Robotics in revolutionizing neurosurgery.

Robot-assisted neurosurgery has revolutionized intricate brain and spinal procedures. From PUMA 560 to NeuroArm and ROSA, robotic systems have enhanced precision and enabled minimally invasive techniques. Despite challenges in LMICs, collaborative efforts in infrastructure, education, and international partnerships can foster equitable adoption of these transformative technologies.

Current status of implementation of trauma registries' in LMICs & facilitators to implementation barriers: A literature review & consultation.

Background & objectives Many low- and middle- income countries (LMICs) have attempted to implement trauma registries with varying degrees of success. This study aimed to understand the registry implementation mechanism in LMICs better. Study objectives include assessment of the current use of trauma registries in LMICs, identification of barriers to the process and potential areas for intervention, and investigation of the registry implementation experience of key stakeholders in LMICs. Methods An initial narrative review of articles on trauma registry use in LMICs published in English between January 2017 and September 2023 was conducted. Key findings identified in this review were used to establish a theoretical framework from which an interview guide was subsequently developed. Expert consultation with key stakeholders in trauma registry implementation in two LMICs was conducted to assess the experience of registry implementation further. Results The presence of trauma registries in LMICs is limited. Key implementation barriers include funding concerns, uncoordinated administrative efforts, lack of human and physical resources (i.e., technology, equipment), and challenges in data management, analysis, and quality. Stakeholder interviews highlighted the importance of trauma registry development but echoed some obstacles, notably funding and data collection barriers. Interpretation & conclusions Barriers to registry implementation are ubiquitous and may contribute to the low uptake of registries in LMICs. One potential solution to these challenges is the application of the WHO International Registry for Trauma and Emergency Care. Future studies examining context-specific challenges to registry implementation and sustained utilization are required.

Addressing the oversight medical cases in low-middle-income countries: poor mention of shaken baby syndrome in Nigeria; reasons, challenges, and recommendations.

INTRODUCTION: Shaken baby syndrome (SBS) is a severe form of child abuse that results in a triad of clinical findings: subdural hematoma, retinal hemorrhages, and encephalopathy. These injuries can lead to significant brain damage, developmental delays, disabilities, or even death. In addition to these, other indicative signs include bruises, vomiting, full fontanelles, sleepiness, seizures, and fractures. METHODS: This paper reviews the existing literature on SBS in Nigeria, identifies the challenges contributing to its underrecognition, and provides evidence-based recommendations for improving diagnosis, management, and prevention strategies in the region. CONCLUSIONS: Despite the profound impact of SBS, its recognition and management are inadequate, particularly in low- and middle-income countries (LMICs) like Nigeria, due to limited diagnostic capabilities and documentation. Addressing these gaps is crucial for safeguarding the well-being of infants and young children in Nigeria.

AI and neurosurgery: a new era of enhanced outcomes.

Artificial Intelligence (AI) is revolutionizing neurosurgery by enhancing diagnostic accuracy, surgical planning, and personalized patient care. Despite challenges like data privacy and bias, AI's integration promises to transform surgical outcomes and advance neurosurgical practice.

Breaking barriers: Addressing gender disparity in neurosurgery.

Neurosurgery is still dominated by men, with only 16.7% of neurosurgeons being women and even fewer in leadership roles. This disparity affects research, patient care, and health policy. To enhance care and equity, addressing barriers for women through targeted mentorship, inclusive practices, and policy changes is essential. CORRESPONDENCE: Despite significant progress in medical education and practice, neurosurgery remains a male-dominated specialty. This gender disparity is not merely a reflection of societal biases but a systemic issue that affects both the professional advancement of women and the quality of care delivered to patients. As the global health community strives for equity, the underrepresentation of women in neurosurgery demands urgent attention.

Long-term follow-up of the TRED-HF trial: Implications for therapy in patients with dilated cardiomyopathy and heart failure remission.

AIMS: In TRED-HF, 40% of patients with recovered dilated cardiomyopathy (DCM) relapsed in the short term after therapy withdrawal. This follow-up investigates the longer-term effects of therapy withdrawal. METHODS AND RESULTS: TRED-HF was a randomized trial investigating heart failure therapy withdrawal in patients with recovered DCM over 6 months. Those randomized to continue therapy subsequently withdrew treatment between 6 and 12 months. Participants were recommended to restart therapy post-trial and were followed until May 2023. Clinical outcomes are reported in a non-randomized fashion from enrolment and from the end of the trial. The primary outcome was relapse defined as ≥10% reduction in left ventricular ejection fraction to <50%, doubling in N-terminal pro-B-type natriuretic peptide to >400 ng/L, or clinical features of heart failure. From enrolment to the last follow-up (median 6 years, interquartile range 6-7), 33 of 51 patients (65%) relapsed. The 5-year relapse rate from enrolment was 61% (95% confidence interval [CI] 45-73) and from the end of the trial was 39% (95% CI 19-54). Of 20 patients who relapsed during the trial, nine had a recurrent relapse during follow-up. Thirteen relapsed for the first time after the trial; seven had restarted low intensity therapy, four had not restarted therapy and two did not have therapy withdrawn. The mean intensity of therapy was lower after the trial compared to enrolment (mean difference -6 [-8 to -4]; p < 0.001). One third of relapses during follow-up had identifiable triggers (arrhythmia [n = 4], pregnancy [n = 1], hypertension [n = 1], infection [n = 1]). Corrected atrial fibrillation was associated with reduced risk of relapse (hazard ratio 0.33, 95% CI 0.12-0.96; p = 0.042). CONCLUSIONS: The risk of relapse in the 5 years following the TRED-HF trial remained high. Restarting lower doses of heart failure medications at the end of the trial, external triggers and disease progression are likely to have contributed to relapse.

Antibiotic misuse in neurosurgery: a threat to patient safety and surgical outcomes.

Inappropriate antibiotic use in neurosurgery poses significant threats to global public health. Infections in neurosurgical patients can lead to devastating consequences, complicated by antibiotic-resistant bacteria. The CDC reports at least 2.8 million drug-resistant infections annually in the US, resulting in 35,000 deaths. Addressing this issue requires interdisciplinary approaches, engaging healthcare providers, researchers, policymakers, and the public. Understanding factors contributing to antibiotic misuse is essential in safeguarding the future of surgical procedures and protecting patient health.

Precision prediction of heart failure events in patients with dilated cardiomyopathy and mildly reduced ejection fraction using multi-parametric cardiovascular magnetic resonance.

AIMS: To assess whether left ventricular (LV) global longitudinal strain (GLS), derived from cardiovascular magnetic resonance (CMR), is associated with (i) progressive heart failure (HF), and (ii) sudden cardiac death (SCD) in patients with dilated cardiomyopathy with mildly reduced ejection fraction (DCMmrEF). METHODS AND RESULTS: We conducted a prospective observational cohort study of patients with DCM and LV ejection fraction (LVEF) ≥40% assessed by CMR, including feature-tracking to assess LV GLS and late gadolinium enhancement (LGE). Long-term adjudicated follow-up included (i) HF hospitalization, LV assist device implantation or HF death, and (ii) SCD or aborted SCD (aSCD). Of 355 patients with DCMmrEF (median age 54 years [interquartile range 43-64], 216 men [60.8%], median LVEF 49% [46-54]) followed up for a median 7.8 years (5.2-9.4), 32 patients (9%) experienced HF events and 19 (5%) died suddenly or experienced aSCD. LV GLS was associated with HF events in a multivariable model when considered as either a continuous (per % hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.00-1.21, p = 0.045) or dichotomized variable (LV GLS > -15.4%: HR 2.70, 95% CI 1.30-5.94, p = 0.008). LGE presence was not associated with HF events (HR 1.49, 95% CI 0.73-3.01, p = 0.270). Conversely, LV GLS was not associated with SCD/aSCD (per % HR 1.07, 95% CI 0.95-1.22, p = 0.257), whereas LGE presence was (HR 3.58, 95% CI 1.39-9.23, p = 0.008). LVEF was neither associated with HF events nor SCD/aSCD. CONCLUSION: Multi-parametric CMR has utility for precision prognostic stratification of patients with DCMmrEF. LV GLS stratifies risk of progressive HF, while LGE stratifies SCD risk.

Bridging the gap: enhancing TBI care in Pakistan's primary and secondary healthcare settings.

Traumatic Brain Injury (TBI) in Pakistan is predominantly caused by road traffic accidents, falls, and violence, resulting in approximately 300,000 new cases annually. Significant gaps exist in awareness, resources, and accessibility for effective TBI management, especially in primary care settings. To improve care, strategies include training healthcare providers, nationwide awareness campaigns, strengthening healthcare infrastructure, and establishing referral systems. Collaboration between government, NGOs, and international partners is crucial for enhancing TBI management.

Pioneers of Neurosurgery in the South Asian Association for Regional Cooperation (SAARC) Region: A Historical Vignette and Beyond.

South Asia, consisting of Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka, spreads between the Himalayan base and the Indian Ocean and shares identical geophysical characteristics. With the inclusion of its newest member Afghanistan, these 8 member nations of the South Asian Association for Regional Cooperation (SAARC) share more or less a homogenous geographical, political, and historical background and cultural heritage, with a significant role in shaping the world. This densely populated area is home to around a quarter of the world's total population. From the ancient ages, the neurosurgical practice has paced relentlessly and in the last 100 years, it has reached its zenith. With modern advancements, neurosurgery has developed in its diagnostic and treatment modalities along with facilities for training and education. Despite falling behind owing to economic, educational, and geopolitical constraints, the pioneers of the SAARC region have established the fields of neurosurgery in their respective countries with command. No constraint could stop them from educating and training young physicians to make competent neurosurgeons to evolve the field of neurosurgery in their countries. Their firm determination and hard work paved the way to keep this field striving and thriving, to serve a substantial volume of the world population with their neurosurgical insight and skill. However, this region needs to go a long way as the number of neurosurgeons and facilities is still insufficient. This can be achieved with the guidance and collaboration among the neurosurgeons of the SAARC region as the youth here are talented and hardworking.

Democratizing neurosurgical knowledge: a call for publishing reform.

Publishing a scientific article in good journals with good Impact factor has become very difficult these days. This is not all depend on the quality of article. Most of times it's the lack of ability to pay the article processing fee. In Low and middle income countries (LMIC) it becomes more difficult as the research is not supported by government and institutions. Here we delve into the real problems of research article publication in LMIC.

Strength in silence: the journey of mothers raising children with hydrocephalus.

BACKGROUND: Raising a child with hydrocephalus can be very challenging, especially in low- and middle-income countries. In Pakistan, mothers being the primary caregivers for their hydrocephalic children are under tremendous stress. METHODS: This study explores the challenges faced by Pakistani mothers raising children with hydrocephalus, employing a qualitative methodology through focus group discussions comprising ten mothers of hydrocephalic babies at Tertiary Care Hospital in Pakistan. RESULTS: The findings highlight three main themes: emotional toll, social isolation, and financial strain. Mothers experience significant emotional stress due to societal stigma and a lack of support, particularly from their husbands and family. Social isolation is prevalent, as mothers fear sharing their burdens and face physical confinement due to their children's needs. Financial strain is another major issue, with high medical costs adding to their economic difficulties. CONCLUSION: The study emphasizes improved access to specialized care, awareness campaigns to reduce stigma, financial assistance, and stronger community support networks to support these mothers better. Addressing these unmet needs is crucial for empowering Pakistani mothers in their caregiving roles and improving the quality of life for their children with hydrocephalus.

Carving a Path to the Brain: A Study on Neurosurgery Career Choices.

BACKGROUND: Medical students often face challenges in choosing a career path due to limited exposure to specialized fields like neurosurgery. Understanding their perceptions and experiences is crucial in addressing the gaps in neurosurgical education and inspiring future neurosurgeons. METHODS: A cross-sectional study was conducted involving 461 medical students, utilizing convenience sampling. Data collection employed a validated, self-administered tool. Statistical analysis in SPSS Version 25 included t-tests and chi-square tests, comparing scores based on age, gender, year of study, and exposure to the formal neurosurgical rotations in their institute. Significance value was set at P < 0.05. RESULTS: In the study of 461 medical students, 79.8% identified with the 19-23 age group, and 63.8% affirmed neurosurgery exposure. Medical students' perceptions included: 167 (36.3%) students found neurosurgery teaching sufficient; 164 (35.6%) disagreed that obtaining neurosurgical history is difficult; 224 (48.6%) agreed on neurosurgical disease complexity; and 250 (54.2%) found these diseases challenging and interesting. A majority of 183 (39.7%) respondents agreed that neurosurgical diseases had poor outcomes. Regarding training for neurosurgical surgery, 205 (44.5%) participants strongly agreed on its length, and 215 (46.7%) consented to extensive operating hours. However, 167 (36.3%) strongly disagreed about the ample job prospects in Pakistan. CONCLUSIONS: Enhancing neurosurgery education with quality, consistency, and adaptability is essential to bridge gaps and inspire future neurosurgeons. These findings guide improvements in educational programs, preparing a skilled workforce to meet evolving health-care demands.