Medical Specialties Commons^™

Facilitators And Barriers To Neurologist Referral Of Patients For Epilepsy Surgery Evaluation., Chloé E Hill, Daniel Hochster, Jessica E Baker, Alison L Herman, Nishad Shaheid, Susanna S O'Kula, Jack M Parent, Darin B Zahuranec, Lesli E Skolarus

Neuroscience Articles

OBJECTIVE: Epilepsy surgery offers a potential cure for drug-resistant epilepsy (DRE), yet surgery is underutilized. An estimated 5% of patients with DRE undergo long-term EEG monitoring (LTM) annually, the requisite first step of evaluation for surgical candidacy. Much of the variation in LTM referral may be attributable to individual neurologist practice rather than patient characteristics. We explored neurologist behaviors and practices in epilepsy surgery referral to guide future interventions to expand patient access to surgery.

METHODS: This qualitative interview study recruited neurologists who treated adults with epilepsy. Interviews were grounded in the Theoretical Domains Framework (TDF) of behavior change to …

22q11.2 Enhanced Recovery After Surgery Pathway (Eras), Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Silent But Deadly: A Case Of Obtuse Marginal Artery Occlusion., Austin M Miller, Vishal Tharani, Erin Fraser, Howard W Levitin

Heart and Vascular Articles

The obtuse marginal artery (OMA) is a key branch of the left circumflex coronary artery, supplying blood to the lateral wall of the left ventricle. OMA occlusions can result in myocardial ischemia and serious cardiac events, often presenting with subtle or atypical electrocardiogram (EKG) changes, unlike the more pronounced alterations observed with left anterior descending artery occlusions. This case report discusses a 57-year-old female presenting with chest pain and shortness of breath, indicative of acute coronary syndrome. The patient's initial EKG showed occasional premature ventricular contractions (PVCs), T-wave flattening in aVL, and 1 mm ST elevation in V6, but otherwise, …

Evolution Of The Family Medicine Clerkship: A Cera Secondary Analysis., Bryce A Ringwald, David Banas, Allison Macerollo, Ericka Bruce, Matthew Farrell

Medical Education Articles

BACKGROUND AND OBJECTIVES: The family medicine clerkship has been found to influence medical students' decision-making regarding specialty choice. Understanding how the family medicine clerkship has changed over the past decade may assist in recruitment efforts. Our study explored trends in family medicine clerkship design, length, and format and correlated these characteristics with high proportions of medical school graduates choosing family medicine.

METHODS: We performed a secondary analysis of the Council of Academic Family Medicine Educational Research Alliance annual family medicine clerkship director surveys from 2012 to 2023. We analyzed standard family medicine clerkship structure questions that were asked in each …

Small And Sick Newborn Care: Changes In Service Readiness Scoring Between Baseline And 2023 For 65 Neonatal Units Implementing With Nest360 In Kenya, Malawi, Nigeria, And Tanzania, Rebecca E. Penzias, Morris Ondieki Ogero, Robert Tillya, Irabi Kassim, Olabisi Dosunmu, Opeyemi Odedere, Hannah Mwaniki, Vincent Ochieng, Dolphine Mochache, William Macharia

Paediatrics and Child Health, East Africa

Health Facility Assessments (HFAs) are important for measuring and tracking service readiness for small and sick newborn care (SSNC). NEST360 Alliance aims to reduce neonatal mortality in four countries (Kenya, Malawi, Nigeria, Tanzania). NEST360 and UNICEF facilitated HFA tool design with ministries of health in four African countries and developed two complimentary approaches to summarize readiness. Using the NEST360/UNICEF HFA tool, we collected data, developed two service readiness scoring approaches for SSNC (standards-based scoring by adapted World Health Organization (WHO) health system building blocks (HSBBs) and assessing service readiness across the health system, and level-2+ scoring by WHO clinical interventions), …

Prenatal Substance Exposure And Positive Developmental Delay Screening Among Patients In Foster Care, Lauren Malthaner, Jill Mcleigh, Gregory Knell, Katelyn Jetelina, Folefac Atem, Sarah Messiah

Behavioral Health/Developmental Delay

Prenatal substance exposure (PSE) is a known risk factor for negative birth outcomes and long-term health outcomes like neurodevelopmental problems. Children in foster care have increased exposure to PSE and higher proportions of developmental delay compared with the general population. It is unclear whether differences still exist among developmental delay screening among children in foster care with and without PSE.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

A Case Of Culture-Proven Cutaneous Atypical Mycobacterial Infection Caused By Mycobacterium Immunogenum, Faraz Yousefian, Aysham Chaudry, Francesca Ceci, Charay Jennings-Dover, Dionne Louis

Dermatology Resident Research

No abstract available

Supplementation With Ready-To-Use Therapeutic Food Has No Effect On Adverse Outcomes Among Undernourished Children Aged 6–59 Months With Severe Pneumonia, Damalie Nalwanga, Elisa Giallongo, Victor Musiime, Sarah Kiguli, Peter Olupot-Olupot, Florence Alaroker, Robert Opoka, Abner Tagoola, Mainga Hamaluba, Christabel Mogaka

Paediatrics and Child Health, East Africa

Objectives: To investigate the effect of supplementation with ready-to-use therapeutic food (RUTF) on adverse outcomes among undernourished children aged 6–59 months with severe pneumonia.

Methods: This secondary analysis of the COAST-Nutrition (ISRCTN10829073) included children hospitalized for severe pneumonia in Uganda and Kenya. Undernutrition was defined as having either a weight-for-age z score, height-for-age z score, or weight-for-height/length z score below the median of the WHO reference population (< 0) or mid-upper arm circumference (MUAC) below 13.5 cm. Participants were randomized to receive 1 sachet of RUTF daily for 8 weeks in addition to the usual diet (intervention) or usual diet alone (control). The primary composite outcome for adverse events was any one of mortality, re-admission, or deterioration of nutritional status by day 90 of follow-up.

Results: Of 846 main trial participants, 741 (88%) met the inclusion criteria (intervention: 374 versus control: 367). Of 687 (93%) participants in whom the primary outcome was assessed, 370 …

Assessment Of Autonomic Nervous System Functions In Patients With Chronic Inflammatory Demyelinating Polyradiculoneuropathy: An Electrodiagnostic Study, Raghda Nidal Hathal, Farqad Bader Hamdan, Akram M. Al-Mahdawi

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic immune-mediated neuropathy predominantly affecting the peripheral nervous system including the nerve roots. The objectives of this study were to assess autonomic dysfunction in patients with CIDP using electrodiagnostic techniques and to examine its relationship with clinical and demographic characteristics, COMPASS-31 scores, and the Hughes disability scale.

Methods: This case–control observational study included 25 patients with CIDP and 26 age- and sex-matched healthy controls and was conducted at the Neurophysiology Unit of Baghdad Teaching Hospital, Baghdad from February to November, 2024. All participants underwent autonomic function assessment, including Ewing’s cardiovascular …

Retraction Notice, Editor Pjns

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Down Syndrome In Africa: Challenges, Opportunities, And Future Directions, Eimear Mcglinchey, Salina Tewolde, Amanda He, Juan Fortea, Lingani Mbakile-Mahlanza, Ayda Tefera, Emmanuel Epenge, Jason Hassenstab, Rachel Maina, Zul Merali

Brain and Mind Institute

INTRODUCTION: As life expectancy improves for people with Down syndrome (DS) in Africa, the risk of developing DS-associated Alzheimer’s disease (DSAD) will rise. There is a pressing need to plan for this emerging challenge, particularly in the context of existing health and social disparities.

METHODS: This work emerged from a pan-African collaboration, including discussions at the Brain Ageing and Dementia in Low- and Middle-Income Countries conference held in Nairobi in 2024, where stakeholders identified regional priorities for DS and dementia care.

RESULTS: Limited epidemiological, cognitive, biomarker data, delayed diagnoses, and gaps in specialized services may impact access …

Demographic And Clinical Characteristics Of Patients With Benign Bone Tumors: Evidence Of Bimodal Age Distribution In A Hispanic Population, Blake Martin, Mohammad Khalil, Juan Lopez-Alvarenga, Michael Sander

School of Medicine Publications

Background

As far as researchers know, there's no way to prevent BBTs from forming. Although these tumors generally do not metastasize, they can still be dangerous as they may grow and compress healthy tissues and lead to poor outcomes. The principal objective was to evaluate the demographic and clinical characteristics linked to BBTs in individuals from the Rio Grande Valley. We hypothesized that older age and males would have greater frequency of BBTs.

Methods

This was a retrospective chart review and IRB approval was obtained prior to starting this study. We obtained medical charts for individuals who had been diagnosed …

Impact Of Metabolically Healthy Obesity On Post Percutaneous Coronary Intervention Outcomes In Patients With Acute Myocardial Infarction: A Nationwide Propensity Matched Analysis, Rupak Desai, Adhvithi Pingili, Arankesh Mahadevan, Vishal Reddy Bejugam, Hafeezuddin Ahmed, Vamsikalayan Borra, Adil Sarvar Mohammed, Gayatri Bondi, Shobana Krishnamurthy, Nithya Borra

School of Medicine Publications

Background

Obesity paradox in post-percutaneous coronary intervention (PCI) outcomes among acute myocardial infarction (AMI) patients is a known controversy. However, these studies included patients who had diabetes, hypertension, or hyperlipidemia. We studied relationship between metabolically healthy obesity (MHO—without diabetes, hypertension, or hyperlipidemia) and in-hospital post-PCI outcomes among AMI patients.

Methods

We extracted data from National Inpatient Sample 2020 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for admissions of AMI patients who underwent PCI. We then identified patients with diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity index and Clinical Classifications Software and excluded them. Then, using Elixhauser …

Scoring Large Muscle Movements In Pediatric Sleep Studies: An Educational Module For Sleep Technologists, Shauna Michelle Vandoren, David G. Ingram

Posters

Introduction Restless Sleep Disorder (RSD) has recently been recognized as a distinct sleep disorder, with Large Muscle Movement (LMM) scoring being a crucial component of its diagnostic criteria. This project aimed to develop and implement an online educational module to enhance the knowledge and skills of sleep technologists to accurately score LMMs. Methods We constructed an online learning module that included training on the identification and scoring of LMMs in pediatric sleep studies. The module consisted of a 10-question pre-assessment, the educational content (which explained the background of RSD diagnosis, the role of LMMs in diagnostic criteria, and current scoring …

Correlation Of Magnetic Resonance Imaging Findings With Clinical Outcomes In Acute Transverse Myelitis: A Comprehensive Retrospective Study, Anjlee Shankar, Faheem Soomro, Dipanty Khastoori, Tahira Maqsood, Sajjad Jalbani, Alam Ibrahim Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective: Acute transverse myelitis (ATM) is an inflammatory spinal cord disorder presenting with motor, sensory, and autonomic dysfunction. The objective of this study was to assess the prognostic value of spinal MRI findings and treatment timing in predicting neurological outcomes in patients with acute transverse myelitis.

Methods: A retrospective analysis was conducted on 90 patients diagnosed with ATM at Chandka Medical College Hospital, Larkana, between January 2021 and December 2023. All patients underwent spinal MRI at presentation, and imaging characteristics—including lesion location, longitudinal extent, and enhancement pattern—were recorded. Clinical outcomes were assessed at one month, three months, and …

Impact Of Physical Exercise On Reducing The Frequency And Severity Of Migraine Without Aura: A Multi-Center Cross-Sectional Study, Amir Hamza, Abdul Wahid, Abdul Bari, Mohammad Azam, Riaz Ahmed, Ikram Ullah

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective: Migraine without aura is the most common subtype of migraine and causes significant distress to its sufferers. The objective of this study was to evaluate the role of physical exercise in reducing the frequency and severity of attacks in patients with migraine without aura.

Methods: This multicenter cross-sectional study was conducted from March 2024 to February 2025 in departments of neurology and medicine in two tertiary care hospitals in Quetta and Khuzdar. A total of 384 adults age 18–60 years with migraine without aura, diagnosed using ICHD-3 criteria, were selected through consecutive sampling. Patients with other headache …

Raising Awareness In South Punjab: The Importance Of Consulting Neurologists For Neurological Disorders, Muhammad Fahad Saleem, Mohammad Wasay, Sohaib Hassan, Muhammad Wahab Qureshi, Muhammad Hamza Khan, Muhammad Wazir

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Best Practices For A Competency-Based Curriculum In Critical Care Ultrasonography For Fellows, Paru Patrawalla, Frances West, Navitha Ramesh, Paul Mayo, Amik Sodhi

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

New guidelines from the Accreditation Council on Graduate Medical Education for critical care ultrasound (CCUS) training went into effect on July 1, 2024, for critical care medicine and combined pulmonary and critical care medicine fellows. Fellowship programs will need to ensure that their fellows demonstrate competence in skills that are essential to CCUS, which currently encompasses applications in basic cardiac, lung/pleural, abdominal, and vascular ultrasonography (US). This may be a challenge for fellowship programs that have nascent CCUS curricula and limited faculty expertise. In this Perspective, we share expert and evidence-based recommendations on how to implement a competency-based curriculum in …

Neurosurgery Research In Pakistan: An Analysis Of Publications, Citations, And Gender Disparities, Waseem Hassan

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Hope In The Face Of Subacute Sclerosing Panencephalitis: A Case Report Of Complete Remission With Isoprinosine, Nimra Shafique, Syed Muhammad Essa, Amanullah Kakar

Pakistan Journal of Neurological Sciences (PJNS)

Subacute Sclerosing Panencephalitis (SSPE) is a rare and relentless neurodegenerative disorder linked to persistent measles virus infection. We present a case of a 16-year-old female with gradually worsening rigidity, cognitive decline, and myoclonic seizures, minimally responsive to valproic acid. A history of measles infection at the age of two years emerged. Positive cerebrospinal fluid (CSF) IgG and IgM anti-measles antibodies, along with an elevated CSF/serum antibody index, confirmed SSPE. Treatment with Inosine pranobex and clonazepam yielded significant motor and seizure control improvements. This case highlights the importance of early SSPE diagnosis and tailored interventions, shedding light on clinical progression and …

Predictors And Prevention Of Neurological Disability In Adult Bacterial Meningitis: A Narrative Review With Clinical Perspective, Sadiq Ali Shah

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: Bacterial meningitis remains a neurological emergency in adults, with substantial mortality and long-term sequelae, including cognitive impairment, hearing loss, seizures, and focal deficits. The objective of this narrative review was to summarize current evidence on predictors of neurological disability and highlight strategies for prevention and long-term care.

Methods: A narrative literature review was conducted using PubMed, Scopus, and Google Scholar for English-language studies published between 2000 and 2025. Keywords included bacterial meningitis, neurological sequelae, predictors, and adults. A total of 40 studies were included after screening 200 abstracts . Key prospective studies, clinical trials, and reviews were …

Clinicoradiological Findings And Outcome Of Posterior Reversible Encephalopathy Syndrome In Children: A Cross-Sectional Study, Zia Ur Rehman Muhammad, Shaila Ali, Shumaila Rafiq, Javeria Raza Alvi, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterised by altered sensorium, seizures, visual impairment and behavioural changes. The objective of the study was to evaluate clinicoradiological findings and outcome of PRES in children.

Methods: A prospective cross-sectional study was conducted at department of pediatric neurology, the Children’s Hospital Lahore from October 2020 to September 2023. Clinical and demographic data were colllected on a structured proforma. Investigations comprised complete blood count, biochemistry, urinalysis, complement levels, inflammatory markers, immune panel, lipid profile and abdominal ultrasonography. All patients underwent MRI brain. Outcome was categorized as complete recovery or …

Spectrum Of Demyelinating Diseases In Pakistan: A Multicenter Cross-Sectional Study, Zainab Aslam Saeed Memon, Safia Awan, Haris Majid Rajput, Qamar Un Nisa, Muhammad Subhan, Lal Chand, Muhammad Wazir Ali Khan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective: Demyelinating diseases are a heterogeneous group of disorders of the central nervous system, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM). Data from South Asia remain scarce, despite potential regional variations in disease spectrum and outcomes. The objective of this study was to characterize the demographic, clinical, and disability profile of patients with demyelinating disorders across Pakistan.

Methods: This multicenter cross-sectional study was conducted between August 2017 and December 2019 across 39 neurology centers in Pakistan. Adult patients (≥18 years) diagnosed with demyelinating disorders using standardized criteria were included. Data on …

Association Of Sars-Cov-2 With Health-Related Quality Of Life 1 Year After Illness Using Latent Transition Analysis, Lauren Wisk, Michael Gottlieb, Peizheng Chen, Huihui Yu, Kelli O'Laughlin, Kari Stephens, Graham Nichol, Juan Carlos Montoy, Robert Rodriguez, Michelle Santangelo, Kristyn Gatling, Erica Spatz, Arjun Venkatesh, Kristin Rising, Mandy Hill, Ryan Huebinger, Ahamed Idris, Michael Willis, Efrat Kean, Samuel Mcdonald, Joann Elmore, Robert Weinstein

Department of Emergency Medicine Faculty Papers

BACKGROUND: Long-term sequelae after SARS-CoV-2 infection may impact health-related quality-of-life (HRQoL), yet it is unknown how HRQoL changes during recovery. We compared patient-reported HRQoL among adults with COVID-19-like illness who tested SARS-CoV-2 positive (COVID+) with those who tested negative (COVID-).

METHODS: Participants in this prospective, multicenter, longitudinal registry study were enrolled from December 2020 through August 2022 and completed 3-month follow-up assessments until 12 months after enrollment. Participants were adults (≥18 years) with acute symptoms suggestive of COVID-19 who received a Food and Drug Administration-approved SARS-CoV-2 test. Participants received questions from PROMIS-29 (subscales: physical function, anxiety, depression, fatigue, social participation, …

Assessment Of Emergency Medicine Residents' Situational Awareness And Perception Of Patient Safety Culture In The Emergency Department, Adriana Olson, Nathan Olson, Nicholas Hartman, Casey Morrone, Morgan Battaglia, Kamna Balhara

Department of Emergency Medicine Faculty Papers

BACKGROUND: Situational awareness (SA) and positive safety climate are crucial to patient safety. Little is known about emergency medicine (EM) trainees' SA and perception of emergency department (ED) safety climate, and the interactions of those factors with safety-related behaviors.

OBJECTIVES: Our objective was to evaluate EM residents' perceptions of ED safety climate, self-reported SA, and comfort with identifying, rectifying, and reporting safety hazards.

METHODS: In this cross-sectional study at two EM residencies, residents completed the Situational Awareness Rating Technique (SART) after ED-based or simulated resuscitations as well as a survey regarding safety climate and comfort with identifying, rectifying, and reporting …

Utility Of Revised Risk Analysis Index As A Predictor Of Mortality And Morbidity In Orthopaedic Trauma., Chirag Soni, Victor Koltenyuk, Nithin Gupta, Haad A Arif, Aruni Areti, Taylor Manes, Luke A Lopas, Jan P Szatkowski, Christian A Bowers, Benjamin C Taylor, Jack W Weick

Trauma and Acute Care Articles

OBJECTIVES: The aim of this study was to determine the applicability of the Revised Risk Analysis Index (RAI-Rev) in orthopaedic trauma and compare the predictive discrimination for the RAI-Rev and the 5-Item Modified Frailty Index (mFI-5) for 30-day postoperative outcomes.

DESIGN: This is a retrospective cohort study.

SETTING: The American College of Surgeons National Surgical Quality Improvement database was used.

PATIENT SELECTION: All patients aged 18 or older who underwent surgical treatment for forearm, humerus, pelvis, acetabulum, femur, tibia, and hindfoot fractures from 2015 to 2020 were included.

OUTCOME: 30-day postoperative mortality, major complications, and wound complications consisting of surgical …

Surgical Management Of An Intracranial Injury Caused By A Handcrafted Arrow In Sub-Saharan Africa: A Global Neurosurgical Relevance., Allie L Heineman, Quinn Jackson, Chris Karas, Robert Galler, Victor Awuor, Hiren Patel

Trauma and Acute Care Articles

This case report and literature review describe an intracranial injury resulting from a handcrafted arrow that required emergent surgical management in a patient treated at a public hospital in Sub-Saharan Africa. The authors are members of the non-profit organizations Chunilal Initiative and Kisumu Intuitive, which deliver charitable neurosurgical care to the region on a quarterly basis. This unique neurotrauma case, involving a penetrating, contaminated, metallic object, highlights the surgical and antibacterial management of intracranial arrow injuries and emphasizes the importance of neurosurgical missions to underserved regions globally. The patient is a 16-year-old male tribal member with no known or reported …

Accidental Ingestion Of Extended-Release Guanfacine In A Toddler., Dina R Assali, Alek Q Adkins, Jonathan Chang

Trauma and Acute Care Articles

This case report describes the clinical presentation and treatment following an exploratory ingestion of extended release (ER) guanfacine in a healthy toddler. Guanfacine, an alpha-2a agonist, can cause transient hypertension as it moves from the serum into the CNS where it causes the more commonly seen central nervous system (CNS) depression, hypotension, and bradycardia. Persistent hypertension requiring intravenous (IV) vasodilatory medication is a rare and life-threatening complication of an alpha-2 agonist with only one other published report. This case report re-emphasizes and further expands available literature on this rarely reported effect.

Epidemiology Of Hip Dislocations In The United States From 1990 To 2019: A Temporal Study Using The Global Burden Of Disease Database., Ambrose Loc T Ngo, Gabrielle Dykhouse, Taylor J Manes, Phillip C Mckegg, Cameron J Sabet, Brett Barthman, Robert Golden

Trauma and Acute Care Articles

Introduction Hip dislocations are devastating injuries that require urgent intervention to minimize the development of severe complications. This study aimed to evaluate the epidemiology of hip dislocations in the United States (U.S.) from 1990 to 2019. Methods This study is a descriptive retrospective epidemiological study. The Global Burden of Disease (GBD) database was used to collect epidemiological data on hip dislocation in the U.S. from 1990 to 2019. Data included years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people. Data were regionally stratified into Northeast, Midwest, South, and West by the U.S. Census definition. Bartlett's test was …

Long-Term Non-Conditional And Conditional Metastasis Of Uveal Melanoma By Tumor Size Category In 8034 Patients, Rolika Bansal, Hidayet Sener, Jerry A. Shields, Carol L. Shields

Wills Eye Hospital Papers

PURPOSE: To estimate metastasis of patients with uveal melanoma (UM) based on tumor size categories classified by ultrasonographic thickness as small (0.0-3.0 mm), medium (3.1-8.0 mm), or large (≥8.1 mm) using both non-conditional and conditional analyses.

DESIGN: Retrospective analysis.

METHODS: A retrospective study of 8034 cases over 35-years at a single ocular oncology referral center evaluated the primary endpoint of cumulative incidence of metastasis at 5-, 10-, 15-, 20-, 25- and 30-years using non-conditional and conditional analysis at 3-years, 5-years, and 10-years of metastasis-free survival.

RESULTS: The mean thicknesses for small, medium, and large UMs were 2.5 mm, 5.0 mm, …