Digital Commons Network^™

Prevalence And Clinical Correlates Of Intraspinal And Vertebral Anomalies In Congenital, Adolescent Idiopathic, And New-Onset Scoliosis: A Comparative Study In Saudi Arabia, Faisal M Alkhunein, Mishari N Alanezi, Nwaf A Alshahir, Abdulkarim S Alsulimi, Abdulrahman H Salman, Habib Ullah Chaudhary, Abdulmajeed A Alzakri

Saudi Medical Journal

Objective: To explore the prevalence of and clinical associations between intraspinal and vertebral abnormalities in patients with congenital scoliosis (CS), adolescent idiopathic scoliosis (AIS), and early-onset scoliosis in Saudi Arabia. Methods: This retrospective cohort investigation included patients aged 18 years or younger diagnosed with CS, AIS, or new-onset idiopathic scoliosis who underwent full-spine magnetic resonance imaging between 2015 and 2025 at a tertiary center in Riyadh, Saudi Arabia. Clinical and radiological data were collected, and intraspinal and vertebral anomalies were classified. Statistical analyses included Chi-square, Fisher's exact test, and the Wilcoxon rank-sum test, with significance set at p < 0.05. Results: A …

Dietary Fat Intake And Its Influence On The Association Between Liver Fat And Brain Choline Metabolism In Young Saudi Women, Halima S. Hawesa, Mansour E. Shanawani, Haya A. Alshegri, Mahasin G. Hassan, Amal I. Alorainy, Nouf A. Alroqaiba, Shanoo G. A. Sheikh

Saudi Medical Journal

Objective: Fat-rich nutrition may influence the neurochemical consequences of hepatic lipid accumulation. This study examined whether percent energy from fat modifies the association between liver fat and the brain (Cho/Cr) ratio in healthy young women. Methods: A total of 109 healthy Saudi women aged 18–25 years underwent brain magnetic resonance spectroscopy (¹H-MRS) to quantify Cho/Cr ratios. Liver fat was estimated using MRI-based proton density fat fraction (PDFF), and lipid intake was assessed using a validated food frequency questionnaire. Multivariable regression models tested the interaction between liver fat and fat-derived energy intake, followed by simple slopes analysis, regression …

Urinary Incontinence's Prevalence, Risk Factors, And Quality Of Life Impact On Working Women In Saudi Arabia, Ahmed Mansor, Hatim Tagalsir Osman Ali, Maha Ali, Arwa Abd Al Salam Ashry, Ghala Abdullah Alharbi, Khalid Albasheer, Omer Munder, Isam Mohamed Babbiker Ahmed

Saudi Medical Journal

Background: This study aimed to investigate the prevalence and severity of Urinary incontinence (UI) among working women in Saudi Arabia (SA), identify the associated demographic, lifestyle, medical, and obstetric risk factors, and assess its effect on quality of life and work productivity. The UI is a common underreported condition that affects women's daily functioning and life quality, particularly in the workplace. Methods: During 2025, 390 working women in SA who were at least 18 years old and from various work sectors participated in a descriptive cross-sectional survey. Data were gathered using a validated, structured questionnaire; statistical analysis was carried out …

Artificial Intelligence In Pharmaceutical Care: Transforming Drug Discovery, Development, And Patient-Care Delivery, Abdulrahman G. Alharbi, Abdulrahman A. Aljabri

Saudi Medical Journal

The integration of artificial intelligence (AI) into pharmaceutical care represents a paradigm shift in healthcare delivery, offering unprecedented opportunities to revolutionize medication management, accelerate drug development, and enhance patient outcomes. This comprehensive review synthesized evidence from global literature (2021–2025) examining AI applications across drug discovery and development, clinical trials optimization, medication therapy management, and pharmacy operations. The AI demonstrated prediction accuracies of 86–98% in drug discovery, 80% improvement in clinical trial recruitment efficiency, and 32.7% increase in medication adherence over standard care. The global AI drug discovery market, valued at \$1.5 billion (2023), is projected to reach \$11.8 billion by …

Emerging Strategies For Cardio-Renal Protection Beyond Raas Blockade: Emphasis On Non-Diabetic Ckd And Resistant Hypertension, Fahad S. Alrashidi

Saudi Medical Journal

Non-diabetic chronic kidney disease (ND-CKD) complicated by resistant hypertension remains a high-risk phenotype even when renin–angiotensin system blockade is optimized. This review synthesizes contemporary evidence for cardio-renal protection beyond traditional renin-angiotensin-aldosterone system inhibition (RAASi), with emphasis on mechanisms, clinical trial data, and pragmatic sequencing. Sodium–glucose cotransporter 2 inhibitors provide hemodynamic and tubular benefits that translate into renal and heart failure risk reduction in many patients with ND-CKD. Non-steroidal mineralocorticoid receptor antagonism (MRA) like finerenone targets inflammatory and fibrotic signaling and may add incremental benefit when potassium is proactively managed. The GLP-1 receptor agonists offer cardiometabolic advantages with emerging kidney signals, …

The Use Of Platelet-Rich Plasma For De Quervain's Tenosynovitis: A Systematic Review With Limited Meta-Analysis, Abdullah W. Abumadian, Mohanad I. Binibrahim, Abdurrahman H. Sultan, Mohammed A. Addas, Hattan Y. Bamagaus, Sultan K. Alhaddad, Motasem O. Bamabad, Bayan A. Ghalimah

Saudi Medical Journal

Introduction: De Quervain's tenosynovitis (DQT) is a painful wrist condition that impairs daily activities. Corticosteroid (CS) injections are commonly used for symptom relief, but their effects may diminish over time. Platelet-rich plasma (PRP) has emerged as a regenerative alternative that promotes tissue healing rather than merely suppressing inflammation. This systematic review and limited meta-analysis compare the efficacy and safety of PRP versus CS injections in DQT. A limited meta-analysis was chosen due to the high heterogeneity between studies (I² = 98.7%). Methodology: A comprehensive literature search identified six studies comparing PRP and CS injections. Pain and functional outcomes …

Healthcare-Associated Infection Causes And Mitigation Strategies: A Systematic Review, Mohammad Irfan, Nahed Alquwez

Saudi Medical Journal

Objective: To describe the landscape of healthcare-associated infections (HAI) and, in particular, to pay attention to the types of infection that are usually seen, the most common infectious agents involved and the effective prevention strategies. Methods: A detailed search was performed using Google and PubMed, and studies that exclusively addressed healthcare associated infections or their mitigation. Studies published since 2000 were included. Data from individual articles were extracted and categorized by study focus, type of infection, causes and contributing factors, and documented mitigation strategies. Editorials, reviews, case studies, meta-analyses, and systematic reviews were excluded. Results: The analysis showed that infections …

Clinical Outcomes Of Decompression Versus Decompression With Instrumented Fusion For Lumbar Spinal Stenosis Secondary To Degenerative Spondylolisthesis: A Systematic Review And Meta-Analysis, Lama N. Alqahtani, Ahmed K. Alzahrani, Razan A. Almutairi, Abdulaziz M. Salah, Shahad F. Khan, Mohammad G. Sindi, Khalid E. Fassi, Abdulrahman M. Alshami, Ibrahim A. Hakami

Saudi Medical Journal

Objective: To compare decompression alone with decompression with fusion in patients with degenerative lumbar spondylolisthesis. Methods: PubMed, Google Scholar, Ovid, and Web of Science databases were searched up to March 2025 for randomized controlled trials (RCTs). The primary outcomes were the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. The secondary outcomes included operative time, length of hospital stay, intraoperative blood loss, reoperation, complications, and cost. Pooled analysis was performed using a random-effects model in Review Manager following Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The quality of included randomized trials was evaluated using the …

Computed Tomography Findings Of Normal Appendix In Pediatric Population, Thanwarat Koonthong, Teerasak Phewplung*

Chulalongkorn Medical Journal

Background: Appendicitis remains the most common indication for emergency abdominal surgery in children. Computed tomography (CT) plays a vital role in the evaluation of pediatric patients with suspected appendicitis. Yet, there is limited of literature describing the normal appendiceal diameter in the pediatric Asian population.

Objectives: To characterize the normal pediatric appendix and to identify the variables that influence its diameter in pediatric patients aged one day to 18 years who underwent abdominal CT.

Materials and Methods: The study was approved by the IRB. We conducted a retrospective study of 358 children (≤18 years of age) who underwent abdominal CT …

Feasibility Evaluation Of Tumor Treating Fields For Brainstem Gliomas, Anthony Chen, Ryan Shah, William Shi, Noa Urman, Nadav Shapira, Nicholas Avgeropoulos, Patrick Conlon, Neil Mookerjee, Wenyin Shi

Department of Radiation Oncology Faculty Papers

PURPOSE: Tumor treating fields (TTFields) are FDA-approved for supratentorial glioblastoma, but feasibility in infratentorial tumors remains poorly defined. This simulation study evaluated TTFields dose in brainstem gliomas using patient-specific modeling with scalp-only transducer arrays.

METHODS: MRI and CT imaging from seven patients with brainstem gliomas were used for TTFields planning with MAXPOINT® (Novocure, Switzerland). Clinical target volume (CTV) was defined as enhancing tumor on T1 post-contrast MRI (Gross tumor volume, GTV) plus a 3 mm peritumoral expansion. The platform optimized scalp-only array layouts, and finite element calculations generated maps of local minimum field intensity (LMiFI, V/cm) and local minimum power …

Greater Weekly Exercise Volume Is Associated With Lower Prevalence Of Metabolic Comorbidities, Psychiatric Conditions, And Exertional Symptoms In Youth Athletes Undergoing Pre-Participation Screening: An Observational Study, Grace Qiu, Seong Kyu Kim, Douglas Corsi, Alexander G. Hajduczok, Imran Masood, Daniel Underberg, Brian Osler, Drew Johnson, David Shipon

Division of Cardiology Faculty Papers

INTRODUCTION: Physical activity has been associated with improved cardiovascular health outcomes in adults. However, the specific associations between physical activity volume and cardiovascular outcomes in youth athletes are less defined.

METHODS: This study analyzed data from the HeartBytes National Youth Database, compiled from Simon's Heart. Simon's Heart is a nonprofit organization that includes information from sports pre-participation examinations for adolescents. The dataset encompasses demographics, electrocardiogram (ECG) findings, and exercise-related symptoms. Youth athletes' self-reported weekly physical activity volume was classified into four levels: < 2 h, 2-5 h, 5-10 h, and >10 h, with less than 2 h taken as the reference group. Given the physical diMerences among athletes …

Ct-Derived Epicardial Adipose Tissue Density And Its Association With Systemic Inflammation And Functional Impairment In Heart Failure With Preserved Ejection Fraction: A Prospective Cross-Sectional Study From Oman, Arif Albulushi, Ahmed Tawfek, Ahmed Basuoni

Journal of the Saudi Heart Association

Background: Heart failure with preserved ejection fraction (HFpEF) is strongly influenced by cardiometabolic comorbidity and systemic inflammation. Epicardial adipose tissue (EAT) is a biologically active visceral fat depot in direct contact with the myocardium, and CT-derived EAT density (attenuation) may reflect inflammatory adipose remodeling beyond adipose quantity alone. However, the clinical relevance of EAT density in HFpEF remains uncertain.

Objectives: To evaluate the association of CT-derived EAT density with systemic inflammatory biomarkers, functional capacity, health status, and echocardiographic indices of HFpEF severity in a prospective cross-sectional cohort.

Methods: In a prospective cross-sectional study conducted between January and July 2024 at …

Clinical Outcomes After Ulnar Collateral Ligament Reconstruction With Palmaris Longus Versus Gracilis Autograft In Baseball Players: A Cohort Analysis, Michael C. Ciccotti, Brooks Martino, Frank Cautela, Nathaniel Tchangou, Daniel Kwak, Eric Didomenico, Harrison S. Fellheimer, Christopher C. Dodson, Steven B. Cohen, Michael G. Ciccotti

Rothman Institute Papers

BACKGROUND: Ulnar collateral ligament (UCL) reconstruction (UCLR) is a common procedure for overhead athletes, particularly baseball players sustaining partial or full UCL tears. Palmaris longus (PL) and gracilis (GR) autografts are the most frequently used graft sources, yet limited data compare clinical outcomes in baseball athletes.

PURPOSE: To compare patient-reported outcomes after UCLR with PL versus GR autografts in baseball players.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients who underwent isolated UCLR with either PL or GR autograft and a minimum of 2 years of follow-up were identified. All reconstructions were performed using the Modified Jobe or …

Hypoglossal Nerve Stimulation For Obstructive Sleep Apnea: A Systematic Review And Meta-Analysis On Responder-Based Outcomes And Between-Study Heterogeneity, Clemens Heiser, Marcel Braun, Colin Huntley, Michael Hutz, Thomas Michael Kaffenberger, Maurits Boon

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background: Hypoglossal nerve stimulation (HNS) is an established surgical therapy for adults with moderate-to-severe obstructive sleep apnea (OSA) who are intolerant to positive airway pressure. Although aggregate response rates of ~70–80% have been reported, substantial variability across clinical settings remains poorly understood. Prior meta-analyses have largely emphasized pooled continuous outcomes, limiting interpretation of responder-based endpoints and drivers of between-study heterogeneity. Methods: A PRISMA-compliant systematic review and meta-analysis was performed. MEDLINE, Embase, and Cochrane CENTRAL were searched from inception through 31 December 2025. Eligible studies enrolled adults with OSA treated with implantable HNS, reported Sher-defined response (≥50% AHI reduction and residual …

Bi-Allelic Loss-Of-Function Variants In Tmem63b Cause Syndromic Surfactant Dysfunction Disorder, Sock Hoai Chan, Audra N Iness, Jill A Rosenfeld, Mir Reza Bekheirnia, Lindsay C Burrage, Matthew Hoi Kin Chau, Chaerish Eint Myet Chae Htoo, Eric C Kao, Shamika Ketkar, Wan Wan Lim, Xi Luo, Rifhan Mazlan, Elizabeth Mizerik, Kein Seong Mun, Kalyani R Patel, Lorraine Potocki, Christina K Rapp, Xavier Roca, Ana Saianda, Ignacio Iglesias-Serrano, Everlyn C Siew, Donald Yuhui Sim, David R Spielberg, Sok-Kun Tae, Jing Xian Teo, Julian Warfsmann, Fan Xia, Child-Eu Registry, Saumya S Jamuar, Ee Shien Tan, Matthias Griese, Weng Khong Lim, Meow-Keong Thong, Keren Machol

Faculty, Staff and Students Publications

Transmembrane protein 63B gene (TMEM63B) encodes a mechanosensitive ion channel expressed in alveolar type II epithelial cells, where it mediates stretch-induced surfactant secretion. While heterozygous gain-of-function variants in TMEM63B have been associated with developmental and epileptic encephalopathy, no human disorder has previously been linked to bi-allelic loss-of-function variants. Here, we report five individuals from four unrelated families with childhood interstitial lung disease and bi-allelic predicted loss-of-function variants in TMEM63B. Affected individuals presented with early-onset respiratory distress, chronic hypoxemia, and diffuse parenchymal lung abnormalities on chest imaging. One individual died in infancy, two underwent bilateral lung transplantation, and two require oxygen …

The Role Of Social Determinants Of Health In Hydroxyurea Adherence Among Persons With Sickle Cell Disease: A Systematic Review, Doreen O. Ugwu, Lori L. Vick, Terika Williams, Aurela Nikaj, Seyi Omeh, Benjamin Becerra Dr., Tilicia Mayo-Gamble

Journal of the Georgia Public Health Association

Objective: Georgia has one of the highest prevalences of sickle cell disease (SCD). For Georgians living with SCD, inadequate medication adherence is associated with important clinical outcomes. One important area that is understudied in SCD is the impact of social determinants of health (SDoH) on medication adherence. A foundational understanding of SDoH is needed to introduce, inform and carry out programs and interventions designed to facilitate hydroxyurea adherence through the state of Georgia.

Method: We conducted a systematic literature review to synthesize the literature on SDoH addressed in studies to improve hydroxyurea adherence in persons with SCD. SDoH were based …

Perspective On Lessons Not Learned: From Coley’S Toxins To Microbial Drug Delivery, Guidance For Institutional Review Boards (Irbs), Brian P. Hanley, Alejandro J. Betancourt, Gustavo Gross, Wilbur (Bo) Bowne

School of Medicine Publications

The bacterial and toxin methods of cancer treatment date back 130 years. This paradigm rests on nonspecific bacterial-toxin-generated immunotherapy. This high-risk oncology research is experiencing a renaissance of methods that are among the most effective yet. Glioblastomas and other resistant cancers are the modern touchpoint, because of remission history following sepsis. Spurred by recent research deaths, we discuss protocols IRBs should consider in live bacterial or synthetic immuno-stimulatory trials. Human systemic inflammatory response syndrome immunology is unique due to non-functioning SIGLEC-13 and 17, which control excessive Toll-like receptor 4 (TLR-4) signaling. This is not a technicality like human CD8+/CD4+ T …

An Examination Of Generative Ai In Medicine, J. Marco Cipriaso, Md, Trishya Srinivasan, Md

The Medicine Forum

The age of artificial intelligence (AI) is upon us. Specifically, generative AI has been transforming how we interface with the world by directly generating its own novel output.¹ Medicine is not immune to this change. AI search tools such as OpenEvidence have shown promise by providing evidence-based recommendations, already proven to perform well in primary care settings, with additional promise for future applications.² AI tools have taken over the note-writing process through ambient software, allowing physicians to dedicate more time to face-to-face interaction with their patients.³ These and other developments show clear reason to be excited about …

Brain On Fire: A Case Of Severe Ifosfamide Encephalopathy And Utilization Of Methylene Blue, Nicholas Spyropoulos, Do, Michelle Joyner, Do

The Medicine Forum

Ifosfamide is a commonly used chemotherapeutic agent indicated for a variety of malignancies; however, given its well-documented complications including Ifosfamide induced encephalopathy (IFE), its overall use is limited. Neurotoxicity secondary to ifosfamide can range from mild confusion to severe neurologic deterioration, with the primary treatment being focused on supportive care. This clinical case highlights a 41-year-old patient with BRAF positive ameloblastic carcinoma who developed acute neurotoxic symptoms following ifosfamide chemotherapy induction. His symptoms, ranging from altered mental status, restlessness, severe headache, and peripheral neuropathy, began shortly after chemotherapy initiation. Both his lab work and imaging could not explain the acute …

Occupational Hydrocarbon Exposure Presenting As Acute Hepatocellular Injury With Atypical Mitotic Figures On Liver Histopathology In An Oil Rig Worker: A Case Report, Hamzah Shariff, Md, Maria Averbuch, Do, Leanna Rucker, Md, Madison Force, Md, Dina Halegoua-De Marzio, Md

The Medicine Forum

Occupational exposure to hydrocarbons and aromatic solvents in the petroleum industry has been somewhat associated with hepatotoxicity, though the clinical manifestations and histologic features remain incompletely characterized. We present the case of a 33-year-old oil rig worker with prolonged occupational exposure to benzene and hydrocarbon compounds who presented with acute hepatocellular liver injury and concurrent biliary pathology. The patient presented with right upper quadrant pain, jaundice, and pale stools. Laboratory evaluation demonstrated marked hepatocellular injury with alanine aminotransferase (ALT) elevation to 1183 U/L and total bilirubin of 6 mg/dL. Extensive infectious, metabolic, and autoimmune evaluation was unrevealing. ANA and ASMA …

Lvad Patient With Delayed Family Involvement Due To Incarceration, J. Marco Cipriaso, Md, Kathleen Mechler, Md

The Medicine Forum

Left ventricular assist device (LVAD) placement requires an extensive support system for success. Patients who are incarcerated face unique challenges in achieving this due to prison rules. We describe a case in which an LVAD patient suffered a massive intracranial hemorrhage, leaving him unable to make his own decisions. Medical teams did not involve his family in admissions for his slow chronic decline, but family were asked to make decisions for him at this acute change causing them significant distress. We advocate that families of incarcerated patients be more routinely involved in provider communications and education related to their chronic …

Isolated Left Ventricle Apical Non-Compaction- A Diagnostic Conundrum, Trisha Sindhu, Md, Ranjita Sengupta, Md

The Medicine Forum

Left ventricular non-compaction (LVNC) cardiomyopathy is a rare myocardial disorder characterized by abnormal morphogenesis of the left ventricle (LV). It is typically associated with additional cardiac abnormalities and is most often diagnosed in childhood.¹ We present a unique case of isolated LVNC in a 42-year-old, physically active African American police officer. This case highlights an uncommon presentation of LVNC and underscores the variable specificity of current diagnostic criteria across diverse patient populations.³

Foreword From Faculty Advisor, Dagan Coppock, Md, Msce

The Medicine Forum

We are honored to present this latest edition of The Medicine Forum. This platform is in its twenty-seventh year serving as an outlet for our medical community’s scholarly and creative efforts. This year, it has been my pleasure to work with Nehar, Jasmine, Hamzah, and Allison on this project. It has been impressive to see them balance their efforts on this scholarly work with their efforts on the wards.

As a Department, we are a productive group of writers, thinkers, scientists, and artists, who send out our work for publication in the larger medical community. What makes The Medicine …

From The Editors, Nehar Damle, Md, Pharmd, Hamzah Shariff, Md, Allison Kayne, Md, Jasmine Lee, Md

The Medicine Forum

As physicians in training, much of our work is shaped by immediacy – responding to evolving clinical situations, navigating diagnostic uncertainty, and making decisions with present information. In this environment, it can be easy to prioritize action over reflection. Yet it is through reflection, inquiry, and shared scholarship that we deepen our understanding of medicine and the patients we serve.

It is within this spirit that we present Volume 27 of The Medicine Forum. This publication represents not only scholarly achievement, but also the intellectual curiosity and dedication that define our community.

This year, we were particularly struck by …

The Medicine Forum: Volume 27

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 27, 2025-2026

TABLE OF CONTENTS

• Case Reports
• Letter to the Editor
• Research Studies
• Humanities & Reflections

Antibiotic Administration After Previable Preterm Prelabor Rupture Of Membranes Is Associated With Prolonged Latency, Alexandra L Hammerquist, Alexander M Saucedo, Selina L Bowler, Mohan Pammi, Catherine Eppes, Ignatia Van Den Veyver, Michael D Jochum, Enrico R Barrozo

Duncan NRI Faculty and Staff Publications

Introduction: While antibiotics have been shown to increase the interval to delivery between rupture of membranes and delivery (latency) and improve neonatal outcomes after viable preterm prelabor rupture of membranes (PPROM), this has not been well investigated in the previable PPROM population. We aimed to investigate the association between antenatal antibiotics and latency following previable PPROM. Secondarily, we examined various maternal and neonatal outcomes. We hypothesized that the administration of antibiotics would prolong latency in pregnancies with previable PPROM.

Methods: Single-center retrospective cohort study that included pregnancies diagnosed with previable PPROM between 140/7 and 216/7 and delivered between 2012 and …

Hiding In Plain Sight: A Case Of Intestinal Tuberculosis Masquerading As Benign Lower Gi Bleeding, Lavender Otom, Priyanka Panwar, Gerald Odong, Fatma Kassim, Patricia Okiro, Christopher Opio, Saleem Abdulkarim

Internal Medicine, East Africa

Background Intestinal tuberculosis (TB) represents the most common form of abdominal TB, often affecting the ileocaecal region. Lower gastrointestinal bleeding is an uncommon presentation and may create significant diagnostic uncertainty, particularly in immunocompromised patients and in settings where inflammatory bowel disease is also encountered.

Case Presentation A woman in her sixties from Africa presented with recurrent diarrhoea and intermittent haematochezia over a 6-month period. Initial endoscopic evaluation was nondiagnostic. Cross-sectional imaging later demonstrated multifocal bowel involvement affecting both the small and large bowel, including ileocaecal and rectoanal disease, with associated abdominopelvic lymphadenopathy. Histopathology from repeat colonoscopy biopsy showed caseating granulomas …

May Measurement Month 2023: Results Of An Opportunistic Blood Pressure Screening Campaign In Kenya, Mzee Ngunga, Thomas Beaney, Gabriele Kerr, Bernard Samia, Lilian Mbau, Neil Poulter, Hellen Nguchu, Jeilan Mohamed, Elijah Ogola

Internal Medicine, East Africa

The May Measurement Month (MMM) is a global screening campaign launched in 2017 to raise awareness of raised blood pressure (BP). Kenya has participated in all previous MMM campaigns. Adults aged ≥18 years were recruited through convenience sampling in nine counties of Kenya. Three seated BP readings were taken on each participant, and a questionnaire collected information on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥140mmHg or diastolic BP ≥90mmHg or being on BP-lowering medication. Controlled BP was defined as being on BP-lowering medication with a BP < 140/90mmHg. Multiple imputation was used to estimate missing BP readings. In total, 4,601 were screened, with a mean age of 41.7 years and 42.7% were female. Of all participants, 1,176 (25.6%) had hypertension, of whom 198 (16.8%) were aware, and 190 (16.2%) were on antihypertensive medication. Of those on antihypertensive medication, 65 (34.2%) had controlled BP, and of all participants with hypertension, 5.5% had controlled BP. The mean systolic and diastolic BPs of those on treatment was significantly higher than those without hypertension. Hypertensive disease in a previous pregnancy was associated with higher BP amongst female participants.

The MMM campaign in Kenya identified a substantial …

Myelomalacia Severity On Preoperative Magnetic Resonance Imaging Does Not Predict Patient-Reported Outcomes After Anterior Cervical Discectomy And Fusion, Mitchell K. Ng, Joshua Mathew, Robert J. Oris, Yulia Lee, Jonathan Dalton, Gregorio Baek, Ashley Thommana, William A. Green, Yasmine Eichbaum, Morgan Hitchner, Brandon Martinazzi, Ali Farooqi, Alec Giakas, Paul Gunter, Vinay Bijoor, Andrew Vanchikorn, John J. Mangan, David I. Kaye, Mark F. Kurd, Thomas Cha, Jose A Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN/SETTING: Retrospective cohort study.

BACKGROUND: Signal changes within the spinal cord on magnetic resonance imaging (MRI) or myelomalacia, are frequently seen in patients with cervical myelopathy. While often assumed to predict the outcomes, their prognostic value remains uncertain. Therefore, this study aimed to: (1) describe the clinical characteristics of patients with myelomalacia undergoing Anterior cervical discectomy and fusion (ACDF); (2) evaluate whether MRI findings correlate with patient-reported outcomes (PROMs); and (3) determine whether morphology predict recovery.

METHODS: A retrospective review at a single tertiary care center was performed (2014-2021). Patients were included if they underwent a primary elective ACDF …

Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope And Limitations, Kai-Uwe Lewandrowski, Álvaro Dowling, Jun Ho Lee, Benedikt W Burkhardt, Óscar L. Alves, Avelino Parajón, Jorge Felippe Ramirez, Nicola Montemurro, Alex R. Vaccaro, Morgan P. Lorio

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Transforaminal endoscopic lumbar decompression (TELD) has emerged as a minimally invasive alternative for managing lumbar stenosis and disc herniations. While the literature consistently reports favorable outcomes, real-world adoption remains variable, with discrepancies often linked to surgeon experience and case complexity.

OBJECTIVE: To evaluate surgeon perspectives on the clinical applicability of TELD across different pathologies and compare these findings with published evidence.

METHODS: An international cross-sectional survey was conducted among spine surgeons. Responses were analyzed using Rasch modeling to assess consensus levels, with agreement categorized as strong, moderate, weak, or disagreement. Differential Item Functioning (DIF) and correlation analyses were applied …