Role and contributions of women in revolutionizing neurosurgery.

We owe it to the women neurosurgeons for paving the way to a more gender-inclusive world of medicine. Their dedication and sacrifices have led them and their followers to scale unimaginable heights in terms of administrative positions, leadership, and academics. In today's scenario, it is safe to say that society has progressed considerably. Past years have seen an uprise in the number of females enrolling in a medical degree programme however, this proportion is highly distorted when it comes to specialties such as Neurosurgery. This disparity seems to be evolving and leveling out in all specialties, as more and more women are stepping out of their comfort zone and challenging the established standards of the society. It is with the collective efforts of all stakeholders and women that we see more women not only choosing such specialties which were previously uncharted terrain, but also leading organizations globally and excelling on the administrative and academic fronts. Veteran female surgeons have revolutionized neurosurgery and its subspecialties in unimaginable ways and the present as well as the future generation neurosurgeons continue to take inspiration from them and follow their footsteps. This paper has put together the contributions of female neurosurgeons in various subspecialties of neurosurgery as well as giving an account of the leadership and administrative positions served by women. We also shed light on the role of women as an academician and a researcher.

A Quality Improvement Study to Improve Oxygen Prescription in the PICU of a Tertiary Care Centre in Delhi, India.

Introduction Oxygen has been gravely misused since its inception as a therapeutic agent. There is a deficit of audits and baseline data for the Indian population, especially in the pediatric age group, which doesn't allow for standardization of protocols and guidelines. Objective Our study aimed at increasing valid prescription rates to 90% by implementation of quality improvement interventions, and assessing knowledge and perception of healthcare workers towards oxygen therapy. Methodology It followed a before-and-after prospective observational study model where baseline audit data was compared with data observed after the implementation of quality improvement strategies. The data was collected through an audit of the medical records of all pediatric patients receiving oxygen therapy in the PICU. Knowledge and perception of healthcare workers about oxygen therapy were assessed via a self-designed questionnaire. The study was undertaken in three phases, including Quality Improvement (QI) team formation and data collection, root cause analysis, and implementation of Plan-Do-Study-Act (PDSA) cycles. Observations and results In the baseline audit, 1.4% of the prescriptions were complete and valid. Subsequently, over the course of four PDSA cycles, valid prescription rates increased; 62.07% in the first, 79.51% in the second, 81.81% in the third, and 91.42% in the fourth cycle respectively. After applying the chi-square test to compare PDSA4 and baseline data, the p-values for written prescriptions and target saturation were found to be statistically significant. In the healthcare worker survey, we found that 100% of them were aware of indications of oxygen prescription, FiO2, and side effects of excessive usage of oxygen therapy, 95% were aware of conditions affecting pulse-oximetry in the pediatric age group, and 75% knew about target saturation and its significance and the procedure to change alarm settings on the monitor. Conclusion Currently, there exists a lack of effective oxygen prescription audits, especially in India, which can be attributed to a lack of awareness and partly, a lack of initiative. Quality improvement initiatives are effective in improving the valid oxygen prescription rate. However, sustained goals can be achieved through regular audits only.

Learnings from Asia's first ever medical student neurosurgery Conference: NEUROFEST, 2022.

The study lays out the design and learnings of Neurofest, Asia's first ever medical student Neurosurgery conference organized by Walter E Dandy Medical Student Neurosurgery Club, India. Neurofest was conducted in October 2022 inclusive of various events: workshops, talks and contests. An online post-conference questionnaire was disseminated among the delegates to record their experience and feedback for the conference. Statistical analysis was performed using SPSS with a level of significance p < 0.05. Of the 158 total delegates, 65.2% (n = 103) participated in this study. The majority of the responders were satisfied with the events at the conference. 85.4% (n = 88) of the respondents reported an increased interest in neurosurgery, probably due to the quality of workshops (p = 0.004), talks by faculty (p = 0.023), contacts with the faculty (p = 0.025) and confidence in approaching a faculty (p < 0.001). 92.2% (n = 95) of the respondents claimed to recommend Neurofest to their colleagues. The reasons for this were found to be the quality of workshops (p = 0.001) and confidence in approaching a faculty (p = 0.030). Nearly all respondents believed that such conferences are important in empowering medical students (n = 100, 97.1%). Similar conferences are required to provide medical students with early exposure to neurosurgery. In the future, continued research is required to optimize neurosurgical conferences and endorse the prospect of neurosurgery as a career option in Lower-Middle Income countries.

Utility of Machine Learning in the Management of Normal Pressure Hydrocephalus: A Systematic Review.

BACKGROUND: In the past decade, many machine learning (ML) models have been used in the management of normal pressure hydrocephalus (NPH). This study aims at systematically reviewing those ML models. METHODS: The PubMed, Embase, and Web of Science databases were searched for studies reporting applications of ML in NPH. Quality assessment was performed using Prediction model Risk Of Bias ASsessment Tool (PROBAST) and Transparent Reporting of a multivariable predication model for Individual Prognosis Or Diagnosis (TRIPOD) adherence reporting guidelines, and statistical analysis was performed with the level of significance of <0.05. RESULTS: A total of 22 studies with 53 models were included in the review, of which the convolutional neural network was the most used model. Inputs used to train various models included clinical features, computed tomography scan, magnetic resonance imaging, intracranial pulse waveform characteristics, and perfusion infusion. The overall mean accuracy of the models was 77% (highest for the convolutional neural network, 98%, while lowest for decision tree, 55%; P = 0.176). There was a statistically significant difference in the accuracy and area under the curve of diagnostic and interventional models (accuracy: 83.4% vs. 69.4%, area under the curve: 0.882 vs. 0.729; P < 0.001). Overall, 59.09% (n = 13) and 81.82% (n = 18) of the studies had high-risk bias and high-applicability, respectively, on PROBAST assessment; however, only 55.15% of the studies adhered to the TRIPOD statement. CONCLUSIONS: Though highly accurate, there are many challenges to current ML models necessitating the need to standardize the ML models to enable comparison across the studies and enhance the NPH decision-making and care.

Macrophages in Recurrent Glioblastoma as a Prognostic Factor in the Synergistic System of the Tumor Microenvironment.

Glioblastoma (GBM) is a common and highly malignant primary tumor of the central nervous system in adults. Ever more recent papers are focusing on understanding the role of the tumor microenvironment (TME) in affecting tumorigenesis and the subsequent prognosis. We assessed the impact of macrophages in the TME on the prognosis in patients with recurrent GBM. A PubMed, MEDLINE and Scopus review was conducted to identify all studies dealing with macrophages in the GBM microenvironment from January 2016 to December 2022. Glioma-associated macrophages (GAMs) act critically in enhancing tumor progression and can alter drug resistance, promoting resistance to radiotherapy and establishing an immunosuppressive environment. M1 macrophages are characterized by increased secretion of proinflammatory cytokines, such as IL-1ß, tumor necrosis factor (TNF), IL-27, matrix metalloproteinase (MMPs), CCL2, and VEGF (vascular endothelial growth factor), IGF1, that can lead to the destruction of the tissue. In contrast, M2 is supposed to participate in immunosuppression and tumor progression, which is formed after being exposed to the macrophage M-CSF, IL-10, IL-35 and the transforming growth factor-ß (TGF-ß). Because there is currently no standard of care in recurrent GBM, novel identified targeted therapies based on the complex signaling and interactions between the glioma stem cells (GSCs) and the TME, especially resident microglia and bone-marrow-derived macrophages, may be helpful in improving the overall survival of these patients in the near future.