Global Neurosurgical Challenges: A Focus on Central Asia.

OBJECTIVE: To evaluate the current state of neurosurgical care in Central Asia, identify the challenges and advancements, and propose recommendations to improve neurosurgical capabilities and access in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. METHODS: A comprehensive review of the neurosurgical infrastructure, availability of neurosurgeons, technological advancements, and healthcare policies in the five Central Asian countries. Analysis included published literature, healthcare reports, and expert opinions to assess the state of neurosurgical care and identify areas for improvement. RESULTS: Significant variation in neurosurgical care was observed across the region. Kazakhstan showed notable advancements, including an increased number of neurosurgeons and progress in specialized fields such as vascular neurosurgery and brain tumor management. Other countries, like Uzbekistan, Tajikistan, and Kyrgyzstan, made strides in improving neurosurgical care but still faced substantial challenges. Common issues included a shortage of neurosurgeons, limited facilities, and inadequate access to modern technology. The lack of research data further highlighted the need for urgent intervention. CONCLUSIONS: To enhance neurosurgical care in Central Asia, a multipronged approach involving targeted investments, policy reforms, international collaborations, and knowledge sharing is recommended. This includes establishing specialized neurosurgical training programs and fellowships, investing in infrastructure and technology, fostering international collaborations for training and research, introducing early neurosurgery education in medical schools, improving access to online education resources, and promoting telemedicine for consultations and follow-up care. These measures are necessary to expand access to essential neurosurgical care and improve outcomes in the regions.

Estimation of free water-corrected microscopic fractional anisotropy.

Water diffusion anisotropy MRI is sensitive to microstructural changes in the brain that are hallmarks of various neurological conditions. However, conventional metrics like fractional anisotropy are confounded by neuron fiber orientation dispersion, and the relatively low resolution of diffusion-weighted MRI gives rise to significant free water partial volume effects in many brain regions that are adjacent to cerebrospinal fluid. Microscopic fractional anisotropy is a recent metric that can report water diffusion anisotropy independent of neuron fiber orientation dispersion but is still susceptible to free water contamination. In this paper, we present a free water elimination (FWE) technique to estimate microscopic fractional anisotropy and other related diffusion indices by implementing a signal representation in which the MRI signal within a voxel is assumed to come from two distinct sources: a tissue compartment and a free water compartment. A two-part algorithm is proposed to rapidly fit a set of diffusion-weighted MRI volumes containing both linear- and spherical-tensor encoding acquisitions to the representation. Simulations and in vivo acquisitions with four healthy volunteers indicated that the FWE method may be a feasible technique for measuring microscopic fractional anisotropy and other indices with greater specificity to neural tissue characteristics than conventional methods.

Test-retest reproducibility of in vivo oscillating gradient and microscopic anisotropy diffusion MRI in mice at 9.4 Tesla.

BACKGROUND AND PURPOSE: Microstructure imaging with advanced diffusion MRI (dMRI) techniques have shown increased sensitivity and specificity to microstructural changes in various disease and injury models. Oscillating gradient spin echo (OGSE) dMRI, implemented by varying the oscillating gradient frequency, and microscopic anisotropy (µA) dMRI, implemented via tensor valued diffusion encoding, may provide additional insight by increasing sensitivity to smaller spatial scales and disentangling fiber orientation dispersion from true microstructural changes, respectively. The aims of this study were to characterize the test-retest reproducibility of in vivo OGSE and µA dMRI metrics in the mouse brain at 9.4 Tesla and provide estimates of required sample sizes for future investigations. METHODS: Twelve adult C57Bl/6 mice were scanned twice (5 days apart). Each imaging session consisted of multifrequency OGSE and µA dMRI protocols. Metrics investigated included µA, linear diffusion kurtosis, isotropic diffusion kurtosis, and the diffusion dispersion rate (Λ), which explores the power-law frequency dependence of mean diffusivity. The dMRI metric maps were analyzed with mean region-of-interest (ROI) and whole brain voxel-wise analysis. Bland-Altman plots and coefficients of variation (CV) were used to assess the reproducibility of OGSE and µA metrics. Furthermore, we estimated sample sizes required to detect a variety of effect sizes. RESULTS: Bland-Altman plots showed negligible biases between test and retest sessions. ROI-based CVs revealed high reproducibility for most metrics (CVs < 15%). Voxel-wise CV maps revealed high reproducibility for µA (CVs ~ 10%), but low reproducibility for OGSE metrics (CVs ~ 50%). CONCLUSION: Most of the µA dMRI metrics are reproducible in both ROI-based and voxel-wise analysis, while the OGSE dMRI metrics are only reproducible in ROI-based analysis. Given feasible sample sizes (10-15), µA metrics and OGSE metrics may provide sensitivity to subtle microstructural changes (4-8%) and moderate changes (> 6%), respectively.

Gender difference in requesting abdominoplasty, after bariatric surgery: Based on five years of experience in two centers in Sulaimani Governorate, Kurdistan Region/Iraq.

BACKGROUND: The increasing incidence of morbid obesity suggests that the quantity of bariatric surgical procedures will continue to multiply each year, many patients who have experienced massive weight loss are left with the dissatisfying consequences of loose and redundant skin, resulting in contour irregularities, an aesthetic and functional problem, and profound dissatisfaction with appearance, residual body image dissatisfaction, There is a subsequent increase in the number of patients seeking additional corrective procedures including abdominoplasty which considered as one of the most popular body-contouring procedures. Correcting skin excess, could improve all the corollaries, including body, and functional problems and gives profound satisfaction with appearance, it has shown to improve both psychological and social aspects of the patients' lives. OBJECTIVES: Is there a gender difference in seeking body countering after bariatric surgery for weight loss? PATIENTS AND METHODS: A longitudinal observational study includes 209 obese patients with mean age of 31 ±â€¯8.6 years; (31 ±â€¯9, 31 ±â€¯7 years for female and male patients respectively). Gender ratio M/F = 1.94/1, mean BMI 40 ±â€¯9 kg/m2sin (n = 138 female) and 45±8m2s in (n = 71 male) patients, and Waist circumference 109 ±â€¯7 cm in female and 118 ±â€¯4 cm in males. RESULTS: Some female (n = 10, 7.25%) patients were seeking abdominoplasty from the third month after the operations were they have lost (21 ±â€¯2 kg) of their excess weight, fourteen patients (10.14%), at 6 months and 27 patients (19.56%) at 12 months, but most of male patients were requesting abdominoplasty (n = 7, 09.86%) at 12 months after the operations. Male patients have shifted their ideal from weight loss to abdominoplasty after losing (50-70) of their excess weight 12 months after the operations. The main motivation of requesting abdominoplasty in female and male patients was physical difficulty because of redundant skin, and a smaller number in both genders were motivated by a friend or by a doctor. CONCLUSION: The motivation for abdominoplasty in females is parallel to the amount of EWL or waist circumference. Female patients are looking for body countering three months after surgery, while male patients more often than not request body shaping following one year after surgery, the age groups are invert in genders; female patients asking for body contouring in younger age group while male patients in older age group.