Eur Arch Otorhinolaryngol 2017; 274:3097-3101. [PMID: 28501959 DOI: 10.1007/s00405-017-4604-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
Recurrence of allergic fungal rhinosinusitis (AFRS) is well recognized. However, there is scarcity in the literature describing involvement of the non-diseased sinuses. We aimed to evaluate the recurrence forms of unilateral AFRS as well as to study the possible predictor factors of developing the disease in the contralateral side. Patients with exclusive unilateral AFRS from (2010 to 2015) were enrolled in multi-institutional case-control study. All patients were evaluated after endoscopic sinus surgery for recurrence. Patient's records were reviewed for demographics, medical treatment, and clinical, radiological, and surgical data. A total of 68 patients were identified. Delayed contralateral involvement after the initial surgery was found in 30.8% with mean duration of recurrence 16.9 months. A significant association was found with the presence of pre-operative contralateral symptoms and signs of inflammation (OR 3.49, 95% CI 1.19-10.22, p value 0.02). Post-operative use of budesonide irrigation was associated with less contralateral involvement (OR 0.11, 95% CI 0.01-0.87, p value 0.01). Association of other variables like: comorbidities, perioperative use of systemic steroid, radiological signs, extent of surgery, additional surgery to the contralateral side, and post-operative use of systemic steroids did not show statistical significance. Involvement of the contralateral sinuses in 30% of unilateral AFRS cases is considered significant. The non-diseased sinuses should be involved in the routine endoscopic examination and post-operative treatment. Further studies are necessary to investigate the possibility of prophylactic surgical intervention of the non-diseased sinuses.
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Affiliation(s)
- Abdulaziz AlQahtani
- Department of Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - N Alshaikh
- Department of Otolaryngology Head and Neck Surgery, Dammam Medical Complex, Dammam, Saudi Arabia
| | - A Alzarei
- Department of Otolaryngology Head and Neck Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - A Musleh
- Department of Otolaryngology Head and Neck Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - A Alamri
- Department of Otolaryngology Head and Neck Surgery, King Salman Hospital, Riyadh, Saudi Arabia
| | - A Alqahtani
- Department of Otolaryngology Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushite, Saudi Arabia
| | - F Alfawwaz
- Department of Otolaryngology Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - F Alshammari
- Department of Otolaryngology Head and Neck Surgery, King Khalid Hospital, Hail, Saudi Arabia
| | - M Aloulah
- Department of Otolaryngology Head and Neck Surgery, King Saud University Medical City, King Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - O Marglani
- Department of Otolaryngology Head and Neck Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - S Alsaleh
- Department of Otolaryngology Head and Neck Surgery, King Saud University Medical City, King Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - T Alandejani
- Department of Otolaryngology Head and Neck Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - H Mokarbesh
- Department of Otolaryngology Head and Neck Surgery, Prince Mohammed bin Naser Hospital, Jazan, Saudi Arabia
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Ashkan K, Alamri A, Ughratdar I. Anti-Coagulation and Deep Brain Stimulation: Never the Twain Shall Meet? Stereotact Funct Neurosurg 2015; 93:373-7. [DOI: 10.1159/000441232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 09/22/2015] [Indexed: 11/19/2022]
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Abstract
Moyamoya disease (MMD) is a chronic cerebrovascular disease involving progressive bilateral stenosis of the intracranial segments of the internal carotid arteries. It results in the development of a rich, but friable collateral supply, prone to rupture. The disease is well described in Japanese literature and was originally thought to be a predozminantly Eastern disease. However, the recent literature describes a Western phenotype that may present with a different clinical course. This review aims to describe the variations in the epidemiology of the MMD between Eastern and Western populations, the possible reasons for them and highlight their implications for clinical practise and future research.
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Affiliation(s)
| | - Alexander Alamri
- b Department of Neurosurgery , King's College Hospital , London , UK
| | - Christos Tolias
- b Department of Neurosurgery , King's College Hospital , London , UK
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Alamri A, Lee J, Aldekhayel S, Shaw K, Zadeh T. Is laparoscopic surgery safe after total abdominal wall reconstruction? Journal of Pediatric Surgery Case Reports 2015. [DOI: 10.1016/j.epsc.2015.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Alamri A, Ughratdar I, Samuel M, Ashkan K. Deep brain stimulation of the subthalamic nucleus in Parkinson's disease 2003–2013: Where are we another 10 years on? Br J Neurosurg 2015; 29:319-28. [DOI: 10.3109/02688697.2014.997669] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Bazzi MD, Nasr FA, Alanazi MS, Alamri A, Turjoman AA, Moustafa AS, Alfadda AA, Pathan AAK, Parine NR. Association between FTO, MC4R, SLC30A8, and KCNQ1 gene variants and type 2 diabetes in Saudi population. Genet Mol Res 2014; 13:10194-203. [PMID: 25501231 DOI: 10.4238/2014.december.4.14] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Recent genome wide association studies identified many loci in several genes that have been consistently associated with type 2 diabetes mellitus in various ethnic populations. Among the genes that were most strongly associated with diabetes were fat mass- and obesity-associated, melanocortin 4 receptor, solute carrier family 30 member 8 (SLC30A8), and a member of the potassium voltage-gated channels. In the present study, we examined the association between variants in fat mass- and obesity-associated [rs9939609 (A/T)], melanocortin 4 receptor [rs17782313 (C/T), and rs12970134 (A/G)], SLC30A8 [rs13266634 (C/T)], and a member of the potassium voltage-gated channels [rs2237892(C/T)] genes in diabetes patients from Saudi Arabia. Genotypes were determined using the TaqMan single-nucleotide polymorphism genotype analysis technique. Minor allele frequency of the 4 variants tested was comparable between type 2 diabetes cases and controls. We observed an association between allele variants of SLC30A8 [rs13266634 (C/T)] and type 2-diabetes (P = 0.04). The other single-nucleotide polymorphisms examined in this study showed moderate or no correlation with diabetes in Saudis. Our data indicate that the SLC30A8 polymorphisms are associated with type 2 diabetes in the Saudi population. There is no evidence supporting an association between variants in the fat mass- and obesity-associated and melanocortin 4 receptor, and a member of the potassium voltage-gated channels genes and type 2 diabetes in the Saudi population.
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Affiliation(s)
- M D Bazzi
- Genome Research Chair, Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - F A Nasr
- Genome Research Chair, Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - M S Alanazi
- Genome Research Chair, Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - A Alamri
- Genome Research Chair, Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - A A Turjoman
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia
| | - A S Moustafa
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia
| | - A A Alfadda
- Obesity Research Center, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A A K Pathan
- Genome Research Chair, Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - N R Parine
- Genome Research Chair, Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
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Alamri A, Semlali A, Jacques É, Alanazi M, Zakrzewski A, Chmielewski W, Rouabhia M. Long-term exposure of human gingival fibroblasts to cigarette smoke condensate reduces cell growth by modulating Bax, caspase-3 and p53 expression. J Periodontal Res 2014; 50:423-33. [DOI: 10.1111/jre.12223] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 01/12/2023]
Affiliation(s)
- A. Alamri
- Oral Ecology Research Group; Faculty of Dentistry; Laval University; Quebec QC Canada
- Genome Research Chair; Department of Biochemistry; College of Science, King Saud University; Riyadh Saudi Arabia
| | - A. Semlali
- Oral Ecology Research Group; Faculty of Dentistry; Laval University; Quebec QC Canada
- Genome Research Chair; Department of Biochemistry; College of Science, King Saud University; Riyadh Saudi Arabia
| | - É. Jacques
- Oral Ecology Research Group; Faculty of Dentistry; Laval University; Quebec QC Canada
| | - M. Alanazi
- Genome Research Chair; Department of Biochemistry; College of Science, King Saud University; Riyadh Saudi Arabia
| | - A. Zakrzewski
- Oral Ecology Research Group; Faculty of Dentistry; Laval University; Quebec QC Canada
| | - W. Chmielewski
- Oral Ecology Research Group; Faculty of Dentistry; Laval University; Quebec QC Canada
| | - M. Rouabhia
- Oral Ecology Research Group; Faculty of Dentistry; Laval University; Quebec QC Canada
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Venugopal N, McCurdy B, Hovdebo J, Al Mehairi S, Alamri A, Sandhu GS, Sivalingam S, Drachenberg D, Ryner L. Automatic conformal prescription of very selective saturation bands for in vivo 1H-MRSI of the prostate. NMR Biomed 2012; 25:643-653. [PMID: 22162346 DOI: 10.1002/nbm.1780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 07/11/2011] [Accepted: 07/13/2011] [Indexed: 05/31/2023]
Abstract
An important step in the implementation of three-dimensional in vivo proton magnetic resonance spectroscopic imaging ((1)H-MRSI) of the prostate is the placement of spatial saturation pulses around the region of interest (ROI) for the removal of unwanted contaminating signals from peripheral tissue. The present study demonstrates the use of a technique called conformal voxel magnetic resonance spectroscopy (CV-MRS). This method automates the placement, orientation, timing and flip angle of very selective saturation (VSS) pulses around an irregularly-shaped, user-defined ROI. The method employs a user adjustable number of automatically positioned VSS pulses (20 used in the present study) which null the signal from periprostatic lipids while closely conforming the shape of the excitation voxel to the shape of the prostate. A standard endorectal coil in combination with a torso-phased array coil was used for all in vivo prostate studies. Three-dimensional in vivo prostate (1)H-MRSI data were obtained using the proposed semi-automated CV-MRS technique, and compared with a standard point resolved spectroscopy (PRESS) technique at TE = 130 ms using manual placement of saturation pulses. The in vivo prostate (1)H-MRSI data collected from 12 healthy subjects using the CV-MRS method showed significantly reduced lipid contamination throughout the prostate, and reduced baseline distortions. On average there was a 50 ± 17% (range 12% - 68%) reduction in lipids throughout the prostate. A voxel-by-voxel benchmark test of over 850 voxels showed that there were 63% more peaks fitted using the LCModel when using a Cramer-Rao Lower Bound (CRLB) cut-off of 40% when using the optimized conformal voxel technique in comparison to the manual placement approach. The evaluation of this CV-MRS technique has demonstrated the potential for easy automation of the graphical prescription of saturation bands for use in (1)H-MRSI.
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Affiliation(s)
- N Venugopal
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada.
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Alamri A, Saeed H, Kumar A, Crocker M, Bell BA. The true value of C-reactive protein measurement in neurosurgical patients. Br J Neurosurg 2011; 25:540-1. [DOI: 10.3109/02688697.2011.584640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Sir Victor Horsley is well known for his pioneering work as a neurological surgeon but his vital contributions to the regulation and advancement of the medical profession are less well understood. This archived literature review of The Horsley collection of papers (UCL Special Collections Library) documents Sir Victor's campaign for the autonomy of the stagnating medical profession of over a century ago. These lessons should empower modern clinicians to retain the professionalism they worry about losing.
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Affiliation(s)
- Alexander Alamri
- Academic Neurosurgery Unit, St George's University of London, London, UK.
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Apok V, Ghosh K, Alamri A. POS02 Moyamoya disease: a UK single centre experience. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Apok V, Alamri A, Qureshi A, Donaldson-Hugh B. POI02 Fulminant cerebellitis related to H1N1: a first case report. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- A Baez-Giangreco
- Advanced Laboratory, Riyadh Medical Complex, Riyadh, Saudi Arabia
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Soyannwo MA, Kurashi NY, Gadallah M, Hams J, el-Essawi O, Khan NA, Singh RG, Alamri A, Beyari TH. Body mass index (BMI) in the Saudi population of Gassim. Afr J Med Med Sci 1998; 27:117-21. [PMID: 10456143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
In a total cross-sectional population survey of the Faizia East Primary Health District of Buraidah, Gassim region of Saudi Arabia, 6,044 (2727 male and 3317 females) subjects out of a de facto population of 7695 got their BMI computed because infants and restless or bedridden subjects could not be examined. Mean (+/- SD) and percentiles (25th & 75th) were calculated in the conventional 5-year age cohorts as well as in functional age groups, namely, 0-5, 6-12, 13-49, 50-69 and 70+ years. 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were computed only for the functional age groups. In general, the trend was for BMI to increase with age in both genders but the curve pattern showed some plateauing from about the age of 50 with slight decline in later life. Females had significantly higher indices than males, this becoming quite prominent from the 10-14 year age cohort. This difference persisted irrespective of the types of age grouping or residential location. Overall means (+/- SD) were 20.14 +/- 5.98 vs 22.22 +/- 7.21 for males and females respectively; df: 5771; p = 0.0000; 95% CI: -2.43, -1.735. Subjects in the urban living environment had significant higher indices than their rural counterpart: (21.666.92 vs 20.446.33: df: 5771; P = 0.0000; 95% CI: 1.595, -0.840). From the age of 15 about one quarter of females are overweight (BMI at the 75th percentile > 25) and from 30 years the same proportion are frankly obese (BMI > 30). Both systolic and diastolic blood pressure were significantly positively correlated with BMI in both genders: male SBP: r = 0.22, P < 0.0001; male DBP: r = 0.21, P < 0.00001; female DBP: r = 0.18, P < 0.00001.
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Affiliation(s)
- M A Soyannwo
- Nephrology Unit, King Fahd Specialist Hospital (KFSH), Buraidah, Gassim, Saudi Arabia
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Soyannwo MA, Gadallah M, Hams J, Kurashi NY, el-Essawi O, Khan NA, Singh RG, Alamri A, Beyari TH. Studies of preventive nephrology: self-urinalysis as a feasible method for early detection of renal damage. Afr J Med Med Sci 1998; 27:27-34. [PMID: 10456125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The ever expanding pool of ESRF patients is exerting considerable strain on the health care resources of all nations of the world. Rationing, in one form or the other has therefore become the norm for most countries. Because dialysis prolongs life and is more readily available, and because ethically acceptable donor kidneys remain in short supply, thus limiting the potential of renal transplantation, this rather exasperating situation is bound to continue unless the entry point into the pool can be actively tacked. As part of our initial effort in this direction, we have examined the feasibility of self urinalysis by the general population as an epidemiological tool for detecting evidence of early renal damage by a total population cross-sectional survey of Faizia East Primary Health District (FEPHD) of Buraidah, capital city of the Gassim region of Saudi Arabia. Out of a de facto population of 7,695, 75.37% (5,800) cooperated fully. Majority of those who could not cooperate (881 [11.44%]) were infants and children. A total of 969 subjects (12.59%), mostly males at work, were not available. Only 45 (0.58%) subjects refused to participate. Housewives were significantly more amenable to the organisation of family self-urinalysis than head of the family (92.2% vs 61.4%; chi square = 321.78; df: 3; P < 0.0001). The mean family size was 7.82 (+/- SD: 3.82). Above the age of 4 years, 66.5% of males (2108/3170) as against 81.7% of females (2,641/3232) were able to carry our self-urinalysis. 11.76% of boys and 8.5% of girls below the age of 5 years were able to carry out self-urinalysis. Only 0.05% of male subjects and 0.03% of females failed to interpret colour change for proteinuria correctly. Similar remarkable competence was demonstrated for glycosuria by the population. We conclude that self-urinalysis is quite feasible in the general population, even if illiterates, if young. It can form a sound foundation, if properly harnessed, for a renal registry.
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Affiliation(s)
- M A Soyannwo
- Nephrology Unit, King Fahd Specialist Hospital (KFSH), Buraidah, Gassim, Saudi Arabia
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Soyannwo MA, Gadallah M, Hams J, Kurashi NY, el-Essawi O, Khan NA, Singh RG, Alamri A, Beyari TH. Some aspects of the pattern of systemic hypertension in the adult population of Gassim, Saudi Arabia: age distribution of the subsets of hypertensives. Afr J Med Med Sci 1998; 27:17-21. [PMID: 10456123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
As part of our studies in prevent nephrology, we have recorded causal blood pressure during a total population cross-sectional survey of the Faizia East Primary Health District of Buraidah (FEPHD), capital of Gassim region of Saudi Arabia. Out of 5671 subjects whose blood pressure could be recorded, 2222 were above 19 years of age and constituted our adult population. For this report, hypertension have been defined as equal to and greater than 140/90 mm Hg. Total hypertensive population had been divided into three subsets, based on this basic definition, namely combined systolic and diastlic hypertension (S/DHPN), isolated systolic hypertension (ISHPN) and isolated diastolic hypertension (IDHPN), a format which is not generally clear in previous studies on the subject. The overall prevalence of systemic hypertension was found to be 23.58%, which is lower than the figure of 36% for USA (pre-primary prevention intensive campaign). It is assumed that all the three subsets mentioned above have been used in calculating the latter. Although males tended to be more hypertensive than females (OR = 1.22; Chi Square = 3.89; P = 0.05; C.I.: 1.00 < OR < 1.49), the marginal difference (25.7% vs 22.10%) was largely due to the IDHPN subset (OR = 1.73; Chi Square = 4.48; P = 0.034; C.I.: 1.01 < OR < 2.96). In both the S/DHPN and ISHPN: statistical significance was not achieved. Significantly, ISHPN subset constituted the bulk--56.68%--of the hypertensive population while IDHPN constituted the least--11.64%. When analysed into 10-year-age cohorts, ISHPN showed the steepest rise in prevalence with age. Rather suprisingly, the IDHPN did not rise with advancing age while the S/DHPN slope was in between the two. We are unable to identify this pattern in our literature search on the subject. We cannot assess its significance by this study, but we wonder whether or not it carries any prognostic significance in terms of target organ damage. It is possible that this pattern may be peculiar to the sub-region but it certainly is not spurious and in our view deserves further scrutiny. We wish to suggest that clear definition of the three subsets of hypertensive population should be mandatory when defining prevalence. This may provide some further clues in the prognosis and pathogenesis of target organ damage.
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Affiliation(s)
- M A Soyannwo
- Nephrology Unit, King Fahd Specialist Hospital (KFSH), Buraidah, Gassim, Saudi Arabia
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Soyannwo MA, Kurashi NY, Gadallah M, Hams J, el-Essawi O, Khan NA, Singh RG, Alamri A, Beyari TH. Blood pressure pattern in Saudi population of Gassim. Afr J Med Med Sci 1998; 27:107-16. [PMID: 10456142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Blood pressure pattern for the Kingdom of Saudi Arabia has not been defined. In a total cross-sectional population survey of the Faizia East Primary Health District of Buraidah, capital of Gassim region, Saudi Arabia, 5671 subjects out of a de facto population of 7695 got their blood pressure recorded. The study district consisted of an urban section and a rural sector. Mean systolic and diastolic blood pressure were computed for the total population in conventional 5-year age cohorts as well as in an arbitrary functional age groups. The curve pattern and trends of the percentiles, were defined. Mean blood pressure (systolic and diastolic) was found to rise with age in both genders (male SBP: r = 0.66, P < 0.000001: female SBP: r = 0.58, P < 0.00001; male DBP: r = 0.53, P < 0.00001; female DBP: r = 0.45, P < 0.00001) and to correlate significantly with BMI. Both systolic and diastolic values were consistently higher in females than males. Overall means (+/- SD) were: for SBP, male 109.9 (+/- 21.57) vs female 114.33 (+/- 21.22) mm Hg; df: 5669: P < 0.00000; CI: -5.5, -2.0; for DBP, male 62.85 (+/- 16.89) vs female 64.67 (+/- 14.99) mm Hg; df: 5669; P < 0.0000; CI: -2.65, -0.989. Proteinuria (macroalbuminuria) was found to correlate positively and very significantly with both systolic and diastolic blood pressure: for SBP: r = 0.074, P < 0.0001; DBP: r = 0.055, P < 0.0001. Perhaps more significantly, in the context of preventive nephrology, is the observation that the intercept of the regression line with blood pressure was below the level conventionally regarded as hypertensive, suggesting that nephron damage may have occurred at this lower level. Overall mean diastolic blood pressure but not systolic was found to be significantly higher in the rural environment than the urban setting: mean rural DBP: 66.43 (+/- 15.699) vs urban: 62.78 (+/- 78); P < 0.00001; rural SBP: 113.71 (+/- 23.95) vs urban: 112.69 (+/- 19.87), P = NS. No discernible effect of consanguinity in marriage on blood pressure could be detected in this study but we believe that further details are required before a definite statement can be made on this important subject. The percentiles presented can only be regarded as foundation figures requiring further validation before they can be useful in determining cut-off levels for hypertension for the Saudi population.
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Affiliation(s)
- M A Soyannwo
- Nephrology Unit, King Fahd Specialist Hospital (KFSH), Buraidah, Gassim, Saudi Arabia
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Soyannwo MA, Gadallah M, Hams J, Kurashi NY, Khan NA, Singh RG, Alamri A, Beyari TH. Contrasting influence of the living environment and gender on systemic hypertension in Saudi population of Gassim, Saudi Arabia. Afr J Med Med Sci 1997; 26:145-52. [PMID: 10456158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
In a cross-sectional total population survey of Faizia East Primary Health District of Buraidah, which is divided into an "urban" and "rural" sections, casual blood pressure was recorded in 5671 subjects. 2222 (910 males) were adults (> 19 years). 3299 (1561 males) were between 3-18 years, making the paediatric/adolescent cohort of the population. The rest were below 3 years and were not included for calculations in this report. For adults, HPN was defined as > or = 140/90 mm Hg and P/A it was > or = 95th percentile for the age cohorts 3-5, 6-9, 10-12, 13-15 and 16-18 years as recommended by The Task Force for Blood Pressure Control in Children (1987). Each of the three subsets of HPN were derived from these basic definitions without modification. In the adults population, overall prevalence (S/DHPN + ISHPN + IDHPN) was 23.58% (524/2222) and gender prevalence was marginal in favour of males (25.71 vs 22.1% for males and females respectively; OR: 1.22, chi square = 3.89; p = 0.05; CI: 1.00 < OR < 1.49). By contrast, overall HPN prevalence in P/A was 10.64% (351/3299) and in all the age cohorts, girls were very significantly more hypertensive than boys. Overall figures were 13.06 vs 7.94% respectively for girls and boys; OR: 0.57; chi square = 22.65; p < 0000019; CI: 0.45 < OR < 0.73. Only in severe HPN (> or = 99th percentile) in 16-18 year age cohort did male preponderance become obvious. When the influence of the living environment was examined, in adult population (urban: 40,001; rural: 1670 subjects), for all age cohorts the rural environment which is largely inhabited by the unsophisticated Bedouins living close to their livestock, significantly predisposed to HPN as compared to the urban setting. Overall figures are 19.95 vs 32.60%, urban vs rural respectively: OR: 0.52; chi square = 40.4; p < 0.000000; CI: 0.42 < OR < 0.64. On the other hand, in the P/A population (2301 urban, 998 rural) for the age cohorts 3-5 and 6-9 years the urban environment significantly predisposed to HPN. At 10-12 years the prevalence was virtually even (12.65 vs 12.71%; OR: 0.99; p: NS). Thereafter, i.e. 13-15, 16-18 year cohorts, the rural environment became more dominant, just like the adult pattern. In other words whatever the factors in the unsophisticated Bedouin "rural" setting which predisposes to HPN does not become operative until after childhood--after 12 years. This contrasting gender and environmental influence in our study population seems unique, being reported for the first time. It may be pointing us in new direction in the elucidation of the pathogenesis of HPN and should deserve further studies.
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Affiliation(s)
- M A Soyannwo
- Nephrology Unit, King Fahd Specialist Hospital (KFSH), Buraidah, Gassim
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Soyannwo MA, Gadallah M, Kurashi NY, Hams J, El-Essawi O, Khan NA, Singh RG, Alamri A, Beyari TH. Studies on preventive nephrology: Systemic hypertension in the pediatric and adolescent population of Gassim, Saudi Arabia. Ann Saudi Med 1997; 17:47-52. [PMID: 17377465 DOI: 10.5144/0256-4947.1997.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Casual blood pressure was recorded for subjects of Faizia East Primary Health District during a cross-sectional population survey. Valid information was obtained from 5671 subjects, out of which 3299 (1561 males and 1738 females) were between the ages of three and 18, constituting therefore the pediatric/adolescent (P/A) sector of our study population. The prevalence of hypertension (HPN), defined as A(3) 95th percentile for total HPN population (mild and severe) and A(3) 99th percentile for severe, was calculated for the three-year age cohorts suggested by the Task Force on Blood Pressure Control in Children (1987). The three subsets of HPN were derived from the suggested cut-off levels without any modifications. Overall prevalence of HPN was, for the P/A, found to be 10.65% (351/3299). Females in all the age cohorts were significantly more hypertensive than males, overall gender prevalence being 7.94% (124/1561) for males against 13.06% (227/1738) for females: P=0.0000019; CI: 0.45<OR7lt;0.73. One hundred and twenty-eight subjects (3.88%) had severe HPN, again with gender difference in favor of females (2.57 versus 5.06%), P=0.00022; CI: 0.33<OR<0.74). Sixty-seven and a half percent (237/351) of the HPN population were in the six to 12 year age group, with the significant gender difference persisting (P=0.000407; CI: 0.41<OR<0.74). Ninety-four of these (73.44%) had the severe HPN, with similarly significant gender difference (P=0.0018; CI: 0.31<OR<0.79). Significantly, 67% of gross proteinuria for the entire population has been found in the same age cohort with the same significant gender difference. ISHPN was found to constitute 51.57% (181/351) of the HPN population, followed by IDHPN with 32.48% (114/351) and S/DHPN the least with 15.95% (56/351). The significant gender difference in favor of females noted seems to be unique to the Saudi population. Similarly, the preponderance of ISHPN subsets is, to our knowledge, being recorded from the first time in literature. When coupled with the pattern of proteinuria, we believe that, in the context of preventive nephrology, greater attention will need to be devoted to the pediatric population, especially females.
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Affiliation(s)
- M A Soyannwo
- Nephrology Unit, King Fahd Specialist Hospital, Buraidah
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