Spinal dural arteriovenous fistula: a comprehensive review of the history, classification systems, management, and prognosis.

Spinal dural arteriovenous fistulas account for the majority of spinal vascular malformations. They are typically located in the thoracolumbar region and are diagnosed in the middle-aged and elderly populations. Although spinal dural arteriovenous fistulas have been postulated to be acquired, their exact development remains uncertain. Typically, the arteriovenous shunt is situated close to the spinal nerve root, inside the dura mater, where the blood from the radiculomeningeal artery and radicular vein intermix. Throughout history, there have been multiple classification systems of spinal arteriovenous shunts since 1967. Those were mainly based on the evolution of diagnostic studies as well as the treatment of these lesions. Such classification systems have undergone significant changes over the years. Unlike intracranial dural arteriovenous fistula, spinal dural arteriovenous fistula is progressive in nature. The neurological manifestations, due to venous congestion, tend to be insidious as well as non-specific. These include sensory deficits, such as paresthesia, bilateral and/or unilateral radicular pain affecting the lower limbs, and gait disturbances. Spinal dural arteriovenous fistulas can be suspected on magnetic resonance imaging/magnetic resonance angiography and confirmed by digital subtraction angiography (DSA). The management includes surgery, endovascular therapy, and in selected cases, radiotherapy. The treatment goal of spinal dural arteriovenous fistula is to halt the progression of the disease. The prognosis depends on both the duration of symptoms as well as the clinical condition prior to therapy. The present article comprehensively reviews the pathophysiology, changes in classification systems, natural history, clinical manifestations, radiological features, management, and prognosis.

Students' Interest in Orthopedic Surgery in Saudi Arabia.

OBJECTIVES: The demand for orthopedic surgery is expected to increase as the Saudi population grows and ages. Therefore, this study aimed to assess the interest of medical students and interns in orthopedic surgery and the factors that influence their interest. METHODS: This cross-sectional study was conducted using a structured questionnaire adapted from a similar study and modified by the authors. The questionnaire was distributed via email to more than 500 medical students from the second year to the internship year. The questionnaire was designed to assess knowledge, interest, and students' perception of orthopedics. RESULTS: Five hundred and ten responses were obtained; 382 (74.90%) were from women. Gender, family orientation, private practice, and perceptions of orthopedic surgery as a stressful specialty or a specialty in crisis were variables that did not influence participants' perceptions of orthopedic surgery. Further, 13% of participants showed early interest in orthopedic surgery, especially during their third year of medical school. Most of the interested participants recognized that having strong level of knowledge, future academic opportunities, a controllable lifestyle, direct patient care, experience during their clerkship, a high salary, immediate satisfaction, and a prestigious specialty were important aspects that determined their interest in considering a future career in orthopedic surgery. Work preferences that had a significant impact on interest included working with patients not requiring long-term care, working only in the hospital, working outside the hospital, and working only during the day. CONCLUSION: There was no difference between genders in terms of interest in orthopedic surgery. This study might serve as a basis for future research assessing the interest of medical students in orthopedic surgery as well as identifying and managing the barriers that prevent students from pursuing careers as orthopedic surgeons.

Parents' perceptions of quality of life of their children and adolescents with type 1 diabetes during Ramadan fasting in Riyadh.

This study aimed to assess parents' perceptions of the quality of life (QoL) of their children with type 1 diabetes (T1D) during Ramadan fasting (RF). In this cross-sectional study, an Arabic-translated version of the standard diabetes-specific QoL questionnaire (PedsQL™ version 3.0) was used to compare perceptions of QoL during Ramadan month (Rm) versus non-Rm (NRm) of parents of children/adolescents with T1D from two tertiary hospitals in Riyadh. We used regression analysis to compare proxies (parents' reports) of their perceptions on their children/adolescents' QoL during Rm compared to NRm. A sample of 61 proxies (parents') of two age groups T1D offspring: 8-12 years (41%) and 13-18 years (59%) who reported their perceptions of their children/adolescents QoL during Rm were matched by children/adolescents' age and gender of 61 proxies in NRm. QoL scores of all domains were significantly lower in Rm compared to NRm; p < 0.0001, however, worries domain showed no statistical differences p = 0.052 in a regression analysis. The total aggregate median (IQR) in Rm was 850 (612-1,062) compared to 1,750 (1,475-2,062) in NRm, p < 0.001. The highest differences in NRm and Rm median scores were observed in communications (OR = 3.64; 95% CI 2.7-5.57) and treatment adherence (OR = 3.09; 95% CI 2.48-3.84) domains especially in the age of 13-18 years. Parents of adolescent boys, who are usually risk-takers and more exposed to outdoor activities, perceived lower QoL for them. Parents of adolescents with T1D perceived a lower QoL for their children during RF, especially in the treatment adherence and communication domains.