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Ali R, Connolly ID, Tang OY, Mirza FN, Johnston B, Abdulrazeq HF, Lim RK, Galamaga PF, Libby TJ, Sodha NR, Groff MW, Gokaslan ZL, Telfeian AE, Shin JH, Asaad WF, Zou J, Doberstein CE. Author Correction: Bridging the literacy gap for surgical consents: an AI-human expert collaborative approach. NPJ Digit Med 2024; 7:93. [PMID: 38609435 PMCID: PMC11015017 DOI: 10.1038/s41746-024-01099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Norman Prince Neurosciences Institute, Providence, RI, USA.
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Oliver Y Tang
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fatima N Mirza
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hael F Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Rachel K Lim
- Department of Surgery & Division of Cardiothoracic Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Tiffany J Libby
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neel R Sodha
- Department of Surgery & Division of Cardiothoracic Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael W Groff
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James Zou
- Departments of Electrical Engineering, Biomedical Data Science, and Computer Science, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Curtis E Doberstein
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
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Abdulrazeq HF, Ali R, Najib H, Doberstein C, Oyelese A, Gokaslan Z, Malik AN, Asaad WF, Greenblatt S. Al-Zahrawi (936-1013 AD): On the Surgical Treatment of Neurological Disorders by the Father of Operative Surgery. World Neurosurg 2024; 184:236-240.e1. [PMID: 38331026 DOI: 10.1016/j.wneu.2024.01.169] [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: 01/23/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Medical knowledge during the medieval ages flourished under the influence of great scholars of the Islamic Golden age such as Ibn Sina (Latinized as Avicenna), Abu Bakr al-Razi (Rhazes), and Abu al-Qasim Khalaf ibn al-Abbas al-Zahrawi, known as Albucasis. Much has been written on al-Zahrawi's innovation in various disciplines of medicine and surgery. In this article, we focus for on the contributions of al-Zahrawi toward the treatment of neurological disorders in the surgical chapters of his medical encyclopedia, Kitab al-Tasrif (The Method of Medicine). METHODS Excerpts from a modern copy of volume 30 of al-Zahrawi's Kitab al-Tasrif were reviewed and translated by the primary author from Arabic to English, to further provide specific details regarding his neurosurgical knowledge. In addition, a literature search was performed using PubMed and Google Scholar to review prior reports on al-Zahrawi's neurosurgical instructions. RESULTS In addition to what is described in the literature of al-Zahrawi's teachings in cranial and spine surgery, we provide insight into his diagnosis and management of cranial and spinal trauma, the devices he used, and prognostication of various traumatic injuries. CONCLUSIONS Al-Zahrawi was a renowned physician during the Islamic Golden age who made significant contributions to the diagnosis and treatment of neurological conditions, particularly cranial and spinal cord injuries. He developed innovative surgical techniques for trephination and spinal traction, which are still used in modern neurosurgery. His insights make him worthy of recognition as an important figure in the history of neurological surgery.
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Affiliation(s)
- Hael F Abdulrazeq
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA.
| | - Rohaid Ali
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Hebah Najib
- Department of Internal Medicine, Touro College of Osteopathic Medicine, Middletown, New York, USA
| | - Curt Doberstein
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adetokunbo Oyelese
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ziya Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Athar N Malik
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Wael F Asaad
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Samuel Greenblatt
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
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Ali R, Connolly ID, Tang OY, Mirza FN, Johnston B, Abdulrazeq HF, Lim RK, Galamaga PF, Libby TJ, Sodha NR, Groff MW, Gokaslan ZL, Telfeian AE, Shin JH, Asaad WF, Zou J, Doberstein CE. Bridging the literacy gap for surgical consents: an AI-human expert collaborative approach. NPJ Digit Med 2024; 7:63. [PMID: 38459205 PMCID: PMC10923794 DOI: 10.1038/s41746-024-01039-2] [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] [Received: 06/30/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024] Open
Abstract
Despite the importance of informed consent in healthcare, the readability and specificity of consent forms often impede patients' comprehension. This study investigates the use of GPT-4 to simplify surgical consent forms and introduces an AI-human expert collaborative approach to validate content appropriateness. Consent forms from multiple institutions were assessed for readability and simplified using GPT-4, with pre- and post-simplification readability metrics compared using nonparametric tests. Independent reviews by medical authors and a malpractice defense attorney were conducted. Finally, GPT-4's potential for generating de novo procedure-specific consent forms was assessed, with forms evaluated using a validated 8-item rubric and expert subspecialty surgeon review. Analysis of 15 academic medical centers' consent forms revealed significant reductions in average reading time, word rarity, and passive sentence frequency (all P < 0.05) following GPT-4-faciliated simplification. Readability improved from an average college freshman to an 8th-grade level (P = 0.004), matching the average American's reading level. Medical and legal sufficiency consistency was confirmed. GPT-4 generated procedure-specific consent forms for five varied surgical procedures at an average 6th-grade reading level. These forms received perfect scores on a standardized consent form rubric and withstood scrutiny upon expert subspeciality surgeon review. This study demonstrates the first AI-human expert collaboration to enhance surgical consent forms, significantly improving readability without sacrificing clinical detail. Our framework could be extended to other patient communication materials, emphasizing clear communication and mitigating disparities related to health literacy barriers.
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Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Norman Prince Neurosciences Institute, Providence, RI, USA.
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Oliver Y Tang
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fatima N Mirza
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hael F Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Rachel K Lim
- Department of Surgery & Division of Cardiothoracic Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Tiffany J Libby
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neel R Sodha
- Department of Surgery & Division of Cardiothoracic Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael W Groff
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James Zou
- Departments of Electrical Engineering, Biomedical Data Science, and Computer Science, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Curtis E Doberstein
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
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Ali R, Tang OY, Connolly ID, Abdulrazeq HF, Mirza FN, Lim RK, Johnston BR, Groff MW, Williamson T, Svokos K, Libby TJ, Shin JH, Gokaslan ZL, Doberstein CE, Zou J, Asaad WF. Demographic Representation in 3 Leading Artificial Intelligence Text-to-Image Generators. JAMA Surg 2024; 159:87-95. [PMID: 37966807 PMCID: PMC10782243 DOI: 10.1001/jamasurg.2023.5695] [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] [Received: 05/31/2023] [Accepted: 08/25/2023] [Indexed: 11/16/2023]
Abstract
Importance The progression of artificial intelligence (AI) text-to-image generators raises concerns of perpetuating societal biases, including profession-based stereotypes. Objective To gauge the demographic accuracy of surgeon representation by 3 prominent AI text-to-image models compared to real-world attending surgeons and trainees. Design, Setting, and Participants The study used a cross-sectional design, assessing the latest release of 3 leading publicly available AI text-to-image generators. Seven independent reviewers categorized AI-produced images. A total of 2400 images were analyzed, generated across 8 surgical specialties within each model. An additional 1200 images were evaluated based on geographic prompts for 3 countries. The study was conducted in May 2023. The 3 AI text-to-image generators were chosen due to their popularity at the time of this study. The measure of demographic characteristics was provided by the Association of American Medical Colleges subspecialty report, which references the American Medical Association master file for physician demographic characteristics across 50 states. Given changing demographic characteristics in trainees compared to attending surgeons, the decision was made to look into both groups separately. Race (non-White, defined as any race other than non-Hispanic White, and White) and gender (female and male) were assessed to evaluate known societal biases. Exposures Images were generated using a prompt template, "a photo of the face of a [blank]", with the blank replaced by a surgical specialty. Geographic-based prompting was evaluated by specifying the most populous countries on 3 continents (the US, Nigeria, and China). Main Outcomes and Measures The study compared representation of female and non-White surgeons in each model with real demographic data using χ2, Fisher exact, and proportion tests. Results There was a significantly higher mean representation of female (35.8% vs 14.7%; P < .001) and non-White (37.4% vs 22.8%; P < .001) surgeons among trainees than attending surgeons. DALL-E 2 reflected attending surgeons' true demographic data for female surgeons (15.9% vs 14.7%; P = .39) and non-White surgeons (22.6% vs 22.8%; P = .92) but underestimated trainees' representation for both female (15.9% vs 35.8%; P < .001) and non-White (22.6% vs 37.4%; P < .001) surgeons. In contrast, Midjourney and Stable Diffusion had significantly lower representation of images of female (0% and 1.8%, respectively; P < .001) and non-White (0.5% and 0.6%, respectively; P < .001) surgeons than DALL-E 2 or true demographic data. Geographic-based prompting increased non-White surgeon representation but did not alter female representation for all models in prompts specifying Nigeria and China. Conclusion and Relevance In this study, 2 leading publicly available text-to-image generators amplified societal biases, depicting over 98% surgeons as White and male. While 1 of the models depicted comparable demographic characteristics to real attending surgeons, all 3 models underestimated trainee representation. The study suggests the need for guardrails and robust feedback systems to minimize AI text-to-image generators magnifying stereotypes in professions such as surgery.
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Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Oliver Y. Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ian D. Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston
| | - Hael F. Abdulrazeq
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fatima N. Mirza
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rachel K. Lim
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Michael W. Groff
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Konstantina Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tiffany J. Libby
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Curtis E. Doberstein
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - James Zou
- Department of Biomedical Data Science and, by courtesy, Computer Science and Electrical Engineering, Stanford University, Stanford, California
| | - Wael F. Asaad
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Neuroscience, Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence
- Department of Neuroscience, Brown University, Providence, Rhode Island
- Department of Neuroscience, Carney Institute for Brain Science, Brown University, Providence, Rhode Island
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Ali R, Tang OY, Connolly ID, Zadnik Sullivan PL, Shin JH, Fridley JS, Asaad WF, Cielo D, Oyelese AA, Doberstein CE, Gokaslan ZL, Telfeian AE. Performance of ChatGPT and GPT-4 on Neurosurgery Written Board Examinations. Neurosurgery 2023; 93:1353-1365. [PMID: 37581444 DOI: 10.1227/neu.0000000000002632] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/19/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Interest surrounding generative large language models (LLMs) has rapidly grown. Although ChatGPT (GPT-3.5), a general LLM, has shown near-passing performance on medical student board examinations, the performance of ChatGPT or its successor GPT-4 on specialized examinations and the factors affecting accuracy remain unclear. This study aims to assess the performance of ChatGPT and GPT-4 on a 500-question mock neurosurgical written board examination. METHODS The Self-Assessment Neurosurgery Examinations (SANS) American Board of Neurological Surgery Self-Assessment Examination 1 was used to evaluate ChatGPT and GPT-4. Questions were in single best answer, multiple-choice format. χ 2 , Fisher exact, and univariable logistic regression tests were used to assess performance differences in relation to question characteristics. RESULTS ChatGPT (GPT-3.5) and GPT-4 achieved scores of 73.4% (95% CI: 69.3%-77.2%) and 83.4% (95% CI: 79.8%-86.5%), respectively, relative to the user average of 72.8% (95% CI: 68.6%-76.6%). Both LLMs exceeded last year's passing threshold of 69%. Although scores between ChatGPT and question bank users were equivalent ( P = .963), GPT-4 outperformed both (both P < .001). GPT-4 answered every question answered correctly by ChatGPT and 37.6% (50/133) of remaining incorrect questions correctly. Among 12 question categories, GPT-4 significantly outperformed users in each but performed comparably with ChatGPT in 3 (functional, other general, and spine) and outperformed both users and ChatGPT for tumor questions. Increased word count (odds ratio = 0.89 of answering a question correctly per +10 words) and higher-order problem-solving (odds ratio = 0.40, P = .009) were associated with lower accuracy for ChatGPT, but not for GPT-4 (both P > .005). Multimodal input was not available at the time of this study; hence, on questions with image content, ChatGPT and GPT-4 answered 49.5% and 56.8% of questions correctly based on contextual context clues alone. CONCLUSION LLMs achieved passing scores on a mock 500-question neurosurgical written board examination, with GPT-4 significantly outperforming ChatGPT.
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Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Patricia L Zadnik Sullivan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - John H Shin
- Department of Neuroscience, Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Jared S Fridley
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Wael F Asaad
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Department of Neuroscience, Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
- Department of Neuroscience, Brown University, Providence , Rhode Island , USA
- Department of Neuroscience, Carney Institute for Brain Science, Brown University, Providence , Rhode Island , USA
| | - Deus Cielo
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Curtis E Doberstein
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Albert E Telfeian
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
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Ali R, Tang OY, Connolly ID, Fridley JS, Shin JH, Zadnik Sullivan PL, Cielo D, Oyelese AA, Doberstein CE, Telfeian AE, Gokaslan ZL, Asaad WF. Performance of ChatGPT, GPT-4, and Google Bard on a Neurosurgery Oral Boards Preparation Question Bank. Neurosurgery 2023; 93:1090-1098. [PMID: 37306460 DOI: 10.1227/neu.0000000000002551] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/09/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES General large language models (LLMs), such as ChatGPT (GPT-3.5), have demonstrated the capability to pass multiple-choice medical board examinations. However, comparative accuracy of different LLMs and LLM performance on assessments of predominantly higher-order management questions is poorly understood. We aimed to assess the performance of 3 LLMs (GPT-3.5, GPT-4, and Google Bard) on a question bank designed specifically for neurosurgery oral boards examination preparation. METHODS The 149-question Self-Assessment Neurosurgery Examination Indications Examination was used to query LLM accuracy. Questions were inputted in a single best answer, multiple-choice format. χ 2 , Fisher exact, and univariable logistic regression tests assessed differences in performance by question characteristics. RESULTS On a question bank with predominantly higher-order questions (85.2%), ChatGPT (GPT-3.5) and GPT-4 answered 62.4% (95% CI: 54.1%-70.1%) and 82.6% (95% CI: 75.2%-88.1%) of questions correctly, respectively. By contrast, Bard scored 44.2% (66/149, 95% CI: 36.2%-52.6%). GPT-3.5 and GPT-4 demonstrated significantly higher scores than Bard (both P < .01), and GPT-4 outperformed GPT-3.5 ( P = .023). Among 6 subspecialties, GPT-4 had significantly higher accuracy in the Spine category relative to GPT-3.5 and in 4 categories relative to Bard (all P < .01). Incorporation of higher-order problem solving was associated with lower question accuracy for GPT-3.5 (odds ratio [OR] = 0.80, P = .042) and Bard (OR = 0.76, P = .014), but not GPT-4 (OR = 0.86, P = .085). GPT-4's performance on imaging-related questions surpassed GPT-3.5's (68.6% vs 47.1%, P = .044) and was comparable with Bard's (68.6% vs 66.7%, P = 1.000). However, GPT-4 demonstrated significantly lower rates of "hallucination" on imaging-related questions than both GPT-3.5 (2.3% vs 57.1%, P < .001) and Bard (2.3% vs 27.3%, P = .002). Lack of question text description for questions predicted significantly higher odds of hallucination for GPT-3.5 (OR = 1.45, P = .012) and Bard (OR = 2.09, P < .001). CONCLUSION On a question bank of predominantly higher-order management case scenarios for neurosurgery oral boards preparation, GPT-4 achieved a score of 82.6%, outperforming ChatGPT and Google Bard.
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Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Jared S Fridley
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Patricia L Zadnik Sullivan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Deus Cielo
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Curtis E Doberstein
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Albert E Telfeian
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Wael F Asaad
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
- Department of Neuroscience, Brown University, Providence , Rhode Island , USA
- Carney Institute for Brain Science, Brown University, Providence , Rhode Island , USA
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Rashid RH, Ali R, Zahid M, Ali M, Ahmad T. Flexor Hallucis Longus Transfer And V-Y Plasty: An Effective Treatment Modality for Chronic Achilles Rupture - A Case Series. Malays Orthop J 2023; 17:59-65. [PMID: 38107357 PMCID: PMC10722995 DOI: 10.5704/moj.2311.009] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/22/2022] [Indexed: 12/19/2023] Open
Abstract
Introduction To assess outcomes of FHL transfer and V-Y plasty for chronic Achilles rupture due to insertional Achilles tendinopathy. Materials and methods A case series of 12 patients was conducted between 1st January 2017 and 31st December 2018. The patients had short flexor hallucis longus tendon transfer with gastrocnemius lengthening by V-Y plasty for Achilles tendon rupture. Patients were allowed full weight bearing at six weeks post-operatively, and were followed up at three months and six months post-operatively, when the range of motion of the ankle was examined, and the outcome was assessed using the EFAS score. Results Of the 12 patients in the study, the majority were males; the mean age was 50.6±8.96 years. A significant improvement in dorsiflexion and plantarflexion was noted at the six-month follow-up compared to the three-month follow-up (P=<0.001 for both). When compared to the normal side, dorsiflexion and plantarflexion of the affected ankle were significantly less at three months but were comparable at six months post-operatively. A significant improvement was noted in the mean EFAS score at the six-month follow-up (25.5±5.71) compared to three months (18.6±0.90) post-surgery (P=0.001). Males were also noted to have significantly higher EFAS scores at their six-month follow-up than females (P=0.022). In contrast, a negative correlation was noted between the European Foot and Ankle Society (EFAS) score at the final follow-up and age (P=0.011). Conclusion FHL tendon transfer with V-Y plasty in chronic Achilles rupture due to insertional Achilles tendinopathy is an effective procedure resulting in the restoration of the ankle range of motion and improvement in functional scores.
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Affiliation(s)
- R H Rashid
- Section of Orthopaedics, Aga Khan University Hospital, Karachi, Pakistan
| | - R Ali
- Section of Orthopaedics, Aga Khan University Hospital, Karachi, Pakistan
| | - M Zahid
- Section of Orthopaedics, Aga Khan University Hospital, Karachi, Pakistan
| | - M Ali
- Section of Orthopaedics, Aga Khan University Hospital, Karachi, Pakistan
| | - T Ahmad
- Section of Orthopaedics, Aga Khan University Hospital, Karachi, Pakistan
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Gürsoy V, Hunutlu FÇ, Pinar IE, Göktuğ MR, Ali R, Özkocaman V, Özkalemkaş F. The clinical impacts of the controlling nutritional status score on patients with Hodgkin lymphoma. Eur Rev Med Pharmacol Sci 2023; 27:9916-9927. [PMID: 37916361 DOI: 10.26355/eurrev_202310_34170] [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: 11/03/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the clinical importance and potential mechanisms of controlling nutritional status (CONUT) score as a prognostic tool for Hodgkin lymphoma (HL). PATIENTS AND METHODS Diagnosed with HL, 307 patients were included in the study. Patients' demographic data, stages, B symptoms, extranodal involvement, presence of bulky disease, laboratory findings, treatments, treatment responses, nutritional status, and overall survival (OS) rates were evaluated from the hospital records. The primary endpoint of our study was to evaluate and classify newly diagnosed HL patients under the CONUT score. The secondary endpoint was to indicate any relationship between nutritional status, CONUT score, and other prognostic factors and OS. RESULTS Of 307 patients (173 males, 134 females), the mean age was 41.58±16.26 (ranging between 18-82 years). The most common type of malignancy was nodular sclerosis (72.53%). To the receiver operating characteristic (ROC) curve analysis, the best cut-off point was 2.5 to predict mortality. Eigthy-five (27.7%) and 222 (72.3%) patients had ≥3 and ≤2 CONUT scores, respectively. Twenty-four (10.80%) and 23 (27.10%) cases were also mortal in the patients with ≤2 and ≥3 CONUT scores, respectively (p<0.001). Survival times were significantly lower in those with higher (≥3) CONUT scores (p<0.001) than among the other patients. CONCLUSIONS Evaluation of nutritional status plays an important role in the response and survival of those with hematological malignancies. Malnutrition can reduce patients' tolerance to chemotherapy and increase the risk of secondary infections. In this study, undernutrition evaluated with the CONUT score was demonstrated to be a potential independent prognostic factor for OS in patients with HL.
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Affiliation(s)
- V Gürsoy
- Department of Hematology, Bursa City Hospital, Bursa, Turkey.
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Tang OY, Ali R, Connolly ID, Fridley JS, Zadnik Sullivan PL, Cielo D, Oyelese AA, Doberstein CE, Telfeian AE, Gokaslan ZL, Shin JH, Asaad WF. Letter: The Urgency of Neurosurgical Leadership in the Era of Artificial Intelligence. Neurosurgery 2023; 93:e69-e70. [PMID: 37319400 DOI: 10.1227/neu.0000000000002576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Rohaid Ali
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Jared S Fridley
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Patricia L Zadnik Sullivan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Deus Cielo
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Curtis E Doberstein
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Albert E Telfeian
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Wael F Asaad
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
- Department of Neuroscience, Brown University, Providence , Rhode Island , USA
- Carney Institute for Brain Science, Brown University, Providence , Rhode Island , USA
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Ali R, Zahran O, El-samie FEA, Eldin SS. Efficient Blind Signal Separation Algorithms for Wireless Multimedia Communication Systems.. [DOI: 10.21203/rs.3.rs-2869492/v1] [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] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
This paper studies the problem of multi-user blind signal separation (BSS) in wireless communications. The existing separation algorithms work on quadrature phase shift keying (QPSK). Through this work two proposed algorithms were presented to enhance the BSS performance. The first proposed algorithm uses wavelet denoising to remove noise from the received signals in time domain. It adopts different modulation techniques such as minimum shift keying (MSK), quadrature phase shift keying (QPSK), and Gaussian minimum shift keying (GMSK) then uses several BSS algorithms such as independent component analysis (ICA), principle component analysis (PCA), and multi user kurtosis (MUK) algorithms. The second proposed algorithm transfers the problem of BSS to transform domain and uses wavelet denoising to reduce noise effect on received mixture. BSS with Discrete Sine Transform (DST) and Discrete Cosine Transform (DCT) were investigated and compared to time domain performance. Minimum square error (MSE) and signal to noise ratio (SNR) were used as the evaluating metrics. Simulation results proved that in time domain, MUK with QPSK gives best performance and wavelet denoising was found to enhance the performance of BSS under all conditions. Signal separation in transform domain was found to give better performance than that in time domain due to the energy compaction process of these transforms and noise reduction due to their averaging effect.
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Gjorgjieva T, Chaloemtoem A, Shahin T, Bayaraa O, Dieng MM, Alshaikh M, Abdalbaqi M, Del Monte J, Begum G, Leonor C, Manikandan V, Drou N, Arshad M, Arnoux M, Kumar N, Jabari A, Abdulle A, ElGhazali G, Ali R, Shaheen SY, Abdalla J, Piano F, Gunsalus KC, Daggag H, Al Nahdi H, Abuzeid H, Idaghdour Y. Systems genetics identifies miRNA-mediated regulation of host response in COVID-19. Hum Genomics 2023; 17:49. [PMID: 37303042 DOI: 10.1186/s40246-023-00494-4] [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: 03/23/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Individuals infected with SARS-CoV-2 vary greatly in their disease severity, ranging from asymptomatic infection to severe disease. The regulation of gene expression is an important mechanism in the host immune response and can modulate the outcome of the disease. miRNAs play important roles in post-transcriptional regulation with consequences on downstream molecular and cellular host immune response processes. The nature and magnitude of miRNA perturbations associated with blood phenotypes and intensive care unit (ICU) admission in COVID-19 are poorly understood. RESULTS We combined multi-omics profiling-genotyping, miRNA and RNA expression, measured at the time of hospital admission soon after the onset of COVID-19 symptoms-with phenotypes from electronic health records to understand how miRNA expression contributes to variation in disease severity in a diverse cohort of 259 unvaccinated patients in Abu Dhabi, United Arab Emirates. We analyzed 62 clinical variables and expression levels of 632 miRNAs measured at admission and identified 97 miRNAs associated with 8 blood phenotypes significantly associated with later ICU admission. Integrative miRNA-mRNA cross-correlation analysis identified multiple miRNA-mRNA-blood endophenotype associations and revealed the effect of miR-143-3p on neutrophil count mediated by the expression of its target gene BCL2. We report 168 significant cis-miRNA expression quantitative trait loci, 57 of which implicate miRNAs associated with either ICU admission or a blood endophenotype. CONCLUSIONS This systems genetics study has given rise to a genomic picture of the architecture of whole blood miRNAs in unvaccinated COVID-19 patients and pinpoints post-transcriptional regulation as a potential mechanism that impacts blood traits underlying COVID-19 severity. The results also highlight the impact of host genetic regulatory control of miRNA expression in early stages of COVID-19 disease.
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Affiliation(s)
- T Gjorgjieva
- Biology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - A Chaloemtoem
- Biology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - T Shahin
- Biology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - O Bayaraa
- Biology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - M M Dieng
- Biology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - M Alshaikh
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - M Abdalbaqi
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - J Del Monte
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - G Begum
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - C Leonor
- Biology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - V Manikandan
- Biology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - N Drou
- Center for Genomics and Systems Biology, NYU Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - M Arshad
- Center for Genomics and Systems Biology, NYU Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - M Arnoux
- Center for Genomics and Systems Biology, NYU Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - N Kumar
- Seha (Abu Dhabi Health Services Company), Abu Dhabi, United Arab Emirates
| | - A Jabari
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - A Abdulle
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - G ElGhazali
- Sheikh Khalifa Medical City-Union 71 PureHealth, Abu Dhabi, United Arab Emirates
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - R Ali
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - S Y Shaheen
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - J Abdalla
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - F Piano
- Biology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Center for Genomics and Systems Biology, NYU Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - K C Gunsalus
- Biology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Center for Genomics and Systems Biology, NYU Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - H Daggag
- Seha (Abu Dhabi Health Services Company), Abu Dhabi, United Arab Emirates
| | - H Al Nahdi
- Seha (Abu Dhabi Health Services Company), Abu Dhabi, United Arab Emirates
| | - H Abuzeid
- Seha (Abu Dhabi Health Services Company), Abu Dhabi, United Arab Emirates
| | - Y Idaghdour
- Biology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
- Center for Genomics and Systems Biology, NYU Abu Dhabi, Abu Dhabi, United Arab Emirates.
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Newland D, Pak J, Ali R, Nemeth T, Tressel W, Kronmal R, Albers E, Friedland-Little J, Ahmed H, Kemna M, Hong B, Spencer K, Law Y. Mycophenolic Acid Therapeutic Drug Monitoring Using Area Under the Curve in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1633] [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: 04/05/2023] Open
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13
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Ali R, Hagan M, Tang OY, Sastry R, O'Brien J, Dean Roye G, Toms SA, Asaad W, Doberstein CE, Oyelese A, Gokaslan ZL, Telfeian AE. 116 Switching from System-Based to Problem-Based Charting Increases the Patient-Specific Expected Mortality Rate and Length of Stay on a Neurosurgery Service. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_116] [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: 03/18/2023] Open
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14
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Ali R, Tang OY, Moldovan K, Torabi R, Furie K, Roye GD, Gokaslan ZL, Telfeian A, Yaghi S, Doberstein CE, Jayaraman MV. Letter: A Stroke Admissions Navigator Improves Adherence to Joint Commission Specifications for Hunt-Hess and Intracerebral Hemorrhage Scores. Neurosurgery 2023; 92:e118-e119. [PMID: 36942963 DOI: 10.1227/neu.0000000000002461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/23/2023] Open
Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Krisztina Moldovan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Radmehr Torabi
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Karen Furie
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - G Dean Roye
- Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Albert Telfeian
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shadi Yaghi
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Curtis E Doberstein
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mahesh V Jayaraman
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Shah S, Ali R, Baig S. Abstract No. 172 Safety of Early Enteral Nutrition After Push and Pull Type Gastrostomy Tubes. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.228] [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: 02/26/2023] Open
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16
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Ali R, Hagan MJ, Bajaj A, Alastair Gibson J, Hofstetter CP, Waschke A, Lewandrowski KU, Telfeian AE. IMPACT OF THE LEARNING CURVE OF PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY ON CLINICAL OUTCOMES: A SYSTEMATIC REVIEW. Interdisciplinary Neurosurgery 2023. [DOI: 10.1016/j.inat.2023.101738] [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: 02/03/2023] Open
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17
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Hagan MJ, Telfeian AE, Sastry R, Ali R, Lewandrowski KU, Konakondla S, Barber S, Lane K, Gokaslan ZL. Awake transforaminal endoscopic lumbar facet cyst resection: technical note and case series. J Neurosurg Spine 2022; 37:843-850. [PMID: 35986734 DOI: 10.3171/2022.6.spine22451] [Citation(s) in RCA: 2] [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] [Received: 04/27/2022] [Accepted: 06/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to describe a minimally invasive transforaminal surgical technique for treating awake patients presenting with lumbar radiculopathy and compressive facet cysts. METHODS Awake transforaminal endoscopic decompression surgery was performed in 645 patients over a 6-year period from 2014 to 2020. Transforaminal endoscopic decompression surgery utilizing a high-speed endoscopic drill was performed in 25 patients who had lumbar facet cysts. All surgeries were performed as outpatient procedures in awake patients. Nine of the 25 patients had previously undergone laminectomies at the treated level. A retrospective chart review of patient-reported outcome measures is presented. RESULTS At the 2-year follow-up, the mean (± standard deviation) preoperative visual analog scale leg score and Oswestry Disability Index improved from 7.6 ± 1.3 to 2.3 ± 1.4 and 39.7% ± 8.1% to 13.0% ± 7.4%, respectively. There were no complications, readmissions, or recurrence of symptoms during the 2-year follow-up period. CONCLUSIONS A minimally invasive awake procedure is presented for the treatment of lumbar facet cysts in patients with lumbar radiculopathy. Approximately one-third of the treated patients (9 of 25) had postlaminectomy facet cysts.
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Affiliation(s)
- Matthew J Hagan
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Albert E Telfeian
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rahul Sastry
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rohaid Ali
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Sanjay Konakondla
- 3Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania; and
| | - Sean Barber
- 4Houston Methodist Department of Neurosurgery, Houston, Texas
| | - Kendall Lane
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ziya L Gokaslan
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Ali R, Hagan MJ, Shaaya E, Leary OP, Feler J, Bajaj A, Gokaslan Z, Konakondla S, Mahan MA, Wagner R, Lewandrowski KU, Telfeian AE. Endoscopic Techniques for Spinal Oncology: A Systematic Literature Review. Int J Spine Surg 2022:8412. [DOI: 10.14444/8412] [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: 11/30/2022] Open
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Al Balushi M, Ahmad A, Javaid S, Ahmed L, Al Maskari F, Abdulle A, Ali R. The association between body fat percentage and self-reported depression in the United Arab Emirates. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.133] [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: 11/14/2022] Open
Abstract
Abstract
Background
The United Arab Emirates Healthy Future Study (UAEHFS) is one of the first large prospective cohort studies in the region which examines causes and risk factors for chronic diseases among adult UAE nationals. The aim of this study was to explore the relationship between body fat percentage (BF%) and the eight-item Patient Health Questionnaire (PHQ-8) as a screening instrument for depression among the UAEHFS pilot study participants.
Methods
We analyzed the UAEHFS pilot data to investigate the association between BF% and PHQ-8 adjusted for age and gender. We used multivariate logistic ordinal regression model. To impute missing values, 100 multiple imputations (MI) were performed using multivariate imputation of classification and regression tree. The statistical analysis was performed using R Statistical Software (version 4.2.0)
Results
Out of 517 participants, data from 487 (94.2%) were analyzed after excluding participants who didn't fill out the questionnaires. The median age was 30 years (Interquartile Range: 23 - 38). There were more males (67.8%) than females in the UAEHF pilot data. Approximately, 64 (13.1%) of the participant reported depression. The prevalence of obesity was 35.2% in this study population. The estimated odds ratio of BF% from the fitted multivariate logistic ordinal regression model was OR = 1.046 (95% CI: 1.012-1.08), and OR = 1.03 (95% CI: 1.003-1.057) for the omitted data, and MI (sensitivity analysis) respectively.
Conclusions
High body fat percentage was statistically significantly associated with high risk of reporting depression. Additional research is needed, using the main UAEHFS data (after recruitment is complete), to further investigate the association between body fat percentage and depression.
Key messages
• Our results can help contribute to the knowledge based on current and potential population mental health in the UAE and Gulf Region.
• The main finding of this study that excess body fat is associated with an increased risk of developing depression and vice versa; thus, this could add to the future direction of mental health research.
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Affiliation(s)
- M Al Balushi
- Public Health Research Center, New York University Abu Dhabi , Abu Dhabi, United Arab Emirates
- Institute of Public Health, United Arab Emirates University , Abu Dhabi, United Arab Emirates
| | - A Ahmad
- Public Health Research Center, New York University Abu Dhabi , Abu Dhabi, United Arab Emirates
| | - S Javaid
- Department of Mental Health, United Arab Emirates University , Abu Dhabi, United Arab Emirates
| | - L Ahmed
- Institute of Public Health, United Arab Emirates University , Abu Dhabi, United Arab Emirates
| | - F Al Maskari
- Institute of Public Health, United Arab Emirates University , Abu Dhabi, United Arab Emirates
| | - A Abdulle
- Public Health Research Center, New York University Abu Dhabi , Abu Dhabi, United Arab Emirates
| | - R Ali
- Public Health Research Center, New York University Abu Dhabi , Abu Dhabi, United Arab Emirates
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Sastry RA, Feler JR, Shao B, Ali R, McNicoll L, Telfeian AE, Oyelese AA, Weil RJ, Gokaslan ZL. Frailty independently predicts unfavorable discharge in non-operative traumatic brain injury: A retrospective single-institution cohort study. PLoS One 2022; 17:e0275677. [PMID: 36206233 PMCID: PMC9543962 DOI: 10.1371/journal.pone.0275677] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Frailty is associated with adverse outcomes in traumatically injured geriatric patients but has not been well-studied in geriatric Traumatic Brain Injury (TBI). OBJECTIVE To assess relationships between frailty and outcomes after TBI. METHODS The records of all patients aged 70 or older admitted from home to the neurosurgical service of a single institution for non-operative TBI between January 2020 and July 2021 were retrospectively reviewed. The primary outcome was adverse discharge disposition (either in-hospital expiration or discharge to skilled nursing facility (SNF), hospice, or home with hospice). Secondary outcomes included major inpatient complication, 30-day readmission, and length of stay. RESULTS 100 patients were included, 90% of whom presented with Glasgow Coma Score (GCS) 14-15. The mean length of stay was 3.78 days. 7% had an in-hospital complication, and 44% had an unfavorable discharge destination. 49% of patients attended follow-up within 3 months. The rate of readmission within 30 days was 13%. Patients were characterized as low frailty (FRAIL score 0-1, n = 35, 35%) or high frailty (FRAIL score 2-5, n = 65, 65%). In multivariate analysis controlling for age and other factors, frailty category (aOR 2.63, 95CI [1.02, 7.14], p = 0.005) was significantly associated with unfavorable discharge. Frailty was not associated with increased readmission rate, LOS, or rate of complications on uncontrolled univariate analyses. CONCLUSION Frailty is associated with increased odds of unfavorable discharge disposition for geriatric patients admitted with TBI.
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Affiliation(s)
- Rahul A. Sastry
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
- * E-mail:
| | - Josh R. Feler
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Belinda Shao
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Rohaid Ali
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Lynn McNicoll
- Division of Geriatrics, Department of Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, United States of America
| | - Albert E. Telfeian
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Adetokunbo A. Oyelese
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Robert J. Weil
- Department of Neurosurgery, Brain & Spine, Southcoast Health, Dartmouth, MA, United States of America
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
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Teo M, Abhinav K, Bell-Stephens TE, Madhugiri VS, Sussman ES, Azad TD, Ali R, Esparza R, Zhang M, Steinberg GK. Short- and long-term outcomes of moyamoya patients post-revascularization. J Neurosurg 2022; 138:1374-1384. [PMID: 36272120 DOI: 10.3171/2022.8.jns22336] [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] [Received: 02/15/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The post-bypass stroke risk factors and long-term outcomes of moyamoya patients are not well documented. Therefore, the authors studied 30-day stroke risks and patients’ long-term physical, functional, and social well-being.
METHODS
This was a single-institution combined moyamoya disease (MMD) database interrogation and questionnaire study. From 1991 to 2014, 1250 revascularization procedures (1118 direct bypasses, 132 indirect bypasses) were performed in 769 patients. Completed questionnaires were received from and available for analysis on 391 patients, and 6-month follow-up data were available for 96.4% (741/769) of the patients.
RESULTS
The patients consisted of 548 females and 221 males, with a mean age of 32 years (range 1–69 years). Three hundred fifty-eight bypasses were performed in 205 pediatric patients (73% direct bypasses), and 892 revascularizations were performed in 564 adults (96% direct bypasses). Fifty-two patients (6.8%) developed major strokes with a worsening modified Rankin Scale (mRS) score within 30 days postoperatively. The 30-day major stroke risk was 5.3% (41/769) and 2.6% (12/467) after the first and second bypasses, respectively. Logistic regression analysis revealed that older age, modified MRI (mMRI) score, and hemodynamic reserve (HDR) score are clearly associated with higher postoperative stroke risks. Over a mean follow-up of 7.3 years (range 0.5–26 years), the long-term stroke risk among 741 patients was 0.6% per patient-year; 75% of these patients had excellent outcomes (mRS score 0–1). The long-term outcome questionnaire study showed that 84% (234/277) of patients reported resolution or improvement in their preoperative headache, 83% (325/391) remained employed or in school, and 87% (303/348) were self-caring.
CONCLUSIONS
In this large, single-center surgical series, most of the adult and pediatric patients had direct revascularization, with a 4.2% per-bypass-procedure (6.8% per patient) 30-day major stroke risk and a 0.6% per-patient-year long-term stroke risk. The authors identified various risk factors that are highly correlated with postoperative morbidity (age, mMRI score, and HDR score) and are involved in ongoing work to develop the predictive modeling for future patient selection and treatment.
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Affiliation(s)
- Mario Teo
- Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California
| | - Kumar Abhinav
- Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California
| | - Teresa E. Bell-Stephens
- Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California
| | - Venkatesh S. Madhugiri
- Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California
| | - Eric S. Sussman
- Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California
| | - Tej Deepak Azad
- Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California
| | - Rohaid Ali
- Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California
| | - Rogelio Esparza
- Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California
| | - Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California
| | - Gary K. Steinberg
- Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California
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22
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Ali R, Sugand K, Goodall R, Salciccioli J, Marshall D, Schuster-Bruce J, Abdul-Jabar HB, Shalhoub J. 12 Trends in Neck of Femur Fracture Incidence in EU15+ Countries From 1990–2017. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.447] [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: 11/07/2022]
Abstract
Abstract
Background
Neck of femur fractures (NOFF) pose significant socio-economic costs to society with a high degree of morbidity and mortality. Its incidence rate has been collated within the Global Burden of Disease (GBD) database; however, to date, no comparison across countries has been reported.
Method
NOFF age-standardised incidence rates (ASIR) per 100,000 population were extracted from the GBD database for European Union (EU) 15+ countries over the period 1990 to 2017. Joinpoint regression analysis of the data identified trends in ASIR and associated estimated annual percentage changes (EAPC). These were analysed by specified timeframe, country, and gender.
Results
Of the 19 EU15+ countries, 11 (58%) had overall increases in NOFF ASIRs in 2017 compared to 1990. The median ASIRs were 240/100,000 and 322/100,000 for males and females, respectively, in 1990. By 2017, this had increased to 259/100,000 and 325/100,000, respectively. Females consistently had relatively higher NOFF ASIRs with a median gender fracture gap of 62/100,000 in 2017. Males had a higher percentage change in increasing ASIRs, with a smaller percentage change in decreasing ASIRs for all included countries. The highest national ASIRs was observed in Australia, followed by Finland and Belgium. Conversely the Mediterranean countries demonstrated the lowest ASIRs, closely followed by the USA.
Conclusions
Despite significant advances in primary and secondary hip fracture prevention strategies over the 28-year study period, significant increases in NOFF ASIRs among most EU15+ countries were observed, especially with respect to gender.
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Affiliation(s)
- R Ali
- Queen Elizabeth The Queen Mother, East Kent Hospitals University NHS Foundation Trust , Margate , United Kingdom
| | - K Sugand
- Trauma & Orthopaedic Surgery Unit, Imperial College Healthcare NHS Trust , London , United Kingdom
| | - R Goodall
- Department of Plastic Surgery , Buckinghamshire Healthcare NHS Trust, Oxford , United Kingdom
| | | | - D Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford , Oxford , United Kingdom
| | - J Schuster-Bruce
- Department of Ear, Nose and Throat, Head and Neck Surgery, St Georges University Hospitals NHS Trust , London , United Kingdom
| | - HB Abdul-Jabar
- Trauma & Orthopaedic Surgery Unit, London Northwest University NHS Trust , London , United Kingdom
| | - J Shalhoub
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust , London , United Kingdom
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23
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Md Suhaimi N, Abdul Fatah F, Saili A, Ali R. Determinants of agricultural competitiveness: the case of pineapple production
among smallholders in Johor, Malaysia. Food Res 2022. [DOI: 10.26656/fr.2017.6(s1).003] [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: 11/12/2022] Open
Abstract
Pineapple is a tropical fruit that contains great nutritional values and fine flavour with high
export potential and provides income generation for many smallholders in Malaysia. In
2019, Malaysia exported pineapple-based products worth RM419 million. Therefore, this
paper aimed to analyse the competitiveness of pineapple in Malaysia, which was relatively
understudied in the literature, especially in Asia. In this study, the level of competitiveness
of fresh pineapple production among smallholders at the farm level was evaluated using
an extension to the Policy Analysis Matrix (PAM). The extension provides a disaggregate
analysis that has allowed the development of the distribution of competitiveness scores for
each pineapple production at individual farms, taking into consideration the drawbacks of
the use of aggregated data. In the second stage of the analysis, the multiple regression
method was used to examine the key determinants that affected the competitiveness of
pineapple production. A sample of 191 smallholders was randomly selected in Johor. The
results demonstrated that Malaysian smallholders particularly in Johor had strong
comparative advantages in the production of pineapple. The findings showed the Social
Cost Benefit (SCB) value was less than 1, which means at a social price, the average
smallholders were socially profitable and internationally competitive. However, by using
disaggregated data, the results proved that some smallholders were not producing social
profits where 29% of them remained uncompetitive internationally. Apart from that, the
results of regression analysis revealed that the competitiveness of pineapple production
was significantly influenced by age, working experience, farm size and the variety of
pineapple. To conclude, the study presented recommendations for the potential
enhancement of viability and competitiveness of pineapple smallholders.
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24
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Telfeian AE, Sastry R, Ali R, Oyelese A, Fridley J, Camara-Quintana JQ, Niu T, Lewandrowski KU, Gokaslan ZL. Awake, Transforaminal Endoscopic Lumbar Decompression Surgery to Treat L5-S1 Adjacent Segment Disease: A Case Series. Pain Physician 2022; 25:E649-E656. [PMID: 35793189] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Lumbar radiculopathy secondary to L5-S1 degenerative changes adjacent to a lumbar fusion usually requires extending the fusion to include the degenerative L5-S1 level; this revision surgery can often be a very invasive procedure. OBJECTIVE To describe outcomes of awake, transforaminal endoscopic decompression surgery for patients presenting with lumbar radiculopathy as a result of L5-S1 degenerative disc disease below lumbar fusions. STUDY DESIGN Retrospective chart review. METHODS Awake, endoscopic decompression surgery was performed in 538 patients over a 5-year period from 2014 through 2019 by a single surgeon at a single institution. The records of 18 consecutive patients who underwent transforaminal lumbar endoscopic decompression surgery to treat radiculopathy secondary to L5-S1 adjacent segment disease were retrospectively reviewed. All included patients were followed for at least 2 years after surgery. All patients were treated at L5-S1 and had fusion constructs that ended at L5. RESULTS Thirteen men and 5 women patients ranging in age from 38 to 83 (average age of 68.9 ± 11.5) were treated for symptomatic adjacent segment disease at L5-S1 during the 5-year time period. Surgery was successful in all cases, except 2 patients (11%) at 2 years follow-up had recurrent symptomatic pathology at L5-S1 and required additional surgical treatment. The average preoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were 7.5(± 1.3) and 45.3 (± 12.3) respectively. The average 2-year postoperative VAS and ODI scores were 2.4 (± 1.5) and 22.5 (± 9.6) respectively, excluding the 2 patients with recurrent pathology. The average body mass index (BMI) and L5-S1 disc height in the 2-year successful group (n = 16) were 30.6 (± 7.4) and 8.7 mm (± 3.5 mm) respectively; the average BMI and L5-S1 disc height in the 2-year failure group (n = 2) were 25.8 (± 5.9) and 7.9 (± 2.6) respectively. LIMITATIONS This was a retrospective case series. CONCLUSIONS Endoscopic spine surgery offers patients with fusions that terminate at L5 a safe and effective option for treatment of lumbar degenerative spine disease at L5-S1 below their fusion constructs. A longer follow-up and a larger prospective study would be necessary to consider the utility of endoscopic compression versus extending the fusion construct.
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Affiliation(s)
- Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rahul Sastry
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rohaid Ali
- Dept. of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adetokunbo Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jared Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Tianyi Niu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Kai-Uwe Lewandrowski
- Dept. of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
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25
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Fakih C, Mourad Y, Raad G, Akil W, Sfarjlani R, Chedid J, Daou J, Abou layla H, Ali R, Abou Zeid R, Zahwe R, Saad J, El samad S, Fakih F. P-691 Assessment of ovarian vascularity by three-dimensional vaginal power Doppler on day seven of menstrual cycle to predict the number of eggs collected in antagonist cycle. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.640] [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: 11/15/2022] Open
Abstract
Abstract
Study question
Could ovarian vascularity indices on day 2 and 7 of stimulation, measured by 3-dimensional (3D) vaginal power Doppler, predict after controlled ovarian stimulation?
Summary answer
Ovarian vascularity index (VI) on day 7 may be an indicator of poor (<three mature eggs collected) ovarian responses to gonadotropins.
What is known already
Poor and/or hyper ovarian responses to gonadotropins may be related to cycle cancellation during controlled ovarian stimulation (COS). In this context, gonadotropin dose is often individualized using patient features that predict ovarian response (such as age, antral follicular count (AFC) and anti-Müllerian hormone (AMH)). In parallel, ovarian vascularity color doppler is a valuable evaluation method to predict the ovarian hyperstimulation syndrome and the growth/maturity of Graafian follicles. The aim of the present study is to estimate the utility of 3-dimensional vaginal power Doppler and ovarian vascular flow indices in the prediction of the number of mature occytes collected after COS.
Study design, size, duration
A prospective study was conducted on 296 couples undergoing intracytoplasmic sperm injection cycle at Al Hadi Laboratory and Medical center, Beirut, Lebanon. It was performed between January 2020 and dec 2021. Couples were categorized into poor responders group (3 or less metaphase II (MII) eggs collected) (36.1%), high responders group (16 or more MII eggs collected) group ( 6.7%), and normal responders group (more than 3 and less than 16 MII eggs collected) (57,2%).
Participants/materials, setting, methods
On the second and seventh day of the menstrual cycle, ovarian volume and vascularity parameters (vascularity index (VI), flow index (FI), and vascularity flow index (VFI)) were measured using the 3D power Doppler and the Virtual Organ Computer-Aided Analysis. On day 2 , the antral follicle count was evaluated and a blood sample for AMH testing was collected. Women included in the study have undergone COS using GnRH antagonist protocol.
Main results and the role of chance
Mean age was 35,88+/- 6 year , day2 VI and day2 VFI correlates with the number of egg collected (p = 0.014 and 0.045 respectively).
9 parameters were used to predict poor and high ovarian responses (Age, AMH, AFC, day2 VI, day2 FI , day2 VFI , day7 VI, day7 FI and day7 VFI) in a Receiver operator characteristics (ROC) curve model .
Ovarian day7 FI significantly predicted poor ovarian response to gonadotropins (p = 0.038) with an area under the curve of 0.679. AFC predicted also poor ovarian response to gonadotropins (p = 0.006) . In parallel, AFC significantly predicted high ovarian response to gonadotropins (p = 0.002) and AUC (0.778) while all other 3D doppler parameters couldn’t predict high responders.
Limitations, reasons for caution
It will be necessary to perform a prospective analysis on a broad sample size to validate these findings. In addition, it will be interesting to assess the impact of ovarian vascularity on pregnancy outcomes.
Wider implications of the findings
Assessing ovarian vascularity during ovarian stimulation can help reduce the rate of cycle cancellation. In addition, more studies are welcomed in the field to unravel the mechanisms behind altered ovarian vascularity and to test the possibility of restoring normal ovarian physiology.
Trial registration number
Not Applicable
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Affiliation(s)
- C Fakih
- Al Hadi IVF Center, IVF , Beirut, Lebanon
| | - Y Mourad
- Al Hadi IVF Center, Laboratory , Beirut, Lebanon
| | - G Raad
- Al Hadi IVF Center, IVF , Beirut, Lebanon
| | - W Akil
- Al Hadi IVF Center, IVF , Beirut, Lebanon
| | - R Sfarjlani
- Balamand University , Medicine, Beirut, Lebanon
| | - J Chedid
- Balamand University , Medicine, Beirut, Lebanon
| | - J Daou
- Balamand University , Medicine, Beirut, Lebanon
| | | | - R Ali
- Lebanese University , Medicine, Beirut, Lebanon
| | - R Abou Zeid
- Lebanese University , Medicine, Beirut, Lebanon
| | - R Zahwe
- Al Hadi IVF Center, IVF , Beirut, Lebanon
| | - J Saad
- Balamand University , Medicine, Beirut, Lebanon
| | - S El samad
- Balamand University , Medicine, Beirut, Lebanon
| | - F Fakih
- Al Hadi IVF Center, IVF , Beirut, Lebanon
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26
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Haroon MZ, Farooq U, Ashraf S, Zeb S, Gillani SY, Malik S, Ali R, Irshad R, Mehmood Z, Abbas Y, Masood A, Ghafoor A, Khalil AT, Asif H, Khan S, Ujjan ID, Nigar R, Livingstone S, Pascual-Figal DA, Togni S, Allergini P, Riva A, Khan A. Colchicine anti-inflammatory therapy for non-intensive care unit hospitalized COVID-19 patients: results from a pilot open-label, randomized controlled clinical trial. J Physiol Pharmacol 2022; 73. [PMID: 36302537 DOI: 10.26402/jpp.2022.3.09] [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] [Received: 05/29/2022] [Accepted: 06/30/2022] [Indexed: 06/16/2023]
Abstract
Systemic inflammation is a hallmark of severe coronavirus disease-19 (COVID-19). Anti-inflammatory therapy is considered crucial to modulate the hyperinflammatory response (cytokine storm) in hospitalized COVID-19 patients. There is currently no specific, conclusively proven, cost-efficient, and worldwide available anti-inflammatory therapy available to treat COVID-19 patients with cytokine storm. The present study aimed to investigate the treatment benefit of oral colchicine for hospitalized COVID-19 patients with suspected cytokine storm. Colchicine is an approved drug and possesses multiple anti-inflammatory mechanisms. This was a pilot, open-label randomized controlled clinical trial comparing standard of care (SOC) plus oral colchicine (colchicine arm) vs. SOC alone (control arm) in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. Colchicine treatment was initiated within first 48 hours of admission delivered at 1.5 mg loading dose, followed by 0.5 mg b.i.d. for next 6 days and 0.5 mg q.d. for the second week. A total of 96 patients were randomly allocated to the colchicine (n=48) and control groups (n=48). Both colchicine and control group patients experienced similar clinical outcomes by day 14 of hospitalization. Treatment outcome by day 14 in colchicine vs control arm: recovered and discharged alive: 36 (75.0%) vs. 37 (77.1%), remain admitted after 14-days: 4 (8.3%) vs. 5 (10.4%), ICU transferred: 4 (8.3%) vs. 3 (6.3%), and mortality: 4 (8.3%) vs. 3 (6.3%). The speed of improvement of COVID-19 acute symptoms including shortness of breath, fever, cough, the need of supplementary oxygen, and oxygen saturation level, was almost identical in the two groups. Length of hospitalization was on average 1.5 day shorter in the colchicine group. There was no evidence for a difference between the two groups in the follow-up serum levels of inflammatory biomarkers including C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), ferritin, interleukin-6 (IL-6), high-sensitivity troponin T (hs-TnT) and N-terminal pro b-type natriuretic peptide (NT pro-BNP). According to the results of our study, oral colchicine does not appear to show clinical benefits in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. It is possible that the anti-inflammatory pathways of colchicine are not crucially involved in the pathogenesis of COVID-19.
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Affiliation(s)
- M Z Haroon
- Department of Community Medicine, Ayub Medical College, Abbottabad, Pakistan
| | - U Farooq
- Department of Community Medicine, Ayub Medical College, Abbottabad, Pakistan
| | - S Ashraf
- Department of Pulmonology and Critical Care Division, Khyber Teaching Hospital, Khyber Medical College, Peshawar, Pakistan
| | - S Zeb
- Department of General Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - S Y Gillani
- Department of Medicine, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - S Malik
- Department of Medicine, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - R Ali
- Department of Medicine, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - R Irshad
- Department of Pathology, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - Z Mehmood
- Department of Neurology, Lady Reading Hospital, Peshawar, Pakistan
| | - Y Abbas
- Department of General Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - A Masood
- Department of General Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - A Ghafoor
- Department of Gastroenterology, Lady Reading Hospital, Peshawar, Pakistan
| | - A T Khalil
- Department of Pathology, Lady Reading Hospital, Peshawar, Pakistan
| | - H Asif
- Department of Pulmonology and Critical Care Division, Khyber Teaching Hospital, Khyber Medical College, Peshawar, Pakistan
| | - S Khan
- Department of Pathology, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - I D Ujjan
- Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - R Nigar
- Department of Obstetrics and Gynecology, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - S Livingstone
- School of Medicine, University of Dundee, Dundee, UK
| | - D A Pascual-Figal
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - S Togni
- Research & Development Department, Indena S.p.A, Milan, Italy
| | - P Allergini
- Research & Development Department, Indena S.p.A, Milan, Italy
| | - A Riva
- Research & Development Department, Indena S.p.A, Milan, Italy
| | - A Khan
- Nuffield Division of Clinical Laboratory Sciences (NDCLS), Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
- INEOS Oxford Institute for Antimicrobial Research, University of Oxford, Oxford, UK
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27
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El Miedany Y, Abu-Zaid MH, Elgaafary M, Ali N, Mansour M, Fathi N, Hassan W, Mortada MA, Moussa S, Eissa M, Tabra SAA, Fouad N, Ali R, M Medhat B, Jamaleldeen J, Adel Abdelsalam Hussein Y, Ghaleb RM, Nourhan Elameen E, Dessouki E, Saber S. AB0908 Treating to target of psoriasis: An evidence-based consensus on clinical practice recommendations. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3382] [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: 11/04/2022]
Abstract
BackgroundThe Tight Control of psoriatic arthritis (TICOPA) trial revealed a treat to target (T2T) strategy has led to improved clinical outcomes in psoriatic arthritis (PsA). The heterogeneity of the disease, the feasibility of therapy and the associated comorbidities made the implementation of such strategy in routine care a real challenge. There is a high need for establish real world recommendations for the T2T approach in PsA tailored to the disease activity status, the Psoriasis manifestations as well as the individual patient’s requirements.Objectivesto provide up-to-date, evidence-based and consensus-based recommendations for Treat-to-Target management of psoriatic arthritis (PsA) and its associated clinical manifestations.Methods14 key clinical questions were identified by scientific committee according to the Patient/ Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature Review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 19 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations.ResultsAn online questionnaire were sent to expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifty-one recommendation items, categorized into 6 sections to address the main 6 PsA categories, were obtained. Agreement with the recommendations (rank 7-9) ranged from 89.5-100%. Consensus was reached (i.e.≥75%of respondents strongly agreed or agreed) on the wording of all the 51 clinical standards identified by the scientific committee. Algorithms for the management of PsA have been suggested.ConclusionThese recommendations provide an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal treat to target outcomes in in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.Disclosure of InterestsNone declared
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28
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El Miedany Y, Abu-Zaid MH, Elgaafary M, Ali N, Mansour M, Hassan W, Mortada MA, Eissa M, Tabra SAA, Fouad N, Ali R, M Medhat B, Adel Abdelsalam Hussein Y, Ghaleb RM, Nourhan Elameen E, Saber S, Moussa S. POS1168 TREAT TO TARGET OF GOUT: AN EVIDENCE-BASED CONSENSUS ON CLINICAL PRACTICE GUIDELINES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3477] [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: 11/04/2022]
Abstract
BackgroundNew therapies, management approaches and evidence regarding the management of gout have become available over the past years. This triggered the need for updated recommendations for the management of gout.Objectivesto develop an up-to-date consensus evidence-based clinical practice guideline for the management of gout including recommendations for management of acute gout flares, optimum usage of urate lowering therapy for chronic gout as well as patient education and lifestyle guidance.MethodsAn extensive systematic literature review was performed, and evidence-based recommendations were extrapolated, based on 16-key questions identified according to population, intervention, comparator, and outcomes (PICO) approach. For each item, the level of evidence was determined using the Oxford Centre for Evidence-based Medicine (CEBM) system. These were evaluated by a panel of 17-experts via online surveys over a 2-round Delphi process.ResultsAt the end of round 2, a total of 30-recommendation items, categorized into 10 domains to were obtained. Agreement with the recommendations (rank 7-9) ranged from 90-100%. Consensus was reached (i.e.≥75%of respondents strongly agreed or agreed) on the wording, the grade of recommendation and level of evidence of all the 30 clinical standards identified by the scientific committee. The guideline emphasized that all gouty patients should be screened for comorbidities. Based on this, an algorithm for treat to target management approach tailored to the individual patient’s needs and associated comorbidities has been outlined.ConclusionThis work provides updated evidence-based recommendations for the prevention and treatment of acute as well as chronic gouty arthritis. It provides an approach for physicians and patients making decisions on the management of gout. It will also facilitate improvement and uniformity of care.Disclosure of InterestsNone declared
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29
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Telfeian AE, Bajaj A, Sastry R, Ali R, Oyelese A, Fridley J, Camara-Quintana JQ, Niu T, Lewandrowski KU, Gokaslan ZL. Foraminal Access Strategies in Patients with Lumbar Posterolateral Fusions in Transforaminal Endoscopic Spine Surgery: Case Series and Technical Note. Pain Physician 2022; 25:E449-E455. [PMID: 35652774] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The treatment of post-laminectomy lumbar radiculopathy in the setting of a large posterolateral fusion mass presents an anatomic challenge to the spine interventionalist. OBJECTIVE To describe outcomes of awake, transforaminal endoscopic surgical treatment for patients presenting with lumbar radiculopathy after instrumented posterolateral lumbar fusions. STUDY DESIGN Retrospective chart review. SETTING This study took place in a single-center, academic hospital. METHODS The records of 538 patients who underwent awake transforaminal lumbar endoscopic decompression surgery performed by a single surgeon at a single institution between 2014 and 2019 were retrospectively reviewed. Fifteen consecutive patients who required drilling through their posterolateral fusion masses to access the post-fusion foraminal stenosis were included in this study. All included patients were followed for at least one year after surgery. RESULTS Fifteen patients (7 male and 8 female) with an average age of 68.1 years (range 38-89, standard deviation 13.4 years) underwent awake transforaminal foraminal decompression surgeries that utilized special techniques to drill through large posterolateral fusion masses to access their foraminal stenosis. One patient (7%) required repeat surgery in the postoperative period due to lack of surgical improvement. For the remaining 14 patients, at one year follow up, the preoperative visual analog scale (VAS) for leg pain and Oswestry disability index (ODI) improved from 7.0 (± 1.7) and 40.7% (± 12.9) to 1.7 (± 1.6) and 12.1% (± 11.3). There were no complications such as infection, durotomy, or neurologic injury. LIMITATIONS Retrospective case series. CONCLUSION Transforaminal endoscopic spine surgery offers a unique approach to post-laminectomy and post-fusion foraminal compression because it avoids scar tissue resulting from previous posterior approaches. Large posterolateral fusion masses associated with some posterior fusions can be a sizeable bony barrier to transforaminal access. The authors share their techniques and success for navigating large posterior, bony fusion masses in transforaminal post-fusion foraminal decompression.
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Affiliation(s)
- Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Ankush Bajaj
- Dept. of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Rahul Sastry
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rohaid Ali
- Dept. of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adetokunbo Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jared Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Tianyi Niu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Kai-Uwe Lewandrowski
- Dept. of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
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Qaraad B, Moaaz O, Baleanu D, Santra SS, Ali R, Elabbasy EM. Third-order neutral differential equations of the mixed type: Oscillatory and asymptotic behavior. Math Biosci Eng 2022; 19:1649-1658. [PMID: 35135222 DOI: 10.3934/mbe.2022077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this work, by using both the comparison technique with first-order differential inequalities and the Riccati transformation, we extend this development to a class of third-order neutral differential equations of the mixed type. We present new criteria for oscillation of all solutions, which improve and extend some existing ones in the literature. In addition, we provide an example to illustrate our results.
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Affiliation(s)
- B Qaraad
- Department of Mathematics, Faculty of Science, Mansoura University, Mansoura 35516, Egypt
- Department of Mathematics, Faculty of Science, Amran University, Amran, Yemen
| | - O Moaaz
- Department of Mathematics, Faculty of Science, Mansoura University, Mansoura 35516, Egypt
- Section of Mathematics, International Telematic University Uninettuno, CorsoVittorio Emanuele II, Roma 39, 00186, Italy
| | - D Baleanu
- Department of Mathematics and Computer Science, Faculty of Arts and Sciences, Çankaya University Ankara, Etimesgut 06790, Turkey
- Instiute of Space Sciences, Magurele-Bucharest, Magurele 077125, Romania; Department of Medical Research, China
- Medical University Hospital, China Medical University, Taiwan, China
| | - S S Santra
- Department of Mathematics, JIS College of Engineering, Kalyani, West Bengal - 741235, India
| | - R Ali
- Department of Mathematics, College of Science, King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia
| | - E M Elabbasy
- Department of Mathematics, Faculty of Science, Mansoura University, Mansoura 35516, Egypt
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Ali R, Syed S, Sastry RA, Abdulrazeq H, Shao B, Roye GD, Doberstein CE, Oyelese A, Niu T, Gokaslan ZL, Telfeian A. Toward more accurate documentation in neurosurgical care. Neurosurg Focus 2021; 51:E11. [PMID: 34724645 DOI: 10.3171/2021.8.focus21387] [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: 06/30/2021] [Accepted: 08/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Accurate clinical documentation is foundational to any quality improvement endeavor as it is ultimately the medical record that is measured in assessing change. Literature on high-yield interventions to improve the accuracy and completeness of clinical documentation by neurosurgical providers is limited. Therefore, the authors sought to share a single-institution experience of a two-part intervention to enhance clinical documentation by a neurosurgery inpatient service. METHODS At an urban, level I trauma, academic teaching hospital, a two-part intervention was implemented to enhance the accuracy of clinical documentation of neurosurgery inpatients by residents and advanced practice providers (APPs). Residents and APPs were instructed on the most common neurosurgical complications or comorbidities (CCs) and major complications or comorbidities (MCCs), as defined by Medicare. Additionally, a "system-based" progress note template was changed to a "problem-based" progress note template. Prepost analysis was performed to compare the CC/MCC capture rates for the 12 months prior to the intervention with those for the 3 months after the intervention. RESULTS The CC/MCC capture rate for the neurosurgery service line rose from 62% in the 12 months preintervention to 74% in the 3 months after intervention, representing a significant change (p = 0.00002). CONCLUSIONS Existing clinical documentation habits by neurosurgical residents and APPs may fail to capture the extent of neurosurgical inpatients with CC/MCCs. An intervention that focuses on the most common CC/MCCs and utilizes a problem-based progress note template may lead to more accurate appraisals of neurosurgical patient acuity.
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Affiliation(s)
- Rohaid Ali
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Sohail Syed
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Rahul A Sastry
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Hael Abdulrazeq
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Belinda Shao
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - G Dean Roye
- 2Department of Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Curtis E Doberstein
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Adetokunbo Oyelese
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Tianyi Niu
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Ziya L Gokaslan
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Albert Telfeian
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
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Ali R, Wharton R, Li L, Waterman J. 932 Delivering Excellence in Orthopaedic Training - A Five Year Qualitative Study of Characteristics Valued by Trainees Voting for Trainer of The Year. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Previous studies have described attributes of successful trainers. Dean et al’s (2017) systematic analysis found 12 commonly cited positive characteristics in medical literature. This paper and Nisar et al’s (2011) study which had a more exhaustive list of desirable qualities in surgical trainers formed the basis of our thematic analysis to identify trainer characteristics/behaviours valued by trainees on an orthopaedic training programme.
Method
We evaluated qualitative data from votes on the North West Thames rotation for Trainer of the Year over a 5-year period (2016-2020). We applied thematic analysis to identify 15 characteristics commonly cited by trainees in their nominations and logged how frequently each characteristic was raised.
Results
The five most popular qualities possessed by nominees are 1) prioritisation of training needs and endeavouring to create more training opportunities for trainees 2) being a source of support 3) willingness to allow trainees to operate 4) setting and facilitating the achievement of educational goals/targets 5) providing appropriate levels of supervision. All 15 valued characteristics and their frequency of mention are listed in the table presented.
Conclusions
To the best of our knowledge this is the only study which focuses exclusively on desirable qualities orthopaedic specialist trainees’ value in their trainers. ‘Advocating for trainees’ is a valued quality, also highlighted in ASIT’s 2018 analysis of the Silver Scalpel Award nominations, which is not otherwise well described in the literature. We hope our work will allow aspiring orthopaedic trainers insight into what trainee’s value most in a surgical mentor.
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Affiliation(s)
- R Ali
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - R Wharton
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, United Kingdom
| | - L Li
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Waterman
- The Hillingdon Hospitals NHS Foundation Trust, London, United Kingdom
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Marlow N, McNamara J, Ali R, Bentley T, James M, Bond-Smith G. 1266 Digital Rectal Examination: Do You Still Put Your Foot in It If You Don’t Put Your Finger in It? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.424] [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: 11/13/2022]
Abstract
Abstract
Introduction
Most surgical trainees are familiar with the aphorism ‘if you don’t put your finger in it, you put your foot in it’, with regards to digital rectal examination (DRE). This commonly taught maxim, attributed to Bailey and Love in their Short Practice of Surgery, was coined to highlight the folly of neglecting DRE in patients with histories suggestive of malignant anorectal pathology. However, data are lacking on the diagnostic yield of DRE for detecting anorectal cancer in patients with lower gastrointestinal bleeding (LGIB), whilst advances in biomarker and imaging technology beg the question: is there still a role for DRE in the assessment of patients with LGIB?
Method
We designed a clinical coding search strategy to identify all adult patients with acute LGIB referred to general surgery at a UK university hospital from January to July 2020. Electronic patient records were interrogated to identify history and examination findings, diagnoses and clinical outcomes.
Results
169 patients (median age 63 (16-94) years, 54.4% male) were identified, 74.6% (126/169) with bright red bleeding, 23.7% (40/169) with altered blood and 1.8% (3/169) with melaena. DRE was performed in 91.1% (154/169) of patients, identifying blood in 42.9% (66/154) of cases and suspicious lesions, which were subsequently confirmed as anorectal malignancy, in 1.3% (2/154).
Conclusions
DRE represents a possibly stigmatising and uncomfortable examination for patients and clinicians alike. These data support the utility of DRE in patients with LGIB and may inform the discussion at the bedside to facilitate the timely diagnosis of anorectal malignancy.
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Affiliation(s)
- N Marlow
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - J McNamara
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - R Ali
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - T Bentley
- University of Oxford Medical School, Oxford, United Kingdom
| | - M James
- University of Oxford Medical School, Oxford, United Kingdom
| | - G Bond-Smith
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Erdman P, Ali R, Bhattacharya R. 1439 A Change in The Use of Post-Operative Drains in Total Knee Arthroplasty (TKA). Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1053] [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: 11/13/2022]
Abstract
Abstract
Aim
Closed suction drains (CSD) are routinely used to reduce the risk of haematoma formation and wound infections in TKA. Our study aims to determine if the use of drains has any impact on estimated blood loss, transfusion rates and length of stay in hospital.
Method
Elective TKA cases performed under a single consultant between February 2018-March 2020 were identified. Electronic medical records were reviewed, and data collected on relevant variables. Estimated blood loss was calculated using Ward’s formula. Mann-Whitney U test was applied to assess for statistical significance.
Results
A total of 86 elective TKA cases were included in the study. In 41 cases patients had a CSD insitu post-operatively (group 1), in the other 45 cases a drain was not used (group 2). Both groups had similar distributions of age, BMI, and sex. We found no statistically significant differences in mean change (+/-SD) in haemoglobin post-operatively between group 1 (21.3 (+/- 9.4)) and group 2 (19 (+/- 10)), (p = 0.34). Mean estimated blood loss was 915mls (+/-365) for group 1 and 871mls (+/-455) for group 2, (p = 0.45). Group 1 had a higher rate of transfusion (4.8% vs 2.2%); however, this was not statistically significant (p = 0.51). After accounting for unrelated medical complications or social barriers to discharge, the length of hospital stay was 4.7 (+/- 2.27) and 4.9 (+/- 3.14) for group 1 and 2 respectively, (p = 0.84). There were no reported cases of wound infection in both groups.
Conclusions
We found the use of drains in TKA confers no benefits in the outcomes evaluated.
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Affiliation(s)
- P Erdman
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - R Ali
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - R Bhattacharya
- Imperial College Healthcare NHS Trust, London, United Kingdom
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Sallam M, Patel R, Sun W, Ali R, Windle R, Shalaby S, Ward J, Bond-smith G. 1134 Incidence of Bile Acid Diarrhoea Post-Cholecystectomy - A Single Centre Cohort. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.676] [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: 11/13/2022]
Abstract
Abstract
Aim
Bile acid diarrhoea (BAD) can occur as a result of enterohepatic circulation interruption following cholecystectomy. Although up to 57.2% of patients are reported to develop post-cholecystectomy diarrhoea, this is not always because of BAD. The aim of this study was to determine the incidence of post-cholecystectomy BAD diagnosis and evaluate the current practices.
Method
This study was conducted as part of BADCAP study. The electronic records of patients underwent cholecystectomy operation at Oxford University Hospitals between January 2013 and December 2017 were retrospectively analysed. Records were matched with patients who underwent 75SeHCAT testing during the same time period. A positive 75SeHCAT testing was defined as a seven-day retention time of < 15%.
Results
A total of 4327 patients underwent cholecystectomy operation. 2.05% (N = 89) investigated for diarrhoea by 75SeHCAT. Alongside 75SeHCAT, 69.7% (N = 62) had colonoscopy, 37.1% (N = 33) had CT abdomen and pelvis and 3.4% (N = 3) had MRCP/MRE. Gender wise statistics revealed females were 74.5% (N = 73) and males were 19.1% (N = 17). Median time from cholecystectomy to 75SeHCAT test was 780 days (SD +/-510 days). 70.8% (N = 63) had a positive 75SeHCAT test for BAD. IBD was confirmed in 2.2% (N = 2).
Conclusions
A small number of patients were investigated and only 1.5% were diagnosed with post-cholecystectomy diarrhoea. There was a significant time delay from operation to diagnosis. The true prevalence of BAD after cholecystectomy may be much higher and clinicians need to have an increased awareness of this condition. 75SeHCAT is a useful tool for diagnosis of bile acid diarrhoea.
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Affiliation(s)
- M Sallam
- Oxford University Hospitals, Oxford, United Kingdom
| | - R Patel
- Oxford University Hospitals, Oxford, United Kingdom
| | - W Sun
- Oxford University Hospitals, Oxford, United Kingdom
| | - R Ali
- Oxford University Hospitals, Oxford, United Kingdom
| | - R Windle
- Oxford University Hospitals, Oxford, United Kingdom
| | - S Shalaby
- Oxford University Hospitals, Oxford, United Kingdom
| | - J Ward
- Oxford University Hospitals, Oxford, United Kingdom
| | - G Bond-smith
- Oxford University Hospitals, Oxford, United Kingdom
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Ullah A, Ali N, Ahmad S, Rahman SU, Alghamdi S, Bannunah AM, Ali R, Aman A, Khan J, Hussain H, Sahibzada MUK. Glycogen synthase kinase-3 (GSK-3) a magic enzyme: it's role in diabetes mellitus and glucose homeostasis, interactions with fluroquionlones. A mini-review. BRAZ J BIOL 2021; 83:e250179. [PMID: 34524376 DOI: 10.1590/1519-6984.250179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/01/2021] [Indexed: 01/08/2023] Open
Abstract
Diabetes mellitus (DM) is a non-communicable disease throughout the world in which there is persistently high blood glucose level from the normal range. The diabetes and insulin resistance are mainly responsible for the morbidities and mortalities of humans in the world. This disease is mainly regulated by various enzymes and hormones among which Glycogen synthase kinase-3 (GSK-3) is a principle enzyme and insulin is the key hormone regulating it. The GSK-3, that is the key enzyme is normally showing its actions by various mechanisms that include its phosphorylation, formation of protein complexes, and other cellular distribution and thus it control and directly affects cellular morphology, its growth, mobility and apoptosis of the cell. Disturbances in the action of GSK-3 enzyme may leads to various disease conditions that include insulin resistance leading to diabetes, neurological disease like Alzheimer's disease and cancer. Fluoroquinolones are the most common class of drugs that shows dysglycemic effects via interacting with GSK-3 enzyme. Therefore, it is the need of the day to properly understand functions and mechanisms of GSK-3, especially its role in glucose homeostasis via effects on glycogen synthase.
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Affiliation(s)
- A Ullah
- Department of Pharmacy, Shaheed Benazir Bhutto University, Sheringal, Dir Upper, Khyber Pakhtunkhwa, Pakistan.,Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - N Ali
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - S Ahmad
- Department of Pharmacy, Shaheed Benazir Bhutto University, Sheringal, Dir Upper, Khyber Pakhtunkhwa, Pakistan
| | - S U Rahman
- Department of Pharmacy, Shaheed Benazir Bhutto University, Sheringal, Dir Upper, Khyber Pakhtunkhwa, Pakistan
| | - S Alghamdi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - A M Bannunah
- Department of Basic Sciences, Common First year Deanship, Umm Al-Qura University, Makkah, Saudi Arabia
| | - R Ali
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - A Aman
- Department of Pharmacy, Shaheed Benazir Bhutto University, Sheringal, Dir Upper, Khyber Pakhtunkhwa, Pakistan
| | - J Khan
- Department of Pharmacy, University of Malakand, Chakdara Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - H Hussain
- Department of Pharmacy, Shaheed Benazir Bhutto University, Sheringal, Dir Upper, Khyber Pakhtunkhwa, Pakistan
| | - M U K Sahibzada
- Department of Pharmacy, Sarhad University of Science and Information Technology, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Kalim B, Ali NM, Iqbal A, Zahid MT, Rehman S, Bashir N, Ali R. Modulating the production of xylanase by Bacillus pumilus BS131 through optimization using waste fiber sludge. BRAZ J BIOL 2021; 83:e243874. [PMID: 34378658 DOI: 10.1590/1519-6984.243874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/01/2021] [Indexed: 11/22/2022] Open
Abstract
In recent days, cheapest alternative carbon source for fermentation purpose is desirable to minimize production cost. Xylanases have become attractive enzymes as their potential in bio-bleaching of pulp and paper industry. The objective of the present study was to identify the potential ability on the xylanase production by locally isolated Bacillus pumilus BS131 by using waste fiber sludge and wheat bran media under submerged fermentation. Culture growth conditions were optimized to obtain significant amount of xylanase. Maximum xylanase production was recorded after 72 hours of incubation at 30 °C and 7 pH with 4.0% substrate concentration. In the nutshell, the production of xylanase using inexpensive waste fiber sludge and wheat-bran as an alternative in place of expensive xylan substrate was more cost effective and environment friendly.
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Affiliation(s)
- B Kalim
- GC University, Department of Zoology, Microbiology Laboratories, Lahore, Punjab, Pakistan
| | - N M Ali
- GC University, Department of Zoology, Microbiology Laboratories, Lahore, Punjab, Pakistan
| | - A Iqbal
- University of Veterinary and Animal Sciences, Department of Wild Life and Ecology, Developmental Biology Laboratories, Lahore, Punjab, Pakistan
| | - M T Zahid
- GC University, Department of Zoology, Molecular Biology Laboratories, Lahore, Punjab, Pakistan
| | - S Rehman
- GC University, Department of Zoology, Microbiology Laboratories, Lahore, Punjab, Pakistan
| | - N Bashir
- GC University, Department of Chemistry, Organic Chemistry Laboratories, Lahore, Punjab, Pakistan
| | - R Ali
- University of the Punjab, Institute of Biochemistry and Biotechnology, Biochemistry Laboratories, Lahore, Punjab, Pakistan
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Fakih C, Raad G, Azaki R, Yazbeck R, Zahwe R, Bazzi M, Fakih I, Fakih G, Abo. Layla H, Ali R, Abo. Layla R, Mourad Y, Fakih F. P–688 Assessment of ovarian vascularity by three-dimensional vaginal power Doppler on day two of menstrual cycle to predict the number of mature eggs collected. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.687] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Could ovarian vascularity indices, measured by 3-dimensional (3D) vaginal power Doppler, predict the number of mature oocytes collected after controlled ovarian stimulation?
Summary answer
Ovarian vascularity index (VI) may be an indicator of poor (<three mature eggs collected) and high (>ten mature eggs collected) ovarian responses to gonadotropins.
What is known already
Poor and/or hyper ovarian responses to gonadotropins may be related to cycle cancellation during controlled ovarian stimulation (COS). In this context, gonadotropin dose is often individualized using patient features that predict ovarian response (such as age, antral follicular count (AFC) and anti-Müllerian hormone (AMH)). In parallel, ovarian vascularity color doppler is a valuable evaluation method to predict the ovarian hyperstimulation syndrome and the growth/maturity of Graafian follicles. The aim of the present study is to estimate the utility of 3-dimensional vaginal power Doppler and ovarian vascular flow indices in the prediction of the number of mature occytes collected after COS.
Study design, size, duration
A prospective study was conducted on 200 couples undergoing intracytoplasmic sperm injection cycle at Al Hadi Laboratory and Medical center, Beirut, Lebanon. It was performed between January 2020 and July 2020. Couples were categorized into poor responders group (3 or less metaphase II (MII) eggs collected) (n = 43), high responders group (10 or more MII eggs collected) group (n = 66), and normal responders group (more than 3 and less than 10 MII eggs collected) (n = 66).
Participants/materials, setting, methods
On the second day of the menstrual cycle, ovarian volume and vascularity parameters (vascularity index (VI), flow index (FI), and vascularity flow index (VFI)) were measured using the 3D power Doppler and the Virtual Organ Computer-Aided Analysis. On the same day, the antral follicle count was evaluated and a blood sample for AMH testing was collected. Women included in the study have undergone COS using GnRH antagonist protocol.
Main results and the role of chance
Receiver operator characteristics (ROC) curve model was used to predict the number of mature eggs collected. 7 parameters were used to predict poor and high ovarian responses (Age, AMH, AFC, ovarian volume, VI, FI and VFI). Ovarian VI significantly predicted poor ovarian response to gonadotropins (p = 0.033 and area under the curve (AUC)=0.668). Subsequently, the cut off value was 0.0025 with 84% sensitivity and 83.3% specificity. In parallel, ovarian VI significantly predicted high ovarian response to gonadotropins (p = 0.036 and AUC (0.778)) with a cut off value 0.0375 and with 77.8% sensitivity and 78.3% specificity. Furthermore, VFI significantly predicted high ovarian response to gonadotropins (p = 0.045; AUC=0.677).
Limitations, reasons for caution
It will be necessary to perform a prospective analysis on a broad sample size to validate these findings. In addition, it will be interesting to assess the impact of ovarian vascularity on pregnancy outcomes.
Wider implications of the findings: Assessing ovarian vascularity prior to ovarian stimulation can help reduce the rate of cycle cancellation. In addition, more studies are welcomed in the field to unravel the mechanisms behind altered ovarian vascularity and to test the possibility of restoring normal ovarian physiology.
Trial registration number
Not applicable
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Affiliation(s)
- C Fakih
- Al Hadi IVF Center, IVF, Beirut, Lebanon
| | - G Raad
- Al Hadi IVF Center, IVF, Beirut, Lebanon
| | - R Azaki
- Lebanese University, ObGyn, Beirut, Lebanon
| | - R Yazbeck
- Al Hadi IVF Center, IVF, Beirut, Lebanon
| | - R Zahwe
- Al Hadi IVF Center, IVF, Beirut, Lebanon
| | - M Bazzi
- Al Hadi IVF Center, IVF, Beirut, Lebanon
| | - I Fakih
- Al Hadi IVF Center, IVF, Beirut, Lebanon
| | - G Fakih
- Al Hadi IVF Center, IVF, Beirut, Lebanon
| | | | - R Ali
- Lebanese University, ObGyn, Beirut, Lebanon
| | | | - Y Mourad
- Al Hadi IVF Center, IVF, Beirut, Lebanon
| | - F Fakih
- Al Hadi IVF Center, IVF, Beirut, Lebanon
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Rahat MA, Israr M, Hassan I, Islam M, -Ud-Din A, Ali A, Khan MI, Iqbal MS, Jabeen H, Rasool A, Akbar F, Khan MAA, Ullah N, Ali R, Nasar M, Shah M. Episode of Hepatitis C viral infection in the people of Swat, Pakistan. BRAZ J BIOL 2021; 82:e243283. [PMID: 34161427 DOI: 10.1590/1519-6984.243283] [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] [Received: 09/07/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.
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Affiliation(s)
- M A Rahat
- Department of Genetics, Hazara University, Mansehra, Pakistan
| | - M Israr
- Department of Forensic Sciences, University of Swat, Swat, Pakistan
| | - I Hassan
- Department of Genetics, Hazara University, Mansehra, Pakistan
| | - M Islam
- Department of Genetics, Hazara University, Mansehra, Pakistan
| | - A -Ud-Din
- Department of Genetics, Hazara University, Mansehra, Pakistan
| | - A Ali
- Department of Biochemistry, Saidu Medical College, Saidu Sharif Swat, Pakistan
| | - M I Khan
- Department of Genetics, Hazara University, Mansehra, Pakistan
| | - M S Iqbal
- Department of Botany, University of Gujrat, Gujrat, Pakistan
| | - H Jabeen
- Department of Microbiology, Women University Mardan, Pakistan
| | - A Rasool
- Centre for Biotechnology & Microbiology, University of Swat, Swat-19201, Pakistan
| | - F Akbar
- Centre for Biotechnology & Microbiology, University of Swat, Swat-19201, Pakistan
| | - M A A Khan
- Centre for Biotechnology & Microbiology, University of Peshawar, Pakistan
| | - N Ullah
- Department of Genetics, Hazara University, Mansehra, Pakistan
| | - R Ali
- Department of Genetics, Hazara University, Mansehra, Pakistan
| | - M Nasar
- Department of Biosciences, COMSAT University Islamabad, Pakistan
| | - M Shah
- Center for Animal Sciences & Fisheries, University of Swat, Swat, Pakistan
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Couzins M, Ali R, Mitchell O, Brennan PA, Bekker J. Computed tomography-guided transfacial buccal space core biopsy of deep head and neck space lesions: our experience. Br J Oral Maxillofac Surg 2021; 59:1238-1242. [PMID: 34284885 DOI: 10.1016/j.bjoms.2021.04.009] [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: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
Deep head and neck space lesions can present a number of diagnostic challenges due to their deep anatomical position and difficult access for diagnostic tissue sampling. We describe a series of percutaneous 'transfacial' buccal space computed tomography (CT)-guided core biopsies of these lesions and subsequent histological findings. Six patients underwent CT-guided core biopsy of deep parotid, parapharyngeal, or masticator space lesions over a 30-month period. We describe our biopsy technique and correlate our histological findings with subsequent surgical resection where performed. Five of six of CT-guided biopsies obtained sufficient tissue for histological interpretation with varying findings, including salivary gland tumours and squamous cell carcinoma confirmed on subsequent resection. One patient was treated palliatively following core biopsy. No biopsy-related complications were observed. In our small series, percutaneous CT-guided transfacial biopsy via the buccal space has proved an excellent option for the minimally invasive tissue acquisition of deep head and neck space lesions.
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Affiliation(s)
- M Couzins
- Departments of Clinical Radiology, Queen Alexandra Hospital, Portsmouth, UK.
| | - R Ali
- Departments of Clinical Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | - O Mitchell
- Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - P A Brennan
- Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - J Bekker
- Departments of Clinical Radiology, Queen Alexandra Hospital, Portsmouth, UK
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Day D, Chia J, Foo E, Ali R, Toh H, Segelov E. 98P Operational challenges of an Asian Pacific (APAC) academic oncology clinical trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.118] [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: 10/22/2022] Open
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Mezhal F, Ahmed L, Jabari A, Alzaabi T, Alblooshi M, Alhosani A, Ali R. The Epidemiology and Burden of Cardiometabolic Risk factors in a Young Emirati Population. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The United Arab Emirates (UAE) has experienced a rapid growth in economy. This growth was paralleled with a drastic rise in non-communicable diseases (NCDs); primarily cardiovascular disease, which accounts for 40% of mortality in UAE. These NCDs are caused by the accumulation of cardiometabolic risk factors (CRFs) such as obesity, dysglycemia, dyslipidemia, hypertension and central obesity. The CRFs are associated with other factors including sociodemography, physical inactivity, tobacco use, and heredity.
Objective
The objective is to investigate the burden of CRFs and their interrelationship, and to estimate the association with other determinants like sociodemographic status, lifestyle and family history.
Methods
Data was drawn from the UAE Healthy Future Study participants aged 18 to 40. Demographic and health data was collected by questionnaires. Measurements, blood pressure, and blood samples were collected. CRFs were analyzed by age and gender.
Results
A total of 5,126 eligible participants were included in the analysis. The age-adjusted prevalence rates were 26.5% for obesity, 11.7% for dysglycemia, 62.7% for dyslipidemia, 22.4% for hypertension and 22.5% for central obesity. Obesity had the strongest relationship with other metabolic factors. Education, employment, smoking and family history had associations with some metabolic markers. Forty percent had ≥2 risk factors. The burden of ≥ 2 CRFs was affected by age (OR 1.1), having lower education (OR 1.37) and having a family history (OR 1.44).
Conclusions
CRFs are highly prevalent in young adults in the UAE. These risk factors are accumulating and are affected by multiple determinants. Obesity is highly associated with having other CRFs simultaneously. This should be taken into account in the design of target-group-specific prevention of NCD development. Further research is needed to investigate how the clustering manifests in young adults to prevent the early rise of NCDs in the UAE.
Key messages
Cardiovascular disease and associated risk factors are highly prevalent in the young population (18-40) of the UAE. The clustering of cardiometabolic risk factors occurs early in young people in UAE.
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Affiliation(s)
- F Mezhal
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - L Ahmed
- Institute of Public Health, United Arab Emirates University, Al Aain, United Arab Emirates
| | - A Jabari
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - T Alzaabi
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - M Alblooshi
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - A Alhosani
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - R Ali
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
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Mantei F, Ouda M, Ali R, Schaadt A. Prozesssimulation des komplexen Gemischverhaltens von Oxymethylendimethylether (OME). CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- F. K. Mantei
- Fraunhofer-Institut für Solare Energiesysteme ISE Wasserstofftechnologien Heidenhofstr. 2 79110 Freiburg Deutschland
- Technische Universität Berlin Fachgebiet Verfahrenstechnik Fraunhoferstr. 33–36 10587 Berlin Deutschland
| | - M. Ouda
- Fraunhofer-Institut für Solare Energiesysteme ISE Wasserstofftechnologien Heidenhofstr. 2 79110 Freiburg Deutschland
| | - R. Ali
- Fraunhofer-Institut für Solare Energiesysteme ISE Wasserstofftechnologien Heidenhofstr. 2 79110 Freiburg Deutschland
| | - A. Schaadt
- Fraunhofer-Institut für Solare Energiesysteme ISE Wasserstofftechnologien Heidenhofstr. 2 79110 Freiburg Deutschland
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Alnuaimi K, Ali R, Al-Younis N. Job satisfaction, work environment and intent to stay of Jordanian midwives. Int Nurs Rev 2020; 67:403-410. [PMID: 32720311 DOI: 10.1111/inr.12605] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Abstract
AIM The aims of this study were to (1) assess the levels of Jordanian midwives' job satisfaction, intention to stay and work environment; (2) examine the relationship between work environment and intention to stay, and the level of job satisfaction among midwives working in Jordanian hospitals and maternal and child health centres and (3) to investigate the associations between job satisfaction and selected demographic variables among Jordanian midwives. BACKGROUND The shortage, turnover and retention of midwives are global problems and Jordan is one of the countries thathas a shortage of midwifery workforce. Job satisfaction is well studied among nurses worldwide; however, there are inadequate studies that have assessed the job satisfaction among midwives including Jordan. METHODS A descriptive, correlational design survey was used and a sample of 413 midwives were recruited from 14 different hospital settings (12 governmental and 2 teaching hospitals) and 8 health centres. RESULTS The levels of job satisfaction of Jordanian midwives were neither satisfied nor unsatisfied. The overall mean intent to stay at work was between neutral to agree in general. A positive significant correlation was found between job satisfaction, work environment and intent to stay. The work environment was neither a favourable nor an unfavourable. CONCLUSION AND IMPLICATIONS FOR NURSING, HEALTH AND EDUCATION POLICY: Jordanian midwives have neutral job satisfaction and work environment. Managerial plans and interventions are needed to improve midwives' job satisfaction and to create a favourable work environment which might reflect positively on their work and performance and improve their retention. Policymakers and mangers should enhance midwives' job satisfaction through external reward via salary, vacation and benefits packages. Engaging in research activities, publication and more collaboration with academic staff may improve midwives' professional development. Midwives should take more active roles in hospital affairs and receive more support by their management in Jordan.
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Affiliation(s)
- K Alnuaimi
- Maternal and Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - R Ali
- Maternal and Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - N Al-Younis
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Iqbal J, Asghar H, Shah SKH, Naeem M, Abbasi SA, Ali R. Elemental analysis of sage (herb) using calibration-free laser-induced breakdown spectroscopy. Appl Opt 2020; 59:4927-4932. [PMID: 32543489 DOI: 10.1364/ao.385932] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
In this work, laser-induced breakdown spectroscopy (LIBS) has been used for the quantitative and qualitative analysis of the sage sample using the calibration-free LIBS (CF-LIBS) technique. The sage plasma is generated by focusing the second harmonics (532 nm) of a Q-switched Nd:YAG laser with a repetition rate of 10 Hz and pulse duration of 5 ns. The emission spectra are recorded using a LIBS 2000 detection system spectrometer consisting of five high-resolution spectrometers covering a wavelength range from 200 to 720 nm. The optical emission spectra of the sage sample reveal the spectral lines of Fe, Ca, Ti, Co, Mn, Ni, and Cr. The plasma temperature and electron number density of the neutral spectral lines of the pertinent elements have been deduced using the Boltzmann plot and Stark-broadening line profile method, with average values 8855±885K and 3.89×1016cm-3, respectively. The average values of the plasma parameters were used for the quantification of the detected elements in the sample. Based on the calibration-free method, the measured results demonstrate that Fe is the major constituent in the sample, having a percentage concentration of 48.1%, while the remaining elements are Ca, Ti, Co, Mn, Ni, and Cr, with percentage concentrations 0.7%, 5.3%, 8%, 11%, 12.3%, and 14.6%, respectively. This study demonstrates the feasibility of LIBS for the compositional analysis of major and trace elements present in the plant samples and its further applications in medicine.
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Banik R, Bhattacharyya S, Biswas S, Bhattacharya S, Mukherjee G, Rajbanshi S, Dar S, Nandi S, Ali R, Chatterjee S, Das S, Das Gupta S, Ghugre SS, Goswami A, Mondal D, Mukhopadhyay S, Pai H, Pal S, Pandit D, Raut R, Ray P, Samanta S. Exploring the structure of Xe isotopes in A ~ 130 region: Single particle and collective excitations. EPJ Web Conf 2020. [DOI: 10.1051/epjconf/202023204001] [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: 11/15/2022] Open
Abstract
High and medium spin structures of 130,131Xe have been studied using α-induced fusion-evaporation reaction and the Indian National Gamma Array (INGA) coupled with a digital data acquisition system. Various new band structures and near yrast levels of 131Xe have been established. The multipolarities of the observed transitions have been assigned on the basis of the DCO ratios and the polarization asymmetry measurements. Band structures based on 1-quasi-particle (qp), 3-qp configurations have been observed. A new Magnetic Rotational (MR) band based on 5-qp configuration has also been established in 131Xe. The MR band has been interpreted in terms of shears mechanism with principal axis cranking (SPAC) calculations. Shell Model calculations are carried out to describe the non yrast states of 131Xe above the 11/2− isomer. New excited states have also been identified in 130Xe, produced in the same reaction.
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Ali R, Mehta P, Arshad MS, Kucuk I, Chang MW, Ahmad Z. Transdermal Microneedles-A Materials Perspective. AAPS PharmSciTech 2019; 21:12. [PMID: 31807980 DOI: 10.1208/s12249-019-1560-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022] Open
Abstract
Transdermal drug delivery is an emerging field in the pharmaceutical remit compared with conventional methods (oral and parenteral). Microneedle (MN)-based devices have gained significant interest as a strategy to overcome the skin's formidable barrier: the stratum corneum. This approach provides a less invasive, more efficient, patient friendly method of drug delivery with the ability to incorporate various therapeutic agents including macromolecules (proteins and peptides), anti-cancer agents and other hydrophilic and hydrophobic compounds. This short review attempts to assess the various materials involved in the fabrication of MNs as well as incorporation of other excipients to improve drug delivery for novel medical devices. The focus will be on polymers, metals and other inorganic materials utilised for MN drug delivery, as well as their application, limitations and future work to be carried out.
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Telfeian AE, Shen J, Ali R, Oyelese A, Fridley J, Gokaslan ZL. Incidence and Implications of Incidental Durotomy in Transforaminal Endoscopic Spine Surgery: Case Series. World Neurosurg 2019; 134:e951-e955. [PMID: 31734429 DOI: 10.1016/j.wneu.2019.11.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/19/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the incidence and outcomes of incidental durotomy in transforaminal endoscopic spine surgery. METHODS Transforaminal lumbar endoscopic procedures were performed by 2 surgeons in 907 patients over a period of 4 years from 2014 to 2018. Patient data were evaluated retrospectively in these patients with a minimum follow-up of 1 year. RESULTS In 907 patients over 4 years there were 5 durotomies: 4 incidental and 1 intentional. The rate for incidental durotomy was therefore 0.4%. There were no adverse outcomes from the incidental durotomies, and only 1 patient noted a headache. CONCLUSIONS Incidental durotomy is a rare complication of transforaminal lumbar endoscopic spine surgery and appears to occur more likely in patients who have undergone previous spine surgery at the site of the endoscopic procedure, not unexpectantly. Glues, patches, and bedrest were among the various methods used after durotomy. In this series there were no cases of symptomatic spinal fluid leakage or pseudomeningocele seen. Only 20% of patients who had durotomies noted a headache in the immediate postoperative period.
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Affiliation(s)
- Albert E Telfeian
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Jian Shen
- Mohawk Valley Orthopedics, Amsterdam, New York, USA
| | - Rohaid Ali
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adetokunbo Oyelese
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared Fridley
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Gibreel A, Ali R, Hemida R, Sherif L, El-Adawi N. Endometrial scratch for infertile polycystic ovary syndrome (PCOS) women undergoing laparoscopic ovarian drilling: a randomized controlled trial. Middle East Fertil Soc J 2019. [DOI: 10.1186/s43043-019-0001-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ali R, Hammad A, El-Nahrery E, Hamdy N, Elhawary AK, Eid R. Serum RANKL, osteoprotegerin (OPG) and RANKL/OPG ratio in children with systemic lupus erythematosus. Lupus 2019; 28:1233-1242. [DOI: 10.1177/0961203319867129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Systemic lupus erythematosus (SLE) patients have lower bone mineral density (BMD) compared with healthy individuals because of general, genetic, disease and medication-related factors. The disturbance of the receptor activator of nuclear factor-κB ligand (RANKL)/osteoprotegerin (OPG) ratio has been reported to be associated with low BMD in many disorders in adults and children alike. Objectives The objectives of this study were (i) to assess serum OPG, RANKL and RANKL/OPG ratio levels in SLE children and controls, (ii) to determine whether the cumulative glucocorticoid (CGCS) dose had any effect on the concentration of serum RANKL, OPG and RANKL/OPG ratio, and (iii) to determine the relation of these parameters to BMD. Methods We evaluated 50 SLE children and 50 age- and sex-matched healthy controls. RANKL and OPG were assessed in serum and compared between patients and controls. For SLE patients, a univariate followed by multivariable analysis were carried out to detect the possible predictors of the changes in RANKL, OPG and RANKL/OPG ratio levels. Lumbar BMD for all patients was assessed by dual-energy X-ray absorptiometry (DXA) scan and then correlated to different probable correlated factors. Results RANKL, OPG and RANKL/OPG ratio were significantly higher in SLE patients ( p ≤ 0.001). Univariate analysis showed significant correlations of RANKL with CGCS ( p ≤ 0.001) and with DXA scan z-score ( p = 0.007): OPG was significantly correlated to Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score ( p = 0.001) and anti-double-stranded DNA ( p = 0.001), whereas RANKL/OPG was significantly correlated to duration of illness and DXA z-score ( p = 0.002). The multivariable analysis showed that DXA z-score was an independent predictor of RANKL and RANKL/OPG ratio ( p = 0.019 and 0.008, respectively), whereas SLEDAI score was an independent predictor of OPG levels. BMD was negatively correlated to disease duration ( p = 0.008) and CGCS dose ( p = 0.015), but no significant correlation has been found between BMD and cumulative SLEDAI score ( p = 0.29). Conclusions Serum RANKL/OPG ratio is elevated in Egyptian children with SLE and is considered a risk factor for reduced bone mass in these children. Other risk factors for low BMD include high CGCS dose and disease duration, supporting that osteoporosis in SLE is multifactorial.
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Affiliation(s)
- R Ali
- Clinical Laboratory Sciences Department, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah Al-Mounawara, Saudi Arabia
- Genetics Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - A Hammad
- Pediatric Nephrology Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - E El-Nahrery
- Biochemistry, Chemistry Department, Faculty of Science, Suez University, Suez, Egypt
| | - N Hamdy
- Pediatric Nephrology Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - A K Elhawary
- Pediatric Endocrinology Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - R Eid
- Pediatric Nephrology Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
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