1
|
Inyang D, Madume R, Corriero AC, Sofela A, Osunronbi T. Trends in research grant applications and outcomes among medical students in the United Kingdom: a national self-reported cross-sectional survey. Postgrad Med J 2024; 100:106-111. [PMID: 37973405 DOI: 10.1093/postmj/qgad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/30/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Research funding disparities contribute to clinical academic workforce inequalities. Hence, our study explores the association between student demographics and research grant application rates and outcomes among UK medical students. METHODS This is a national multicentre cross-sectional survey of UK medical students in the 2020-21 academic year. Multiple zero-inflated negative binomial regression and generalized linear model (binomial distribution; logit link) were utilized to investigate the association between student demographics, number of grant applications submitted, and successful grant applications (yes or no). P-values less than a Bonferroni-corrected significance level of 0.05/36 = 0.0014 were considered to be statistically significant. RESULTS A total of 1528 students participated from 36 medical schools. One hundred fifty-one respondents (9.9%) had applied for research grants. Black students submitted applications 2.90 times more often than white students [Incident rate ratio (IRR): 2.90, 95% confidence interval (CI): 1.37-6.16], with no ethnic disparity in the odds of successful applications. Gender did not influence application rates significantly (P = .248), but women were 4.61 times more likely to secure a grant than men [odds ratio: 4.61, 95% CI: 2.04-10.4]. Being a PubMed-indexed author was associated with increased grant application submission rates [IRR: 3.61, 95% CI: 2.20- 5.92] while conducting more research was associated with greater odds of securing a grant [odds ratio: 1.42, 95% CI: 1.17- 1.73]. CONCLUSION Although black students submitted more applications, ethnicity did not influence success rates. Gender did not influence application rates, but women were more successful. These findings underscore the need for strategies supporting women and underrepresented students for continued academic achievement after graduation. KEY MESSAGES What is already known on this topic Research funding for post-PhD researchers is believed to be a major driver of gender and ethnic inequalities in the clinical academic workforce.Students who receive research grants are more likely to receive postgraduate research grants.What this study adds Black students applied for more research grants than white students, but there were no ethnic differences in the odds of securing a grant.There were no gender differences in the research grant application rates. However, female students had greater odds of securing research grants compared to male students.How this study might affect research, practice or policy Medical schools should incorporate grant writing skills into the undergraduate research curriculum. Also, to sustain women's academic success post medical school, the NIHR and affiliates should provide research award extensions and childcare support for women when required.
Collapse
Affiliation(s)
- Deborah Inyang
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
- GKT School of Medical Education, King's College London, London SE1 1UL, United Kingdom
| | - Rachael Madume
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
- Kent and Medway Medical School, Kent CT2 7FS, United Kingdom
| | - Anna Chiara Corriero
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
- School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, United Kingdom
| | - Agbolahan Sofela
- Faculty of Health, University of Plymouth, Plymouth PL6 8BT, United Kingdom
| | - Temidayo Osunronbi
- Department of Health Sciences, University of York, York YO10 5DD, United Kingdom
| |
Collapse
|
2
|
Shahzad M, Borbas B, Sofela A, Muquit S. To assess the safety of laparoscopy in patients with CSF catheters draining distally into the abdomen. Acta Neurochir (Wien) 2024; 166:7. [PMID: 38214791 DOI: 10.1007/s00701-024-05898-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE This study evaluates the safety of laparoscopic procedures in patients with cerebrospinal fluid (CSF) catheters draining distally into the abdomen. METHODS A systematic search across PubMed, Scopus, and Ovid databases using pertinent keywords yielded 47 relevant papers, encompassing 197 cases, for analysis. RESULTS In the pediatric cohort (n = 129), male (49.6%) and female (34.1%) cases were reported, while gender remained unspecified in 16.3%. Shunt indications included unspecified (126 cases) and Meningomyelocele (3 cases). Laparoscopic procedures encompassed gastric (72.1%), urologic (21.7%), and other (6.2%) indications. Peri-operative shunt management included subcostal incision and clamping (1), ICP monitoring and drainage (2), and distal shunt flow confirmation (1). The prevalent complication was mechanical obstruction (10.1%), followed by pseudocyst formation (1.5%) and infection (2.3%). In the adult cohort (n = 61), males (60.6%) and females (39.3%) with a median age of 55 years were observed. Management strategies encompassed sponge packing and mobilization (11), distal shunt flow confirmation (2), shunt clamping (3), Transcranial Doppler monitoring (2), and no manipulation (30). Shunt infection emerged as the primary complication (2). Overall, 24 patients encountered VP shunt-related complications post-laparoscopy. CONCLUSION This study underscores the safety of laparoscopic interventions in patients with ventriculoperitoneal or lumboperitoneal shunts when facilitated by interdisciplinary cooperation. A meticulous preoperative assessment for shunt track localization, intraoperative visualization of shunt tip with CSF flow, vigilant perioperative anesthetic monitoring, and shunt dysfunction surveillance are crucial for favorable outcomes in laparoscopic procedures for these patients.
Collapse
Affiliation(s)
- Muhammad Shahzad
- Department of Neurosurgery, Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK.
| | | | - Agbolahan Sofela
- Department of Neurosurgery, Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK
| | - Samiul Muquit
- Department of Neurosurgery, Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK
| |
Collapse
|
3
|
Adeboye W, Osunronbi T, Faluyi D, Abankwa E, Abraha S, Adamu-Biu F, Ahmad Z, Akhionbare I, Chimba C, Corriero AC, Ibeanusi I, Inyang D, Jones R, Madume R, Mberu V, Mitoko CA, Nelson-Rowe E, O'Riordan M, Shoker S, Sofela A. Predictors of self-reported research engagement and academic-career interest amongst medical students in the United Kingdom: a national cross-sectional survey. Postgrad Med J 2023; 99:1189-1196. [PMID: 37594075 DOI: 10.1093/postmj/qgad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND We hypothesised that the gender/ethnic disparities and reductions in the UK academic-clinician workforce stem from research experience in medical school. This study investigated the factors influencing research engagement and academic-career interests among UK medical students. METHODS Using a 42-item online questionnaire, a national multicentre cross-sectional survey of UK medical students was conducted over 9 weeks in the 2020/21 academic year. Multiple binary logistic and zero-inflated negative binomial regressions were used to evaluate associations between the predictor variables and research engagement (yes/no), number of research projects conducted, and academic-career interest (yes/no). P < 0.05 was considered statistically significant. RESULTS In total, 1573 students participated from 36 medical schools. No ethnic/gender differences in research engagement were observed. However, compared to men, women had a 31% decrease in the odds of being interested in an academic-clinician career [odds ratio (OR): 0.69; 95% confidence interval (CI): 0.52, 0.92]. Positive predictors of interest in academia were being a PubMed-indexed author (OR: 2.19; 95% CI: 1.38, 3.47) and having at least one national/international presentation (OR: 1.40; 95% CI: 1.04, 1.88). Career progression was the primary motivating factor (67.1%) for pursuing research, whereas limited awareness of opportunities (68.0%) and time constraints (67.5%) were the most common barriers. CONCLUSION There were no ethnic differences in research engagement or academic-career intent. Although there were no gender differences in research engagement, female students were less likely to be interested in an academic career. This could be tackled by providing targeted opportunities to increase research productivity and self-efficacy in medical schools. Key messages: What is already known on this topic: There has been a decline in the number of academic clinicians, with a disproportionate gender and ethnic representation in the academic workforce. Engaging medical students in research activities during their medical training could mitigate the declining number of academic clinicians. Differential attainment occurs in medical school and persists after graduation. What this study adds: Although there were no gender/ethnic differences in research engagement amongst UK medical students, our study suggests that female students were less likely to be interested in pursuing an academic career. Time constraints, a lack of awareness of opportunities, and difficulty in finding research supervisors/mentors were the most common barriers to research engagement, whereas PubMed-indexed authorship was the strongest positive predictor of interest in an academic career. How this study might affect research, practice, or policy: Medical schools should facilitate the selection of good-quality research mentors that would provide adequate support to ensure that their students' works are published in peer-reviewed journals. Medical schools should employ local research officers to increase students' awareness of research opportunities.
Collapse
Affiliation(s)
- William Adeboye
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | | | - David Faluyi
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Efua Abankwa
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Semhar Abraha
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | | | - Zain Ahmad
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | | | - Chimba Chimba
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Anna C Corriero
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Ikenna Ibeanusi
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Deborah Inyang
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Robert Jones
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Rachael Madume
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Valentine Mberu
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | | | | | | | - Serena Shoker
- Melanin Medics Research Network, Luton, LU4 8DY, United Kingdom
| | - Agbolahan Sofela
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BT, United Kingdom
| |
Collapse
|
4
|
Osunronbi T, Adeboye W, Faluyi D, Sofela J, Abankwa E, Abraha S, Adamu-Biu F, Ahmad Z, Akhionbare I, Chimba C, Corriero AC, Fofanah IJ, Ibeanusi I, Ibrahim U, Inyang D, Jones R, Kolawole A, Madume R, Mandangu C, Mberu V, Nelson-Rowe E, O'Riordan M, Shoker S, Sofela A. Predictors of self-reported research productivity amongst medical students in the United Kingdom: a national cross-sectional survey. BMC Med Educ 2023; 23:412. [PMID: 37280642 DOI: 10.1186/s12909-023-04412-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/30/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND The number of academic clinicians in the UK is declining and there are demographic inequalities in the clinical-academic workforce. Increased research productivity by medical students is believed to reduce future attrition in the clinical-academic workforce. Thus, this study investigated the association between student demographics and research productivity amongst UK medical students. METHODS This is a national multicentre cross-sectional study of UK medical students in the 2020/21 academic year. We appointed one student representative per medical school, and they disseminated a 42-item online questionnaire over nine weeks, through departmental emails and social media advertisements. The outcome measures were: (i) publications (yes/no) (ii) number of publications (iii) number of first-authored publications (iv) abstract presentation (yes/no). We utilised multiple logistic and zero-inflated Poisson regression analyses to test for associations between the outcome measures and predictor variables at a 5% significance level. RESULTS There are 41 medical schools in the UK. We received 1573 responses from 36 UK medical schools. We failed to recruit student representatives from three newly formed medical schools, whilst two medical schools prohibited us from sending the survey to their students. Women had lower odds of having a publication (OR: 0.53, 95% CI: 0.33-0.85) and on average had fewer first-author publications than men (IRR: 0.57, 95% CI: 0.37-0.89). Compared to white students, mixed-ethnicity students had greater odds of having a publication (OR: 3.06, 95% CI: 1.67-5.59), an abstract presentation (OR: 2.12, 95% CI: 1.37-3.26), and on average had a greater number of publications (IRR: 1.87, 95% CI: 1.02-3.43). On average, students who attended independent UK secondary schools had a higher rate of first-author publications compared to those that attended state secondary schools (IRR: 1.97, 95% CI: 1.23-3.15). CONCLUSION Our data suggest that there are gender, ethnic and socioeconomic inequalities in research productivity among UK medical students. To tackle this, and potentially improve diversity in clinical academia, we recommend that medical schools should facilitate targeted high quality research mentorship, funding and training, especially for under-represented-in-medicine students.
Collapse
Affiliation(s)
- Temidayo Osunronbi
- Melanin Medics Research Network, Luton, UK
- Department of Health Sciences, University of York, York, UK
| | | | | | | | | | | | | | - Zain Ahmad
- Melanin Medics Research Network, Luton, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Agbolahan Sofela
- Faculty of Health, University of Plymouth, Plymouth, UK.
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK.
- School of Medicine, University of Exeter Medical School, Exeter, EX1 2HZ, UK.
| |
Collapse
|
5
|
Osunronbi T, Adeboye W, Faluyi D, Sofela J, Shoker S, O'Riordan M, Mitoko CA, Mberu VK, Mandangu C, Madume R, Kolawole AI, Jones RI, Inyang D, Ibrahim U, Ibeanusi IM, Fofanah IJ, Corriero AC, Chimba C, Akhionbare I, Ahmad Z, Adamu-Biu F, Abraha S, Abankwa E, Sofela A. Predictors of self-reported research self-efficacy and perception of research amongst medical students in the United Kingdom: a national cross-sectional survey. Postgrad Med J 2023; 99:69-76. [PMID: 36841225 DOI: 10.1093/postmj/qgad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/24/2022] [Accepted: 01/06/2023] [Indexed: 02/27/2023]
Abstract
PURPOSE There has been a decline in the number of academic clinicians in the UK, and there are ethnic/gender disparities in the academic workforce. Higher research self-efficacy (RSE) and a positive perception of research (PoR) amongst students are associated with a higher motivation to engage in academic medicine. Hence, this study aimed to determine the factors that influence RSE and PoR amongst UK medical students. METHODS This is a multicentre cross-sectional survey of medical students in 36 UK medical schools in the 2020/21 academic year. Multiple linear regression was used to investigate the association between students' demographics and RSE/PoR. P-values less than a Bonferroni-corrected significance level of .05/28 = .0018 were considered statistically significant. RESULTS In total, 1573 individuals participated from 36 medical schools. There were no ethnic differences in PoR or RSE scores. Although there were no gender differences in PoR, female students had lower RSE scores than male students (adjusted β = -1.75; 95% CI: -2.62, -0.89). Research experience before medical school (adjusted β = 3.02; 95% CI: 2.11, 3.93), being in the clinical training phase (adjusted β = 1.99; 95% CI: 1.09, 2.90), and completing a degree before medical school (adjusted β = 3.66; 95% CI: 2.23, 5.09) were associated with higher RSE. CONCLUSION There were no associations between the predictor variables and PoR. Female students had lower self-reported RSE scores. Future studies should investigate the role of targeted research mentorship in improving RSE amongst female medical students.
Collapse
Affiliation(s)
- Temidayo Osunronbi
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom.,Department of Health Sciences, University of York, York YO10 5DD, United Kingdom
| | - William Adeboye
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - David Faluyi
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Jasmine Sofela
- Faculty of Health, University of Plymouth, Plymouth PL6 8BT, United Kingdom
| | - Serena Shoker
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | | | | | | | - Chenai Mandangu
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Rachael Madume
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | | | - Robert I Jones
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Deborah Inyang
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | | | | | - Isata J Fofanah
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Anna C Corriero
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Chimba Chimba
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | | | - Zain Ahmad
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | | | - Semhar Abraha
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Efua Abankwa
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Agbolahan Sofela
- Faculty of Health, University of Plymouth, Plymouth PL6 8BT, United Kingdom
| | | |
Collapse
|
6
|
Woodfield J, Hoeritzauer I, Jamjoom AA, Jung J, Lammy S, Pronin S, Hannan CJ, Watts A, Hughes L, Moon RD, Darwish S, Roy H, Copley PC, Poon MT, Thorpe P, Srikandarajah N, Grahovac G, Demetriades AK, Eames N, Sell PJ, Statham PF, Abdelsadg M, Abulaila MMS, Ahmed U, Ajmi Q, Al-Mahfoudh R, Ali C, Amarouche M, Andalib A, Arora M, Arora M, Awan M, Baig Mirza A, Bateman A, Bennett I, Bhatti I, Bodkin P, Bommireddy L, Bonanos G, Borg A, Boukas A, Bourne J, Brennan R, Brown J, Brown K, Burton O, Busby C, Chiverton N, Clark S, Copley PC, Cudlip S, Cunningham Y, Dardis R, Darwish S, Davies B, Demetriades AK, Deore S, Derham C, Dherijha M, Dobson G, Duncan J, Durnford A, Durst AZE, Dyson EW, Eames N, Edlmann E, Edwards-Bailey A, Elserius A, Elson B, Fadelalla M, Fountain DM, Gardner A, Ghosh A, Gill JR, Glasmacher SA, Gordon R, Grahovac G, Grenfell R, Habeebullah A, Haliasos N, Hammett T, Hannan CJ, Hill CS, Hoeritzauer I, Holmes D, Hossain-Ibrahim K, Hughes L, Hussain M, Hussain S, Ibrahim R, Jamjoom AAB, John B, Joshi S, Jung J, Kennion O, Khan M, Klejnotowska A, Kumaria A, LaCava R, Lammy S, Lawrence A, Lea M, Leung AHC, Liew I, Luo W, MacCormac O, Manfield J, Mannion R, Merola J, Mishra P, Mohmoud KA, Moon R, Morrison R, Murray O, Nader-Sepahi A, Nnandi C, Pandit A, Patel N, Philip A, Poon MTC, Prasad KSM, Pronin S, Pujara S, Purushothaman B, Rajwani K, Rasul FT, Roy H, Sadek AR, Schramm M, Scicluna G, Sell PJ, Shafafy R, Sharma H, Sheikh A, Sivasubramaniam V, Sofela A, Spink G, Srikandarajah N, Statham PFX, Stokes S, Strachan E, Thakar C, Thanabalasundaram G, Thorpe P, Ulbricht C, Watts A, Whitcher A, White D, Whitehouse K, Wilby M, Woodfield J, Zolnourian A. Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: A multi-centre prospective cohort study. Lancet Reg Health Eur 2023; 24:100545. [PMID: 36426378 PMCID: PMC9678980 DOI: 10.1016/j.lanepe.2022.100545] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.
Collapse
|
7
|
Osunronbi T, Lusta H, Borbas B, Sofela A, Sharma H. Does Preoperative Neutrophil-Lymphocyte Ratio Predict Patient-Reported Pain and Functional Outcomes at 12 Months After Lumbar Fusion? Int J Spine Surg 2022; 16:8290. [PMID: 35584945 PMCID: PMC9421300 DOI: 10.14444/8290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Preoperative neutrophil-lymphocyte ratio (NLR) has been described in various fields to predict pain outcomes, but its prognostic utility for pain/functional outcomes after spine surgery is unclear. OBJECTIVE To determine the relationship between preoperative NLR and pain/functional outcomes at 12 months after lumbar fusion. METHODS We performed a single-center retrospective study of 53 patients who underwent lumbar fusion and collected demographic data including age, sex, body mass index, smoking status, spinal levels operated, and preoperative NLR. Visual analog scale (VAS) for back and leg pain and Oswestry Disability Index (ODI) at baseline and 12 months after lumbar fusion were also collected. The outcome measures were the occurrence of a clinically important improvement in VAS and ODI scores at 12 months. Binary logistic regression was used to estimate the associations of demographic factors and NLR with improvement in VAS and ODI scores. A P value of <0.05 was considered statistically significant. RESULTS There were no statistically significant associations between preoperative NLR and improvement in VAS or ODI scores. A unit increase in baseline VAS back pain score was associated with a 56% increase in the odds of improvement in back pain (OR: 1.56, 95% CI: 1.04-2.35, P = 0.03). Compared to male patients, female patients had 12 times greater odds of an improvement in leg pain (OR: 12.0, 95% CI: 1.3-110, P = 0.03). CONCLUSION Preoperative NLR does not predict patient-reported pain/functional outcomes at 12 months after lumbar fusion. Large-scale prospective multicenter studies are warranted to confirm our findings.
Collapse
Affiliation(s)
- Temidayo Osunronbi
- Hull University Teaching Hospitals NHS Trust, Hull, UK
- Department of Health Sciences, University of York, York, UK
| | - Hiba Lusta
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Balint Borbas
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Agbolahan Sofela
- Faculty of Health, University of Plymouth, Plymouth, UK
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Himanshu Sharma
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| |
Collapse
|
8
|
Osunronbi T, Borbas B, Lusta H, Sofela A, Sharma H. Preoperative lymphocyte percentage and neutrophil-lymphocyte ratio are useful predictors of 30-day postoperative complications after lumbar fusion. Surg Neurol Int 2022; 13:145. [PMID: 35509554 PMCID: PMC9062943 DOI: 10.25259/sni_160_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Lymphocyte percentage/count, platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) have shown prognostic significance in patients with cancer, stroke, and following cardiac surgery. However, the utility of these blood parameters for assessing the 30-day postoperative risk for lumbar fusion complications has not been established. Methods: In this single-center-single-surgeon retrospective series, 77 consecutive patients underwent one- or two-level lumbar fusion. Lymphocyte percentage/count, PLR, and NLR were investigated as predictors of 30-day postoperative complications. Results: Ten of 77 patients had postoperative complications. A unit increase in NLR and lymphocyte percentage was significantly associated with a 23% increase and 7% decrease, respectively, in the odds of a complication occurring. Preoperative NLR ≥ 2.32 and lymphocyte percentage ≤ 29.5% significantly discriminated between the “complication” and “no-complication” groups. Conclusion: Patients with a preoperative lymphocyte percentage of ≤29.5% and/or NLR ≥2.32 should be closely monitored as high-risk groups susceptible to 30-day postoperative complications after lumbar fusion.
Collapse
Affiliation(s)
- Temidayo Osunronbi
- Department of Surgery, Hull University Teaching Hospitals NHS Trust, Anlaby Road, Hull,
- Department of Health Sciences, University of York, York,
| | - Balint Borbas
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth Science Park, Plymouth,
| | - Hiba Lusta
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth Science Park, Plymouth,
| | - Agbolahan Sofela
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Himanshu Sharma
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| |
Collapse
|
9
|
Sofela J, Hunt WTN, Chaytor R, Stephens M, Sofela A, Harmse D, Chave T. A rare case of lipase hypersecretion syndrome. Clin Exp Dermatol 2022; 47:635-638. [PMID: 34890070 DOI: 10.1111/ced.15023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- J Sofela
- Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - W T N Hunt
- Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - R Chaytor
- Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Stephens
- Cellular and Anatomical Pathology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - A Sofela
- South West Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - D Harmse
- Cellular and Anatomical Pathology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - T Chave
- Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| |
Collapse
|
10
|
Sofela A. Re: World Health Organisation grade III meningiomas. A retrospective study for outcome and prognostic factors assessment. Neurochirurgie 2020; 67:210. [PMID: 32589901 DOI: 10.1016/j.neuchi.2020.06.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- A Sofela
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, PL6 8DH Plymouth, United Kingdom.
| |
Collapse
|
11
|
Osunronbi T, Sofela A, Sharma H, Muquit S. Traumatic pneumorrhachis: systematic review and an illustrative case. Neurosurg Rev 2020; 44:731-739. [PMID: 32307638 DOI: 10.1007/s10143-020-01300-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/08/2020] [Accepted: 04/02/2020] [Indexed: 11/24/2022]
Abstract
Pneumorrhachis (PR) refers to free air in the spinal canal. We aim to describe a case report and conduct a systematic review focused on the clinical presentation, diagnosis, and management of traumatic PR. We conducted a language-restricted PubMed, SciELO, Scopus, and Ovid database search for traumatic PR cases published till June 2019. Categorical variables were assessed by Fisher's exact test. In addition to our reported index case, there were 82 articles (96 individual cases) eligible for meta-analysis according to our inclusion/exclusion criteria. Eighty per cent of patients had blunt trauma, while 17% had penetrating injuries. Thirty-four per cent of cases were extradural PR, 21% intradural PR, and unreported PR type in 43%. Nine per cent of patients presented with symptoms directly attributed to PR: sensory radiculopathy (2%), motor radiculopathy (1%), and myelopathy (6%). CT had a 100% sensitivity for diagnosing PR, MRI 60%, and plain radiograph 48%. Concurrent injuries reported include pneumocephalus (42%), pneumothorax (36%), spine fracture (27%), skull fracture (27%), pneumomediastinum (24%), and cerebrospinal fluid leak (14%). PR was managed conservatively in every case, with spontaneous resolution in 96% on follow-up (median = 10 days). Prophylactic antibiotics for meningitis were given in 13% PR cases, but there was no association with the incidence of meningitis (overall incidence: 3%; prophylaxis group (0%) vs non-prophylaxis group (4%) (p = 1)). Occasionally, traumatic PR may present with radiculopathy or myelopathy. Traumatic PR is almost always associated with further air distributions and/or underlying injuries. There is insufficient evidence to support the use of prophylactic antibiotic in preventing meningitis in traumatic PR patients.
Collapse
Affiliation(s)
| | - Agbolahan Sofela
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK. .,Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK.
| | - Himanshu Sharma
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK
| | - Samiul Muquit
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK
| |
Collapse
|
12
|
Adams CL, Ercolano E, Ferluga S, Sofela A, Dave F, Negroni C, Kurian KM, Hilton DA, Hanemann CO. A Rapid Robust Method for Subgrouping Non-NF2 Meningiomas According to Genotype and Detection of Lower Levels of M2 Macrophages in AKT1 E17K Mutated Tumours. Int J Mol Sci 2020; 21:E1273. [PMID: 32070062 PMCID: PMC7073007 DOI: 10.3390/ijms21041273] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 12/19/2022] Open
Abstract
The majority of meningiomas are grade I, but some grade I tumours are clinically more aggressive. Recent advances in the genetic study of meningiomas has allowed investigation into the influence of genetics on the tumour microenvironment, which is important for tumorigenesis. We have established that the endpoint genotyping method Kompetitive Allele Specific PCR (KASP™) is a fast, reliable method for the screening of meningioma samples into different non-NF2 mutational groups using a standard real-time PCR instrument. This genotyping method and four-colour flow cytometry has enabled us to assess the variability in the largest immune cell infiltrate population, M2 macrophages (CD45+HLA-DR+CD14+CD163+) in 42 meningioma samples, and to suggest that underlying genetics is relevant. Further immunohistochemistry analysis comparing AKT1 E17K mutants to WHO grade I NF2-negative samples showed significantly lower levels of CD163-positive activated M2 macrophages in meningiomas with mutated AKT1 E17K, signifying a more immunosuppressive tumour microenvironment in NF2 meningiomas. Our data suggested that underlying tumour genetics play a part in the development of the immune composition of the tumour microenvironment. Stratifying meningiomas by mutational status and correlating this with their cellular composition will aid in the development of new immunotherapies for patients.
Collapse
Affiliation(s)
- Claire L. Adams
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth PL6 8BU, UK (C.N.)
| | - Emanuela Ercolano
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth PL6 8BU, UK (C.N.)
| | - Sara Ferluga
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth PL6 8BU, UK (C.N.)
| | - Agbolahan Sofela
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth PL6 8BU, UK (C.N.)
- Department of Neurosurgery, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth PL6 8DH, UK
| | - Foram Dave
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth PL6 8BU, UK (C.N.)
| | - Caterina Negroni
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth PL6 8BU, UK (C.N.)
| | - Kathreena M. Kurian
- Institute of Clinical Neuroscience, University of Bristol and Southmead Hospital, North Bristol Trust, Bristol BS8 1QU, UK
| | - David A. Hilton
- Cellular and Anatomical Pathology, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth PL6 8DH, UK
| | - C. Oliver Hanemann
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, The John Bull Building, Plymouth Science Park, Research Way, Plymouth PL6 8BU, UK (C.N.)
| |
Collapse
|
13
|
Sofela A, Osunronbi T, Hettige S. Scalp Cirsoid Aneurysms: Case Illustration and Systematic Review of Literature. Neurosurgery 2019; 86:E98-E107. [DOI: 10.1093/neuros/nyz303] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 05/18/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Scalp cirsoid aneurysms are rare subcutaneous arteriovenous fistulae affecting the scalp. They can be easily misdiagnosed and mistreated.
OBJECTIVE
To review reported cases of scalp cirsoid aneurysms for their incidence, etiology, clinical presentation, treatment, and outcomes using an illustrative case.
METHODS
We conducted a PUBMED, SCOPUS, OVID SP, SciELO, and INFORMA search using the keywords; “cirsoid,” “aneurysm,” “arteriovenous,” “malformation,” “scalp,” “vascular,” and “fistula.” We identified 74 pertinent papers, reporting 242 cases in addition to our reported index case.
RESULTS
Median age at presentation was 25 yr (range 1-72 yr); male to female ratio was 2.5:1. The most common symptoms were a pulsatile mass (94% of patients), headaches (25%), and tinnitus (20%). The median duration of symptoms was 3 yr (6 d to 31 yr), with 60.2% occurring spontaneously, 32.23% traumatic, and the rest iatrogenic. A total of 58.5% of cases were managed with surgical excision only, 21.6% with endovascular embolization only, and 14.5% with a combination of both methods. The complication rate observed in the endovascular embolization treatment cohort (55.8%) was significantly higher than that observed in the surgical excision only cohort (9.9%) (P < .00001) and in the combined therapy cohort (0%) (P < .00001). There is a low recurrence rate after treatment irrespective of modality: surgical excision only (6.3%), endovascular embolization only (8.3%), and combined therapy (0%).
CONCLUSION
Scalp cirsoid aneurysms are associated with good prognoses when recognized and managed appropriately. We suggest combining surgery with endovascular embolization as the optimum treatment modality.
Collapse
Affiliation(s)
- Agbolahan Sofela
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Temidayo Osunronbi
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, United Kingdom
| | - Samantha Hettige
- Department of Neurosurgery, St George's University Hospitals NHS Foundation Trust, United Kingdom
| |
Collapse
|
14
|
Hettige S, Sofela A, Bassi S, Chandler C. A review of spontaneous intracranial extradural hematoma in sickle-cell disease. Acta Neurochir (Wien) 2015; 157:2025-9; discussion 2029. [PMID: 26374442 DOI: 10.1007/s00701-015-2582-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
Sickle-cell disease is common among patients of Afro-Caribbean origin. Though it can precipitate neurological conditions, it only rarely causes neurosurgical problems, with very few reported cases. We describe the case of a 7-year-old girl with a background of sickle-cell disease (SCD) brought into an acute neurosurgical unit in extremis, signs of a raised ICP, and with no history of recent trauma. Following further investigations, an acute drop in the hemoglobin and hematocrit levels were noted, with the cause of her presentation being attributed to a sickling crisis causing skull convexity infarction and resulting in spontaneous bilateral extradural hematomas requiring emergency evacuation. We review the current literature and propose the pathophysiological mechanism behind this phenomenon.
Collapse
|
15
|
|
16
|
Sofela A, Hettige S, Bassi S. Malignant Transformation of Craniopharyngiomas. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|