Ruptured cerebral pseudoaneurysm in an adolescent as an early onset of COVID-19 infection: case report.

The clinical manifestations of coronavirus disease 2019 (COVID-19) are non-specific and multi-inflammatory. They vary from mild to severe manifestations that can be life-threatening. The association of SARS-CoV-2 infection and pseudoaneurysm formation or rupture of an already existing aneurysm is still unexplored. Several mechanisms may be involved, including the direct destruction to the artery by the viral infection or through the release of the inflammatory cytokines. We are presenting a case of a 13-year-old girl with a ruptured cerebral pseudoaneurysm of the left middle cerebral artery (M2 segment) with severe intracerebral hemorrhage as the earliest manifestation of COVID-19 infection.

Blunt injury to the right hepatic duct: A rare case report.

INTRODUCTION: Extrahepatic bile duct injuries can occur after abdominal trauma, though more commonly they are iatrogenic. Definitive surgical repair is the mainstay of treatment but has a significant incidence of complications, particularly when managed by non-specialist surgeons or with delayed referral to a specialized center. CASE PRESENTATION: A 17-year-old male presented with a blunt abdominal injury after a fall, resulting in a right hepatic duct injury that was managed with a Roux-en-Y hepaticojejunostomy. Despite the initial surgical repair, the patient developed a bile leak and fluid collections, requiring a second laparotomy for drainage and lavage, with a favorable outcome at a 6-month follow-up. DISCUSSION: Traumatic extrahepatic biliary injuries, though uncommon, can have variable etiologies, with blunt trauma being more prevalent in the pediatric population and associated with higher mortality. In the current case, prompt diagnosis and surgical management with a Roux-en-Y hepaticojejunostomy led to a favorable outcome for the patient presenting with a right hepatic duct injury. CONCLUSION: Injuries to the common hepatic duct are uncommon, but the potential for concomitant injuries to the right or left hepatic ducts should be carefully considered when determining the appropriate surgical management for complex extrahepatic biliary tract trauma.

Subglottic Hemangioma: A Hidden Cause of an Infant's Respiratory Distress.

Subglottic hemangiomas are uncommon forms of infantile vascular tumors often misdiagnosed due to symptom overlap with other conditions like laryngomalacia, bronchiolitis, and asthma. Early and accurate diagnosis is vital for effective management. This case report discusses a unique presentation of subglottic hemangioma in a three-month-old infant, highlighting its diagnostic challenge and management. It adds valuable insights into the differentiation of subglottic hemangioma from other common causes of respiratory distress in infants. The infant presented with severe respiratory distress since birth, worsening over the last four weeks, accompanied by gastroesophageal reflux and poor weight gain. Initially, the case was suspected and treated as croup and laryngomalacia. A CT angiogram revealed a vascular lesion in the subglottic area, confirmed by flexible bronchoscopy as a hemangioma. Treatment with propranolol led to significant improvement. Early diagnosis and treatment of subglottic hemangioma are crucial for a good prognosis. This case emphasizes the importance of considering subglottic hemangioma in infants with unresolved airway distress.

Are the Radiological and Molecular Features of Pediatric Medulloblastomas Valuable Prognostic Indicators? A 10-Year Retrospective Review in the Middle East.

BACKGROUND: Medulloblastomas are the most common malignant brain tumors in the pediatric population. Based on the idea that tumors with identical radio-genomic features should behave similarly, the 4 molecular subtypes are now widely accepted as a guide for the management and prognosis. The radiological features of medulloblastomas can predict the molecular subtype; thus, anticipating the subsequent disease progression. However, this has not been evaluated comprehensively. We aim to thoroughly study the association between the molecular subtypes and radiological features of medulloblastomas. Moreover, we aim to investigate the efficacy of this correlation with the use of progression-free survival and 5-year survival rates. METHODS: A retrospective analysis was conducted for all histopathological confirmed medulloblastomas in pediatric patients (<16 years old) that were operated on in Kuwait over the past ten years (n = 44). The radiological, histological, and molecular characteristics were justifiably evaluated and analyzed in our sample. RESULTS: The overall progression-free survival after one year was noticed among 27 cases (≈44%) and the nonspecific 5-year survival was seen in 31 cases (≈70%) after a 5-year follow-up. Sonic Hedgehog and Wingless had the best outcomes, while group 3 showed the worst outcomes. CONCLUSIONS: Our findings did not support the association between most of the typical magnetic resonance imaging characteristics and survival rate. We further established that Sonic Hedgehog and Wingless biological types have a better prognosis. There was no association observed between the radiographic features, specifically the location, and the molecular subtype.

Biopsychosocial Predictors of Postpartum Depression: Protocol for Systematic Review and Meta-Analysis.

During the postpartum period, psychological disorders may emerge. Aims and objectives: With the current study, we aim to explore the biological determinants that act on women during labor and incur the risk for postpartum depression (PPD). To reach the aim, we will perform the following tasks: (i) identify biological peripartum risk factors and calculate pooled prevalence of PPD for each of them; (ii) explore the strength of the relationship between peripartum risk factors and PPD; (iii) rank the predictors by their prevalence and magnitude of association with PPD. The knowledge obtained will support the development and implementation of early diagnostic and preventive strategies. Methods and analysis: We will systematically go through peer-reviewed publications available in the PubMed search engine and online databases: Scopus, Web of Science, EMBASE. The scope of the review will include articles published any time in English, Arabic, or Polish. We will deduplicate literature sources with the Covidence software, evaluate heterogeneity between the study results, and critically assess credibility of selected articles with the Joanna Briggs Institute's bias evaluation tool. The information to extract is the incidence rate, prevalence, and odds ratio between each risk factor and PPD. A comprehensive analysis of the extracted data will allow us to achieve the objectives. The study findings will contribute to risk stratification and more effective management of PPD in women.

The Role of Nursing Care in the Management of External Ventricular Drains on the Neurosurgical Ward: A Quality Improvement Project.

OBJECTIVE: The management of external ventricular drains (EVDs) is a critical aspect of patient care in the intensive care setting. However, nurses on the general floor are not commonly exposed to patients with EVD and therefore lack the necessary knowledge and skills to manage and troubleshoot EVDs effectively. The aim of this study was to evaluate the level of knowledge, comfort, and impact of EVD management among nurses on the floor after the implementation of a quality improvement (QI) tool. METHODS: This is a cross-sectional study conducted among registered nurses working on the neurosurgical floors of the Montreal Neurological Hospital. Data were collected using a questionnaire based on the plan-do-study-act model. A survey assessing the level of knowledge and comfort with EVD management was conducted before and after the implementation of the QI tool. RESULTS: Seventy-six nurses completed the questionnaire regarding their knowledge and comfort level in EVD management. Results showed that only 42% of the nurses reported feeling "comfortable" whereas 37% reported feeling "uncomfortable" in caring for patients with an EVD. In addition, only 6.5% reported being "comfortable" in troubleshooting a malfunctioning EVD. However, the level of comfort significantly improved after using the QI project. CONCLUSIONS: The results of this study highlight the need for continued training and education to support the care of patients with EVDs in the ward setting. The implementation of a QI tool can significantly improve nurses' knowledge and comfort level in EVD management, leading to improved patient outcomes and overall quality of care.

Upper gastrointestinal tract obstruction caused by a gossypiboma: A rare surgical case report.

INTRODUCTION: Gossypiboma is a term used to describe a condition of leaving a surgical sponge or any other foreign object in a body cavity after surgery. Gossypiboma is a rare but serious medical and legal problem, as it may cause no symptoms or severe complications in the digestive system. In some cases, Gossypiboma may migrate through the wall of an organ and cause damage, such as perforation, obstruction, or fistula formation. CASE REPORT: A 46-year-old male presented to the Emergency Department with abdominal pain, diarrhea, vomiting, and weight loss of about 15 kg through 20 days. The condition developed into constipation. DISCUSSION: The prevalence of complications, known as Gossypibomas, is relatively rare but can cause inflammatory reactions, abscesses, and other complications. Diagnosis is challenging and may require thorough evaluation, imaging, and exploratory surgery. Treatment usually involves surgical removal, either through laparoscopy or laparotomy. Prevention methods, such as accurate counting and implementing surgical safety protocols, are crucial to avoid such incidents. CONCLUSION: Performing a thorough count of all surgical sponges and instruments at both the start and conclusion of the procedure is the most effective method to prevent Gossypiboma. Other preventive measures include using radiopaque sponges and making sure that all sponges are accounted for before closing the incision.

Gastrogastric herniation: An unusual complication following greater curve plication for the treatment of morbid obesity: Case report.

Bariatric surgery is the most effective treatment for obese patients. Laparoscopic greater curvature plication (LGCP) is a good, effective and feasible surgical option for the treatment of obese patients. But it has some complications that should be considered such as gastric remnant distention, stomal stenosis and marginal ulcers. Here, we reported an extremely rare complication "gastro-gastric herniation". This condition was diagnosed through upper gastrointestinal contrast imaging and treated through laparoscopy. The hernia was invaginated and firm continuous sutures were placed. We followed the patient for one year and the results were great. Thus, we can add gastro-gastric hernia to the medical literature as a rare complication of laparoscopic greater curvature gastric plication, and It is considered a serious condition that requires immediate treatment and follow-up.

Endoscopic third ventriculostomy for VP shunt malfunction during the third trimester of pregnancy: illustrative case.

BACKGROUND: Endoscopic third ventriculostomy (ETV) is a successful procedure for treating noncommunicating hydrocephalus as an alternative to initial ventriculoperitoneal (VP) shunt placement and as a salvage procedure when a VP shunt fails. Physiological changes of pregnancy can lead to VP shunt failure and complicate the management of shunt malfunction, particularly in the third trimester. OBSERVATIONS: The authors present a case in which an ETV was successfully used in the third trimester (31 weeks of gestation) of pregnancy for acute hydrocephalus due to VP shunt malfunction, and the patient went on to deliver a healthy baby at term; the patient remained well in the long-term follow-up. An English-language PubMed literature review revealed four cases of VP shunt failure successfully treated with an ETV in the first or second trimester but no such reports in the third trimester of pregnancy. LESSONS: ETV appears to be a safe and effective alternative to VP shunt replacement in the late prenatal period of pregnancy.

A rare case of peritoneal Xanthogranuloma in a 23-year-old woman.

Xanthogranuloma is a very rare tumor when it comes to abdomen. Macroscopically, it is characterized by formation of multiple, golden yellow or bright yellow nodules, whereas histologically, the lesion is predominantly composed of foamy cells mixed with acute and chronic inflammatory cells. We report a case of 23-year-old woman presented to the hospital with chronic constipation, colic abdominal pain and recurrent vomiting. The patient had a history of sigmoid colon volvulus. Radiological investigations showed sigmoid colon elongation, multi-density formations in the left iliac region and pelvis and a small amount of pelvic fluid. Laparoscopy followed by excisional biopsy of the formations were made, and pathological examination showed Xanthogranuloma with no ovarian parenchyma. Hence, Xanthogranuloma should be considered as a differential diagnosis for idiopathic abdominal pain. Laparoscopy and excisional biopsy are suggested procedures when short-term therapy is concerned.

The impact of armed conflict on utilisation of health services in north-west Syria: an observational study.

BACKGROUND: Armed conflicts are known to have detrimental impact on availability and accessibility of health services. However, little is known on potential impact on utilisation of these services and health seeking behaviour. This study examines whether exposure to different types of war incidents affected utilisation of key health services-outpatient consultations, antenatal care, deliveries, and C-sections, in conflict affected areas of north west Syria between 1 October 2014 and 30 June 2017. METHODS: The study is an observational study using routinely collected data of 597,675 medical consultations and a database on conflict incidents that has 11,396 events. Longitudinal panel data analysis was used with fixed effect negative binomial regression for the monthly analysis and distributed lag model with a lag period of 30 days for the daily analysis. RESULTS: The study found strong evidence for a negative association between bombardments and both consultations and antenatal care visits. The monthly Risk Ratio was 0.95 (95% CI 0.94-0.97) and 0.95 (95% CI 0.93-0.98); and the cumulative daily RR at 30 days was 0.19 (95% CI 0.15-0.25) and 0.42 (95% CI 0.25-0.69) for consultations and antenatal care respectively. Explosions were found to be positively associated with deliveries and C-sections. Each one unit increase in explosions in a given month in a given village was associated with about 20% increase in deliveries and C-sections; RR was 1.22 (95% CI 1.05-1.42) and 1.96 (95% CI 1.03-3.74) respectively. CONCLUSION: The study found that access to healthcare in affected areas in Syria during the study period has been limited. The study provides evidence that conflict incidents were associated negatively with the utilisation of routine health services, such as outpatient consultations and antenatal care. Whereas conflict incidents were found to be positively associated with emergency type maternity services-deliveries, and C-sections.

Does establishing a neurovascular unit improve the outcome after surgical clipping for aneurysmal subarachnoid hemorrhage? Results from a 5-year observational study in Kuwait.

BACKGROUND: Failure to prevent rebleeding after cerebral subarachnoid hemorrhage (SAH) is the most frequent reason for high morbidity and mortality of aneurysmal SAH. Our study aims to identify the outcome after surgical clipping of aneurysmal SAH before and after the establishment of the neurovascular unit. The clarifications of the positive turnover in the outcome will be discussed. METHODS: A retrospective cohort analysis was carried out on our experience with a controlled group of patients who underwent clipping for ruptured cerebral aneurysms (n = 61) from January 2015 to December 2019. A modified Rankin scale (mRS) was used to determine the outcome after 6 months of follow-up. RESULTS: The median mRS score (i.e., outcome) on admission was 4, whereas it was with a median score of 2 six months after clipping (P ≤ 0.001). Overall, the cases with a good outcome were 63.9% of the sample, while the poor outcome conditions were 36.1%. The most cases with an improved outcome were after introducing the neurovascular unit, representing a transition of aneurysmal clipping practice in our center. The good outcome was changed from 42% to 76.7%, and the poor outcome was changed from 58% to 23.3% (P = 0.019). The crude mortality rate was similar to the rate worldwide (18%), with a noticeable decrease after organizing a neurovascular subspecialty. CONCLUSION: The outcome after clipping of ruptured SAH can be largely affected by the surgeon's experience and postoperative intensive care. Organizing a neurovascular team is one of the major factors to achieve good outcomes.

Neurosurgery Residents' Perspective on COVID-19: Knowledge, Readiness, and Impact of this Pandemic.

BACKGROUND: The novel coronavirus disease (COVID-19) is a life-threatening illness, which represents a challenge to all health care workers. Neurosurgeons worldwide are affected in different ways. OBJECTIVE: This is the first study regarding the readiness of neurosurgery residents for the COVID-19 pandemic and its impact. The aim is to identify the level of knowledge and readiness and the impact of this virus among neurosurgery residents in different programs. METHODS: A cross-sectional analysis was performed in which 52 neurosurgery residents from different centers were selected to complete a questionnaire-based survey. The questionnaire comprised 3 sections and 27 questions that ranged from knowledge to impact of the pandemic on various features. RESULTS: The median knowledge score was 4 out of 5. The proportion of participants with a satisfactory level of knowledge was 60%. There was a statistically significant difference between the knowledge score and location of the program. Around 48% of the neurosurgery residents dealt directly with patients with COVID-19. Receiving a session about personal protective equipment was reported by 57.7%. Neurosurgery training at the hospital was affected. About 90% believed that this pandemic had influenced their mental health. CONCLUSIONS: Neurosurgery residents have a relatively good knowledge about COVID-19. The location of the program was associated with knowledge level. Most participants did not receive sufficient training about personal protective equipment. Almost all responders agreed that their training at the hospital had been affected. Further studies are needed to study the impact of this pandemic on neurosurgery residents.

The Safety and Efficacy of One Anastomosis Gastric Bypass as a Revision for Sleeve Gastrectomy.

INTRODUCTION: Failure of sleeve gastrectomy poses a potential challenge for surgeons as variable options exist for revision. One anastomosis gastric bypass (OAGB) is a potential revisional option, and in this study, we sought to determine the safety and efficacy of OAGB post sleeve gastrectomy. METHOD: Prospective study on our initial experience with a consecutive group of patients who underwent OAGB as a revisional surgery for sleeve gastrectomy in the period between January 2015 and December 2018 was carried out. Morbidity and mortality data were recorded as well as the effect on comorbidities and weight loss. RESULTS: A total of 56 patients underwent OAGB as a revision of sleeve gastrectomy. The average weight prior to OAGB was 112 ± 24.6 kg. The minimum weight they have reached after is 85 ± 21.3 kg after a duration of 19 ± 9.2 months. Percentage of total weight loss (TWL%) at 1, 3, 6, and 12 months postoperatively was found to be 7.6%, 9.8%, 14.1%, and 28.8%, respectively. TWL% on the last day of follow-up was 24%. Two patients had marginal ulcers, in which one had a perforation. CONCLUSION: OAGB is safe and effective for weight regain post sleeve gastrectomy.

Effect of Sphenoid Sinus Pneumatization on the Surgical Windows for Extended Endoscopic Endonasal Transsphenoidal Surgery.

BACKGROUND: Little is known on the impact of the pattern and extent of pneumatization of the sphenoid sinus (SS) on the dimensions of the surgical windows used in extended endoscopic endonasal transsphenoidal approaches. We therefore investigated whether the distances between the 2 optic canals and between the paired paraclival carotid arteries are influenced by the pattern and extent of pneumatization of the SS. METHODS: One hundred high-resolution computed tomography scans from 47 adult female and 53 adult male patients were analyzed. The pattern of SS pneumatization was classified into conchal, presellar, and sellar types. Sellar-type sinuses were then classified according to a newer detailed classification system. Maximal anteroposterior (AP), transverse (TR), and craniocaudal diameters of the SS, interoptic distance at the limbus sphenoidale (IODL) and at the entrance of the optic canal (IODE) and the intercarotid distance between the paraclival carotids (ICD) were measured. A 2-tailed Mann-Whitney U test and Pearson correlation coefficient (R) were used for statistical analysis. A P value <0.05 was considered statistically significant. RESULTS: Positive correlation was found between IODL and both AP and TR diameters of the SS; between IODE and both AP and TR diameters of the SS; and between ICD and all diameters of the SS. The highest correlation for each of the IODL, IODE, and ICD was noted with the TR diameter of the SS. CONCLUSIONS: During the development of the SS, pneumatization progress likely exerts quantitative and direction-specific forces, which gradually increase the interoptic and intercarotid distances.

Control over the processing of the opponent's gaze direction in basketball experts.

Basketball players' responses to an opposing players' pass direction are typically delayed when the opposing player gazes in another than the pass direction. Here, we studied the role of basketball expertise on this, the so-called head-fake effect, in three groups of participants (basketball experts, soccer players, and non-athletes). The specific focus was on the dependency of the head-fake effect on previous fake experience as an index of control over the processing of task-irrelevant gaze information. Whereas (overall) the head-fake effect was of similar size in all expertise groups, preceding fake experience removed the head-fake effect in basketball players, but not in non-experts. Accordingly, basketball expertise allows for higher levels of control over the processing of task-irrelevant gaze information.