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Morales IC, Desai K, Alam Z, Kumar RP, O'Malley GR, Ruzicka F, Silva NA, Patel NV. Excelencia en Neurocirugía: María Cristina García-Sancho, the First Latina Neurosurgeon in the World. World Neurosurg 2024; 185:310-313. [PMID: 38395351 DOI: 10.1016/j.wneu.2024.02.081] [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: 01/12/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Neurosurgery is a specialty that has been dominated by males. Although there has been an increase in the number of women in the field, it is not yet close to being equal. Some noteworthy women who have carved the path for other women to follow in their footsteps include Drs. Sofía Ionescu and Diana Beck, the first and second female neurosurgeons worldwide, respectively. However, there are limited publications on Dr. María Cristina García-Sancho, the first Latina neurosurgeon. METHODS The purpose of this review was to illuminate the neurosurgical community on the life of Dr. García-Sancho. A thorough literature was performed on medical and non-medical publications that were either authored by Dr. García-Sancho or mentioned her directly. RESULTS Dr. García-Sancho earned her medical degree at the School of Medicine of the National Autonomous University of Mexico under the guidance of Dr. Clemente Robles, who founded Mexico's first neurosurgical department. Her training took her worldwide. CONCLUSIONS Her expertise allowed her to pioneer a revolutionary advancement known as the one-step bilateral cordotomy. Her perseverance led her to becoming the head of the Department of Neurosurgery at the National Cancer Institute of Mexico and co-found the Mexican Society of Neurological Surgery, where she served on the board of directors. This review aims to advocate for an equitable environment in the field of neurosurgery with Dr. García-Sancho's story.
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Affiliation(s)
- Ilona Cazorla Morales
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
| | - Kush Desai
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Zahin Alam
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Rohit Prem Kumar
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Geoffrey R O'Malley
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Francis Ruzicka
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Nicole A Silva
- Department of Neurosurgery, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nitesh V Patel
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA; Department of Neurosurgery, HMH-Jersey Shore University Medical Center, Neptune, New Jersey, USA
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Silva NA, Barrios-Martinez J, Yeh FC, Hodaie M, Roque D, Boerwinkle VL, Krishna V. Diffusion and functional MRI in surgical neuromodulation. Neurotherapeutics 2024; 21:e00364. [PMID: 38669936 PMCID: PMC11064589 DOI: 10.1016/j.neurot.2024.e00364] [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: 11/06/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Surgical neuromodulation has witnessed significant progress in recent decades. Notably, deep brain stimulation (DBS), delivered precisely within therapeutic targets, has revolutionized the treatment of medication-refractory movement disorders and is now expanding for refractory psychiatric disorders, refractory epilepsy, and post-stroke motor recovery. In parallel, the advent of incisionless treatment with focused ultrasound ablation (FUSA) can offer patients life-changing symptomatic relief. Recent research has underscored the potential to further optimize DBS and FUSA outcomes by conceptualizing the therapeutic targets as critical nodes embedded within specific brain networks instead of strictly anatomical structures. This paradigm shift was facilitated by integrating two imaging modalities used regularly in brain connectomics research: diffusion MRI (dMRI) and functional MRI (fMRI). These advanced imaging techniques have helped optimize the targeting and programming techniques of surgical neuromodulation, all while holding immense promise for investigations into treating other neurological and psychiatric conditions. This review aims to provide a fundamental background of advanced imaging for clinicians and scientists, exploring the synergy between current and future approaches to neuromodulation as they relate to dMRI and fMRI capabilities. Focused research in this area is required to optimize existing, functional neurosurgical treatments while serving to build an investigative infrastructure to unlock novel targets to alleviate the burden of other neurological and psychiatric disorders.
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Affiliation(s)
- Nicole A Silva
- Department of Neurological Surgery, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mojgan Hodaie
- Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Daniel Roque
- Department of Neurology, University of North Carolina in Chapel Hill, NC, USA
| | - Varina L Boerwinkle
- Department of Neurology, University of North Carolina in Chapel Hill, NC, USA
| | - Vibhor Krishna
- Department of Neurological Surgery, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
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Behmer Hansen RT, Behmer Hansen RA, Gold JL, Blocher III WA, Palma SD, Susman SJ, Batchu S, Silva NA, Richardson AM. A Decade of Global Skull Base Researchers: Gender Data from over 2,700 Abstract Authors in the Journal of Neurological Surgery Part B: Skull Base. J Neurol Surg B Skull Base 2024; 85:57-66. [PMID: 38274485 PMCID: PMC10807964 DOI: 10.1055/a-1978-9487] [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: 09/28/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The North American Skull Base Society (NASBS) annual conference brings together skull base researchers from surgical and nonsurgical fields. Our objective was to quantify the contributions of the authors by gender, who presented their work at NASBS and were subsequently published in the Journal of Neurological Surgery Part B: Skull Base . Methods Oral and poster abstracts presented at the NASBS annual meeting from January 1, 2011 to December 31, 2020 were extracted from the Journal of Neurological Surgery Part B: Skull Base. The genderize.io Web application programming interface was utilized to determine authorship gender. A minority of first and last authors had departmental affiliations listed; a subgroup analysis was performed of these authors. Results Female gender was assigned to 498 (17.8%) of the 2,798 first authors and 269 (9.7%) of the 2,762 last authors. Female authorship has consistently increased over the last decade. Representation was higher in otolaryngology (23.3% of first authors, 12.1% of last authors; p = 0.018) than neurosurgery (13.5% of first authors, 4.3% of last authors; p = 0.004). Female researchers were not less likely than their male counterparts to receive prestigious oral presentations. Of the 52 total countries represented, 20 (38.5%) had at least one female first author. Representation varied dramatically between countries. Conclusion The NASBS' efforts have undoubtedly contributed to these impressive strides toward gender parity. More work is needed to ensure that the best and the brightest, regardless of background, continue to contribute to skull base surgery research.
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Affiliation(s)
| | | | - Justin L. Gold
- Department of Neurosurgery, Cooper Medical School of Rowan University, Camden, New Jersey, United States
| | | | - Samantha D. Palma
- Department of Neurosurgery, Indiana University, Indianapolis, Indiana, United States
| | - Stephen J. Susman
- Department of Neurosurgery, Indiana University, Indianapolis, Indiana, United States
| | - Sai Batchu
- Independent Researcher, Camden, New Jersey, United States
| | - Nicole A. Silva
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Angela M. Richardson
- Department of Neurosurgery, Indiana University, Indianapolis, Indiana, United States
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Behmer Hansen RT, Palma SD, Blocher III WA, Behmer Hansen RA, Gold JL, Susman SJ, Batchu S, Silva NA, Richardson AM. A Decade of Global Skull Base Researchers: Authorship Trends from 3,295 Abstracts in the Journal of Neurological Surgery Part B: Skull Base. J Neurol Surg B Skull Base 2024; 85:44-56. [PMID: 38274488 PMCID: PMC10807966 DOI: 10.1055/a-2008-2884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/06/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023] Open
Abstract
Objective The North American Skull Base Society (NASBS) multidisciplinary annual conference hosts skull base researchers from across the globe. We hypothesized that the work presented at the NASBS annual conference would reveal diverse authorship teams in terms of specialty and geography. Methods In this retrospective review, abstracts presented at the NASBS annual meeting and subsequently published in the Journal of Neurological Surgery Part B: Skull Base between 01/01/2011 and 12/31/2020 were collected. Variables extracted included year, type of presentation, and author names and affiliations. Statistical analyses were performed with SPSS V23.0 with p -values less than 0.05 considered significant. Geographic heat maps were created to assess author distribution, and a network analysis was performed to display authorship collaboration between geographic regions. Results Of 3,312 published abstracts, 731 (22.1%) had an author with an affiliation outside of the United States. Fifty-seven distinct countries were represented. Three-hundred twenty-four abstracts (9.8%) had authorship teams representing at least 2 different countries. The top five US states by abstract representation were Pennsylvania, California, New York, Ohio, and Minnesota. A majority of authors reported neurosurgery affiliations (56.7% first authors, 53.2% last authors), closely followed by otolaryngology (39.1% first authors, 41.5% last authors). No solo authors and very few (3.3%) of the first authors reported a departmental affiliation outside of otolaryngology or neurosurgery. Conclusions Authors from many countries disseminate their work through poster and oral presentations at the NASBS annual meeting. Ten percent of abstracts were the product of international collaboration. Most authors were affiliated with a neurosurgery or otolaryngology department.
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Affiliation(s)
| | - Samantha D. Palma
- Department of Neurosurgery, Indiana University Indianapolis, Indiana, United States
| | | | | | - Justin L. Gold
- Department of Neurosurgery, Cooper Medical School of Rowan University, Camden, New Jersey, United States
| | - Stephen J. Susman
- Department of Neurosurgery, Indiana University Indianapolis, Indiana, United States
| | | | - Nicole A. Silva
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Angela M. Richardson
- Department of Neurosurgery, Indiana University Indianapolis, Indiana, United States
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Silva NA, Mengistu J, Pillai M, Anand G, Sindelar BD. Outcomes following surgical intervention for acute hemorrhage in severe traumatic brain injury: a review of the National Trauma Data Bank. J Neurosurg 2024; 140:552-559. [PMID: 37548567 DOI: 10.3171/2023.5.jns23126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/25/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Severe traumatic brain injury (TBI) is a public health issue posing significant morbidity and mortality to afflicted patients. While the effect of time to surgery as the primary factor for survival has been extensively studied, long-term dispositional outcomes following intracranial hemorrhage evacuation have not been well described in the literature. Therefore, the aim of this study was to elicit potential prognostic factors in patients presenting with severe TBI that may have a significant impact on discharge disposition. METHODS The authors searched the National Trauma Data Bank (NTDB) for patients included between 2010 and 2019, solely focusing on those with a Glasgow Coma Scale score ≤ 8, signifying severe TBI, and with associated intracranial hemorrhage treated via surgical intervention. Numerous characteristics were analyzed, including demographics (age, sex, race, ethnicity, payment status), discharge disposition, time to surgery, pupillary response, midline shift (> 5 mm), and postoperative inpatient complications and comorbidities. Disposition included routine discharge to home, discharge to home with home health services (HHSs), discharge to acute inpatient rehabilitation (AIR), discharge to a skilled nursing facility (SNF)/long-term acute care hospital (LTACH), and death. RESULTS The authors analyzed data on 7308 patients, 69.6% of whom were White and 11.2% of whom were Black. More young Black and Hispanic patients had severe TBI events than their matched elders, whereas more elderly White patients had severe TBI events than their matched younger counterparts. The most common disposition across all ages was SNF/LTACH. Septuagenarians and octogenarians were 12.1 and 21 times more likely, respectively, to die following a severe TBI than their younger counterparts (p < 0.001). Patients aged 18-29 were 1.7 times more likely to be discharged with HHSs (p < 0.001). Minority race/ethnicity groups were less likely to be discharged to AIR. As age increased, a patient's intensive care unit stay increased by 15 days (p < 0.001) and total hospital length of stay increased by 25 days (p < 0.001). CONCLUSIONS Neurosurgical evacuation of intracranial hemorrhage in severe TBI has variable long-term morbidity. Utilizing the largest collection of trauma data within the United States, the authors present quantitative evidence on discharge disposition. Understanding these tangible points can help neurosurgeons present potential outcomes to patients, promote preventative care, and generate tangible conversations with patients and their family members.
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da Costa MDS, Vaz HHS, Silva NA, Dastoli PA, Nicácio JM, Malveira AS, Flores EIB, Cavalheiro S. Fluorescein-guided resection for pediatric low-grade gliomas: institutional experience on two cases and a narrative literature review. Childs Nerv Syst 2022; 39:1485-1493. [PMID: 36454311 DOI: 10.1007/s00381-022-05773-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Low-grade gliomas compose 30% of pediatric central nervous system tumors and outcomes of disease-free progression, and survival is directly correlated to the extent of resection. The use of sodium fluorescein (Na-Fl) is an intraoperative method in the localization of tumor cells in adult patients to optimize resection. Our purpose is to describe the use of Na-Fl in pediatric low-grade gliomas and its outcomes. METHODS Patients under 18 years of age with low-grade gliomas at the author's institution underwent resection with the use of Na-Fl, with review of preoperative imaging findings, intraoperative results, and follow-up. Then, a comprehensive, narrative literature review of the use of Na-Fl in pediatric low-grade glioma was performed. RESULTS Our single-institution use of Na-Fl in pediatric patients with suspected low-grade glioma demonstrated excellent results of intraoperative enhancement of tumor cells as well as gross total resection. The literature demonstrated 84% Na-Fl staining and 59.2% of gross total resection in pediatric low-grade gliomas with few small case studies, a range of reported findings, and few side effects. CONCLUSION Na-Fl has a promising use in low-grade glioma resection in the pediatric patient population. Further research is warranted, such as randomized controlled studies, to assess Na-Fl as a potential tool in improving resection and long-term favorable outcomes.
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Affiliation(s)
- Marcos Devanir Silva da Costa
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
- Division of Neurosurgery, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, SP, Brazil
| | | | - Nicole A Silva
- Department of Neurosurgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Patricia Alessandra Dastoli
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
- Division of Neurosurgery, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, SP, Brazil
| | - Jardel Mendonça Nicácio
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
- Division of Neurosurgery, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, SP, Brazil
| | - Adib Saraty Malveira
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Sergio Cavalheiro
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
- Division of Neurosurgery, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, SP, Brazil
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Silva NA, Veras MCBM, Nobre MCT, Lima BF, Lima MPC, Gomes FAF. A INFORMATIZAÇÃO DA GESTÃO DE DOCUMENTOS DO SISTEMA DE GESTÃO DA QUALIDADE DO CENTRO DE HEMATOLOGIA E HEMOTERAPIA DO CEARÁ- HEMOCE: UM RELATO DE EXPERIÊNCIA. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.891] [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: 11/11/2022] Open
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Brito MVA, Silva NA, Lima MPC, Lima BF, Gomes FAF, Brunetta DM, Carlos LMB, Veras MCBM. IMPLANTAÇÃO DE INDICADORES DE DESEMPENHO NAS AGÊNCIAS TRANSFUSIONAIS DO HEMOCENTRO COORDENADOR DE FORTALEZA COMO FERRAMENTA DE GESTÃO. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.920] [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: 11/07/2022] Open
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Cornea CM, Silva NA, Marble WS, Hooten K, Sindelar B. Evolution of spinal cord injury treatment in military neurosurgery. Neurosurg Focus 2022; 53:E11. [DOI: 10.3171/2022.6.focus22255] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022]
Abstract
During the mid-1900s, military medicine made historical advancements in the diagnosis, stabilization, and treatment of spinal cord injuries (SCIs). In particular, World War II was an inflection point for clinical practice related to SCIs because of the vast number of devastating injuries to soldiers seen during World War I (WWI). The unprecedented rate of SCI along with growth in the field served as a catalyst for surgical and interdisciplinary advancements through the increased exposure to this challenging pathology. Initially, a tragic fate was assumed for soldiers with SCIs in WWI resulting in a very conservative approach strategy given a multitude of factors. However, soldiers with similar injuries 20 years later saw improved outcomes with more aggressive management interventions by specialists in spine trauma, who applied measures such as spinal traction, arthrodesis, and internal fixation, and with the significant developments in the complex rehabilitation of these patients. This article describes the historical shift in the management of SCIs through the two world wars. These historical lessons of SCI and the fundamental advances in their neurosurgical intervention have molded not only military but also modern civilian treatment of SCI.
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Affiliation(s)
| | - Nicole A. Silva
- Department of Neurosurgery, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | | | - Kristopher Hooten
- Department of Neurosurgery, Walter Reed Army Medical Center, Bethesda, Maryland
| | - Brian Sindelar
- Department of Neurosurgery, University of North Carolina Hospitals, Chapel Hill, North Carolina
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Ferreira GA, Wagner L, Maziero R, Ataide-Silva T, Silva NA, Bertuzzi R, Lima-Silva AE. Caffeine intake reduces sedentary time and increases physical activity predisposition in obese police officers. ACTA ACUST UNITED AC 2021; 54:e11556. [PMID: 34550274 PMCID: PMC8457682 DOI: 10.1590/1414-431x2021e11556] [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: 04/24/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022]
Abstract
Sedentary time is associated with increased obesity in police officers. Caffeine intake may reduce sedentary time but it has not been extensively investigated. In the present study, the effect of caffeine ingestion on sedentary time was investigated in obese police officers. Fourteen obese police officers ingested either 5 mg/kg of caffeine or cellulose (placebo) for six days. Information on inactivity time, time spent with physical activities, self-reported perception of tiredness, and physical activity disposition was obtained daily during the intervention period. Sedentary and physical activity times were divided into two intraday periods (T1: 08:00 am-02:00 pm and T2: 02:00 pm-08:00 pm). Caffeine intake decreased the sedentary time in both T1 (79.2±2.2%) and T2 (79.1±2.5%), when compared with T2 of the placebo condition (81.1±3.6%, P<0.05). Caffeine intake also increased the time spent on light physical activities in T1 and T2 (17±2 and 18±2%), when compared with T2 of the placebo condition (16±3%, P<0.05). In addition, sedentary time increased and light physical activity time decreased from T1 to T2 in the placebo (P<0.001) but not in the caffeine condition (P=0.81). Caffeine intake had no effect on tiredness (P>0.05), but it increased the self-reported physical activity disposition compared to the placebo condition (4.5±2.7 vs 3.2±2.3 units, P<0.05). Caffeine intake reduced the sedentary time and increased the time spent on light physical activities of obese police officers, which seems to be related to a higher disposition for the practice of physical activity.
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Affiliation(s)
- G A Ferreira
- Grupo de Pesquisa em Performance Humano, Universidade Tecnológica Federal do Paraná, Curitiba, PR, Brasil.,Centro Acadêmico de Vitória, Universidade Federal de Pernambuco, Vitória de Santo Antão, PE, Brasil
| | - L Wagner
- Grupo de Pesquisa em Performance Humano, Universidade Tecnológica Federal do Paraná, Curitiba, PR, Brasil
| | - R Maziero
- Grupo de Pesquisa em Performance Humano, Universidade Tecnológica Federal do Paraná, Curitiba, PR, Brasil
| | - T Ataide-Silva
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, AL, Brasil
| | - N A Silva
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, AL, Brasil
| | - R Bertuzzi
- Grupo de Estudos em Desempenho Aeróbio, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A E Lima-Silva
- Grupo de Pesquisa em Performance Humano, Universidade Tecnológica Federal do Paraná, Curitiba, PR, Brasil
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Lulla T, Behmer Hansen RT, Smith CA, Silva NA, Patel NV, Nanda A. Women neurosurgeons around the world: a systematic review. Neurosurg Focus 2021; 50:E12. [PMID: 33789239 DOI: 10.3171/2020.12.focus20902] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 10/30/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gender disparities in neurosurgery have persisted even as the number of female medical students in many countries has risen. An understanding of the current gender distribution of neurosurgeons around the world and the possible factors contributing to country-specific gender disparities is an important step in improving gender equity in the field. METHODS The authors performed a systematic review of studies pertaining to women in neurosurgery. Papers listed in PubMed in the English language were collected. A modified grounded theory approach was utilized to systematically identify and code factors noted to contribute to gender disparities in neurosurgery. Statistical analysis was performed with IBM SPSS Statistics for Windows. RESULTS The authors identified 39 studies describing the density of women neurosurgeons in particular regions, 18 of which documented the proportion of practicing female neurosurgeons in a single or in multiple countries. The majority of these studies were published within the last 5 years. Eight factors contributing to gender disparity were identified, including conference representation, the proverbial glass ceiling, lifestyle, mentoring, discrimination, interest, salary, and physical burden. CONCLUSIONS The topic of women in neurosurgery has received considerable global scholarly attention. The worldwide proportion of female neurosurgeons varies by region and country. Mentorship was the most frequently cited factor contributing to noted gender differences, with lifestyle, the glass ceiling, and discrimination also frequently mentioned. Future studies are necessary to assess the influence of country-specific sociopolitical factors that push and pull individuals of all backgrounds to enter this field.
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Affiliation(s)
- Tina Lulla
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey; and
| | | | - Cynthia A Smith
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey; and
| | - Nicole A Silva
- 2Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina
| | - Nitesh V Patel
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey; and
| | - Anil Nanda
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey; and
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Behbahani S, Smith CA, Carvalho M, Warren CJ, Gregory M, Silva NA. Vulnerable Immigrant Populations in the New York Metropolitan Area and COVID-19: Lessons Learned in the Epicenter of the Crisis. Acad Med 2020; 95:1827-1830. [PMID: 32452838 PMCID: PMC7268828 DOI: 10.1097/acm.0000000000003518] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The epicenter of the COVID-19 crisis since March 17, 2020-the New York metropolitan area-is home to some of the largest Latino immigrant communities in the nation. These communities have long faced barriers to health care access, challenges due to immigration status, and financial and labor instability. The COVID-19 pandemic has aggravated these existing issues in a vulnerable, often forgotten, immigrant community. It has been challenging for this population to access public information regarding COVID-19 testing, treatment, and assistance programs because this information has seldom been disseminated in Spanish and even less frequently in Portuguese. While long-term solutions will require time and changes to policy, some short-term measures can mitigate the current situation. The authors share their experience from Newark, New Jersey, where partnerships of public and private community-based organizations (CBOs) have been successful in establishing trust between the health care system and a fearful Latino community. The Ironbound Initiative, a student group at Rutgers New Jersey Medical School in Newark, New Jersey, has partnered with Mantena Global Care, a Brazilian CBO in Newark, to facilitate dissemination of COVID-19-relevant information. Medical student volunteers, removed from their clinical duties, serve as virtual patient navigators, using social media to reach community members with the goals of improving awareness of precautions to take during the pandemic and of increasing access to needed medical care. These students have collaborated with colleagues in other disciplines to provide necessary legal guidance to community members fearful of seeking care because of their immigration status. The authors urge other academic institutions across the country to recruit multidisciplinary teams of medical, health professions, and law students invested in their local communities and to empower students to partner with CBOs, immigrant community leaders, faith-based organizations, hospitals, and local authorities to support these vulnerable communities during this crisis.
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Affiliation(s)
- Sara Behbahani
- S. Behbahani is a third-year student, Rutgers New Jersey Medical School, Newark, New Jersey; ORCID: http://orcid.org/0000-0001-9159-4745
| | - Cynthia A. Smith
- C.A. Smith is a lawyer and first-year student, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michelly Carvalho
- M. Carvalho is an incoming nursing student, Rutgers School of Nursing, Newark, New Jersey
| | - Christopher J. Warren
- C.J. Warren is a third-year student, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Micah Gregory
- M. Gregory is a nurse and project coordinator, West Virginia Prevention Research Center, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Nicole A. Silva
- N.A. Silva is a recent graduate, Rutgers New Jersey Medical School, Newark, New Jersey, and incoming postgraduate year 1 neurosurgery resident, University of North Carolina, Chapel Hill, North Carolina
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Silva NA, Cerasiello SY, Herendeen JS, Sotayo A, Say I, Mazzola CA, Liu JK, Eloy JA. Gender differences in NIH grant funding in neurological surgery. J Clin Neurosci 2020; 80:43-49. [DOI: 10.1016/j.jocn.2020.07.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/23/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
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Joseph P, Silva NA, Nanda A, Gupta G. Evaluating the Readability of Online Patient Education Materials for Trigeminal Neuralgia. World Neurosurg 2020; 144:e934-e938. [PMID: 32992056 DOI: 10.1016/j.wneu.2020.09.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/15/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients, including patients with chronic pain conditions, increasingly turn to the Internet for health information. To facilitate comprehension, this information ought to be written at or below the 8th grade reading level, which is the average American adult's reading level. This study measured the reading level of popular online sources for trigeminal neuralgia. METHODS The top 10 search results for the search term "trigeminal neuralgia" were selected for inclusion. Flesch Reading Ease, Flesch-Kincaid Grade Level, Gunning Fog Index, Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index, and Linsear Write Formula were used to assess readability. One-way analysis of variance was used to test for statistical differences in average readability scores among the different web pages. RESULTS Across the web pages, the average readability scores were as follows: Flesch Reading Ease, 42.1 ± 7.7; Flesch-Kincaid Grade Level, 10.9 ± 0.9; Gunning Fog Index, 15 ± 1.5; Simple Measure of Gobbledygook, 10.9 ± 1.2; Coleman-Liau Index, 12.1 ± 1.3; Automated Readability Index, 11.9 ± 1.4; Linsear Write Formula, 12.4 ± 1.7. Results from one-way analysis of variance demonstrated no statistically significant difference in overall readability scores (F12,78 = 0.008; P > 0.05). CONCLUSIONS The writing of popular online education materials for trigeminal neuralgia is likely too complex for the average American adult to comprehend. This material should be revised to be readable at or below the 8th grade reading level. A variety of easily readable online education materials for trigeminal neuralgia can assist patients in understanding their illness and potentially improve patient decision making and outcomes.
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Affiliation(s)
- Pradeep Joseph
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
| | - Nicole A Silva
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Anil Nanda
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gaurav Gupta
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Behmer Hansen RT, Silva NA, Cuevas R, Cerasiello SY, Richardson AM, Mammis A, Nanda A. Fellowship, gender, and scholarly productivity: trends among academic neurosurgeons in the US. J Neurosurg 2020:1-9. [PMID: 32858514 DOI: 10.3171/2020.5.jns20577] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 02/24/2020] [Accepted: 05/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Current data on fellowship choice and completion by neurosurgical residents are limited, especially in relation to gender, scholarly productivity, and career progression. The objective of this study was to determine gender differences in the selection of fellowship training and subsequent scholarly productivity and career progression. METHODS The authors conducted a quantitative analysis of the fellowship training information of practicing US academic neurosurgeons. Information was extracted from publicly available websites, the Scopus database, and the Centers for Medicare and Medicaid Services Open Payments website. RESULTS Of 1641 total academic neurosurgeons, 1403 (85.5%) were fellowship trained. There were disproportionately more men (89.9%) compared to women (10.1%). A higher proportion of women completed fellowships than men (p = 0.004). Proportionally, significantly more women completed fellowships in pediatrics (p < 0.0001), neurooncology (p = 0.012), and critical care/trauma (p = 0.001), while significantly more men completed a spine fellowship (p = 0.012). Within those who were fellowship trained, the academic rank of professor was significantly more commonly held by men (p = 0.001), but assistant professor was held significantly more often by women (p = 0.017). The fellowships with the largest mean h-indices were functional/stereotactic, pediatrics, and critical care/trauma. Despite more women completing neurooncology and pediatric fellowships, men had significantly greater h-indices in these subspecialties compared to women. Women had more industry funding awards than men in pediatrics (p < 0.0001), while men had more in spine (p = 0.023). CONCLUSIONS Women were found to have higher rates for fellowship completion compared with their male counterparts, yet had lower scholarly productivity in every subspecialty. Fellowship choice remains unequally distributed between genders, and scholarly productivity and career progression varies between fellowship choice.
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Affiliation(s)
| | - Nicole A Silva
- 2Department of Neurosurgery, University of North Carolina at Chapel Hill, North Carolina
| | - Rebecca Cuevas
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Samantha Y Cerasiello
- 3Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Angela M Richardson
- 5Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Antonios Mammis
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anil Nanda
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey.,4Department of Neurosurgery, Robert Wood Johnson Barnabas Health, Livingston, New Jersey; and
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Barinsky GL, Daoud D, Tan D, Cerasiello SY, Silva NA, Grube JG, Baredes S, Gray ST, Eloy JA. Gender Representation at Conferences, Executive Boards, and Program Committees in Otolaryngology. Laryngoscope 2020; 131:E373-E379. [PMID: 32673426 DOI: 10.1002/lary.28823] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 04/09/2020] [Revised: 04/22/2020] [Accepted: 05/17/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Women represent approximately 28.0% of academic otolaryngologists. Previous studies have shown that women in academic medicine, including surgical subspecialties, have disparate career advancement opportunities and grant funding compared to male counterparts. Representation at major academic meetings is an important career advancement opportunity. In this study, we assess the representation of women at otolaryngology conferences. STUDY DESIGN Cross-sectional analysis of otolaryngology conference programs. METHODS All publicly available scientific programs from The American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting (AAO-HNSF), the Triological Society Annual Combined Sections Meeting (TS), and the Triological Society Annual Meeting at Combined Otolaryngology Spring Meetings (TS-COSM) were obtained and analyzed. Name and gender were collected, along with the type of role: speaker, panelist, oral session moderator, and other leadership positions. Yearly trends were analyzed and compared between the conferences and in aggregate. RESULTS AAO-HNSF had available scientific programs from 2012-2017, while TS and TS-COSM had programs available from 2003-2018. Across all conferences and years, 16.9% of recorded opportunities were occupied by women, with an upward trend from 2005 to 2018. Program committees had the highest proportion of women (21.4%) and presidential citation and guest of honor recipients had the lowest (9.1%). Of all panels, 87.5% did not have any women panelists in 2003, but by 2018 only 24.0% panels were male-only. There was marked repetition among women occupying roles, with only 423 unique women occupying a total of 1,733 filled spots. CONCLUSION Measured representation of women in academic otolaryngology conferences has improved from 2003-2018. Despite this improvement, gender disparity still exists. LEVEL OF EVIDENCE 5 Laryngoscope, 131:E373-E379, 2021.
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Affiliation(s)
- Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Deborah Daoud
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Didem Tan
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Samantha Y Cerasiello
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Nicole A Silva
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jordon G Grube
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Silva NA, Cerasiello SY, Behmer Hansen RT, Liu JK, Eloy JA. Letter to the Editor Regarding “Investigating the Gender Pay Gap in Industry Contributions to Academic Neurosurgeons”. World Neurosurg 2020; 138:574-575. [DOI: 10.1016/j.wneu.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 11/27/2022]
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Silva NA, Goldstein IM. Obstruction of Ventriculoperitoneal Shunt After Myelography-Report of a Unique Case and Its Treatment. World Neurosurg 2019; 134:443-447. [PMID: 31756508 DOI: 10.1016/j.wneu.2019.11.067] [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: 07/24/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Myelography, frequently supplanted by noninvasive, efficient magnetic resonance imaging, remains a useful technique when evaluating the spinal canal in nerve root avulsion, radiation therapy treatment planning, cerebrospinal fluid (CSF) loculation, and CSF leak. Myelography is achieved through a lumbar puncture and instillation of nonionic, water-soluble intrathecal iohexol (Omnipaque, GE Healthcare, Marlborough, Massachusetts, USA) contrast. The aim of the study was to highlight a possible complication of obstruction of a shunt valve due to an increased viscosity of the CSF after intrathecal Omnipaque contrast administration during myelography. CASE DESCRIPTION The authors report a case of myelography that resulted in obstruction of a ventriculoperitoneal (VP) shunt. A 23-year-old female with significant medical history of neurofibromatosis type I, obstructive hydrocephalus, anterior cervical diskectomy and fusion, and VP shunt placement underwent diagnostic computed tomography after myelography with Omnipaque contrast to assess possible CSF loculation and cord impingement from her cervical instrumentation. The patient experienced somnolence after myelography from obstruction of the VP shunt, with marked ventriculomegaly demonstrated by computed tomography of the head. A shunt tap and shunt pumping regimen resulted in resolution of the obstruction and hydrocephalus, with return to neurologic baseline. CONCLUSIONS This is a recent case of VP shunt obstruction after myelography, of which previous cases reported are decades old. A shunt pumping regimen may be a nonoperative, effective mean for similar mechanical obstructions of VP shunts for restoration of flow and patency of the shunt system in these patients. We encourage physicians to consider the possibility of shunt obstruction after diagnostic myelography. Caution and close observation should be considered in patients undergoing myelography with a programmable VP shunt.
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Affiliation(s)
- Nicole A Silva
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ira M Goldstein
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
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19
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Liu JK, Silva NA, Sevak IA, Eloy JA. Transbasal versus endoscopic endonasal versus combined approaches for olfactory groove meningiomas: importance of approach selection. Neurosurg Focus 2019; 44:E8. [PMID: 29606049 DOI: 10.3171/2018.1.focus17722] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 11/06/2022]
Abstract
OBJECTIVE There has been much debate regarding the optimal surgical approach for resecting olfactory groove meningiomas (OGMs). In this paper, the authors analyzed the factors involved in approach selection and reviewed the surgical outcomes in a series of OGMs. METHODS A retrospective review of 28 consecutive OGMs from a prospective database was conducted. Each tumor was treated via one of 3 approaches: transbasal approach (n = 15), pure endoscopic endonasal approach (EEA; n = 5), and combined (endoscope-assisted) transbasal-EEA (n = 8). RESULTS The mean tumor volume was greatest in the transbasal (92.02 cm3) and combined (101.15 cm3) groups. Both groups had significant lateral dural extension over the orbits (transbasal 73.3%, p < 0.001; combined 100%), while the transbasal group had the most cerebral edema (73.3%, p < 0.001) and vascular involvement (66.7%, p < 0.001), and the least presence of a cortical cuff (33.3%, p = 0.019). All tumors in the combined group were recurrent tumors that invaded into the sinonasal cavity. The purely EEA group had the smallest mean tumor volume (33.33 cm3), all with a cortical cuff and no lateral dural extension. Gross-total resection was achieved in 80% of transbasal, 100% of EEA, and 62.5% of combined cases. Near-total resection (> 95%) was achieved in 20% of transbasal and 37.5% of combined cases, all due to tumor adherence to the critical neurovascular structures. The rate of CSF leakage was 0% in the transbasal and combined groups, and there was 1 leak in the EEA group (20%), resulting in an overall CSF leakage rate of 3.6%. Olfaction was preserved in 66.7% in the transbasal group. There was no significant difference in length of stay or 30-day readmission rate between the 3 groups. The mean modified Rankin Scale score was 0.79 after the transbasal approach, 2.0 after EEA, and 2.4 after the combined approach (p = 0.0604). The mean follow-up was 14.5 months (range 1-76 months). CONCLUSIONS The transbasal approach provided the best clinical outcomes with the lowest rate of complications for large tumors (> 40 mm) and for smaller tumors (< 40 mm) with intact olfaction. The role of EEA appears to be limited to smaller, appropriately selected tumors in which olfaction is already absent. EEA also plays an important adjunctive role when combined with the transbasal approach for recurrent OGMs invading the sinonasal cavity. Careful patient selection using an individualized, tailored strategy is important to optimize surgical outcomes.
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Affiliation(s)
- James K Liu
- Departments of1Neurological Surgery.,3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | | | - Jean Anderson Eloy
- Departments of1Neurological Surgery.,4Ophthalmology and Visual Sciences, Rutgers New Jersey Medical School; and
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20
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Silva NA, Silva Vaz HH, Ribeiro AF, Sule H, Sifri ZC, Nanda A, Jennings Simões EL. Neurosurgery in the Brazilian Amazon: Is It Possible? World Neurosurg 2019; 130:192-200. [PMID: 31295601 DOI: 10.1016/j.wneu.2019.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/05/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The need for neurosurgical care across the globe remains a public health issue. The creation of sustainable neurological surgery departments and training programs will be indispensable in alleviating the burden of neurological disease in low to middle income countries (LMICs). METHODS We reviewed the history of the neurological surgery department and residency program of Santarém in the state of Pará, Brazil, from 1999 to the present. We have described the epidemiology unique to the region and provided evidence of a sustainable practice in a LMIC. The challenges, limitations, and resources were explored. RESULTS We have provided a historical vignette of the evolution of neurological surgery in the Brazilian Amazon, including the creation of a sustainable neurological surgery practice and accredited residency program. In addition, we assessed the neurological surgery burden and epidemiology unique to the region, with an emphasis on the community and indigenous health in this remote area. We also explored the future directions of this example, which could affect the international neurological surgery community. CONCLUSION A sustainable neurosurgery practice and training program is possible in a LMIC. Training neurosurgeons in developing regions of LMICs is a sustainable method to decrease the morbidity and mortality of neurological diseases and prevent the misdistribution of physicians in a country. We encourage adaptation of sustainable neurological surgery practices in similar regions across the world to increase access to necessary neurosurgical care.
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Affiliation(s)
- Nicole A Silva
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Office of Global Health, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | | | - Harsh Sule
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Office of Global Health, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Office of Global Health, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Anil Nanda
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Silva NA, Taylor BES, Herendeen JS, Reddy R, Eloy JA, Liu JK. Return to the Emergency Room with or without Readmission After Endoscopic Transsphenoidal Surgery in Socioeconomically Disadvantaged Patients at an Urban Medical Center. World Neurosurg 2018; 124:S1878-8750(18)32862-6. [PMID: 30579010 DOI: 10.1016/j.wneu.2018.12.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/01/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although reducing 30-day hospital readmissions is now a priority in neurosurgical quality improvement, postoperative emergency room (ER) visits have remained poorly understood, in particular, in populations with limited access to outpatient care. After endoscopic transsphenoidal surgery, the unique pathologic entities treated can engender a variety of surgical and metabolic complications-often dangerous, delayed, and nonspecific in presentation. We sought to characterize the causes and timing of ER visits-with or without readmission-in a socioeconomically disadvantaged population. METHODS We reviewed all the patients undergoing ETS by our skull base team from 2009 to 2017 to determine their socioeconomic profile and causes of ER visits. For external validation, we compared our results with national data from the American College of Surgeons National Surgical Quality Improvement Program. RESULTS Of the 229 patients, 35 (15.3%) had visited the ER within 30 days of discharge. Of these 229 patients, 21 (9.2%) were readmitted, and 109 (47.6%) were insured by Medicaid. The most common reasons for the ER visits were headache (8 of 35 [22.9%]), hyponatremia (7 of 35 [20.0%]), and epistaxis (5 of 35 [14.3%]). The most common cause for readmission was symptomatic hyponatremia (6 of 21 [28.6%]). The other reasons for readmission included meningitis (2 of 21 [9.5%]), adrenal crisis (2 of 21 [9.5%]), and cerebrospinal fluid leakage (1 of 21 [4.8%]). The average time to readmission was 10.9 days. According to the National Surgical Quality Improvement Program database, the 30-day readmission rate was 5.5%, of which 22.2% were for hyponatremia. CONCLUSION Delayed hyponatremia accounts for a large proportion of ER visits and unplanned readmissions. Close follow-up with diligent, multidisciplinary care might reduce the number of ER visits and readmission in this population.
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Affiliation(s)
- Nicole A Silva
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Blake E S Taylor
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - John S Herendeen
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Renuka Reddy
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Ophthalmology and Visual Sciences, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - James K Liu
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
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Silva NA, Shao B, Sylvester MJ, Eloy JA, Gandhi CD. Unruptured aneurysms in the elderly: perioperative outcomes and cost analysis of endovascular coiling and surgical clipping. Neurosurg Focus 2018; 44:E4. [DOI: 10.3171/2018.1.focus17714] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVEObservation and neurosurgical intervention for unruptured intracranial aneurysms (UIAs) in the elderly population is rapidly increasing. Cerebral aneurysm coiling (CACo) is favored over cerebral aneurysm clipping (CAC) in elderly patients, yet some elderly individuals still undergo CAC. The cost-effectiveness of treating UIAs requires further exploration. Understanding the effect of intervention on hospital charges and length of stay (LOS) as well as perioperative mortality and complications can further shed light on its economic impact. The purpose of this study was to analyze the cost and perioperative outcomes of UIAs in elderly patients (≥ 65 years of age) after CACo or CAC intervention.METHODSRetrospective cohorts of CACo and CAC admissions were extracted from National (Nationwide) Inpatient Sample data obtained between 2002 and 2013, forming parallel intervention groups to compare the following outcomes between elderly and nonelderly patients: average LOS and mean hospital admission costs, in-hospital mortality, and complications. Covariates included sex, race or ethnicity, and comorbidities.RESULTSElderly patients undergoing CAC experienced an average LOS of 8.0 days, whereas elderly patients undergoing CACo stayed an average of 3.2 days. The mean hospital charges incurred during admission totaled $95,960 in the elderly patients who underwent CAC versus $87,960 in the ones who underwent CACo. Elderly patients in whom CAC was performed had a 2.2% rate of in-hospital mortality, with a 2.6 greater adjusted odds of in-hospital mortality than nonelderly patients treated with CAC. In contrast, elderly patients who underwent CACo had a 1.36 greater adjusted odds of in-hospital mortality than their nonelderly counterparts. Compared to nonelderly patients receiving both interventions, elderly individuals had a significantly higher prevalence of various comorbidities and incidence of complications. Elderly patients who received CAC experienced a 10.3% incidence rate of perioperative stroke, whereas their CACo counterparts experienced this complication at a rate of 3.5%. Elderly patients treated with CAC had greater odds of perioperative acute renal failure, whereas their CACo counterparts had greater odds of perioperative deep venous thrombosis and pulmonary embolism.CONCLUSIONSIntervention with CAC and CACo in the elderly is resource intensive and is associated with higher risk than in the nonelderly. Those deciding between intervention and conservative management should consider these risks and costs, especially the 2.2% postoperative mortality rate associated with CAC in the elderly population. Further comparative cost-effectiveness research is needed to weigh these costs and outcomes against those of conservative management.
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Affiliation(s)
| | | | - Michael J. Sylvester
- 2Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- 1Department of Neurological Surgery and
- 3Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan; and
- 4Department of Neurological Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
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Sanches S, Fraga MC, Silva NA, Nunes P, Crespo JG, Pereira VJ. Pilot scale nanofiltration treatment of olive mill wastewater: a technical and economical evaluation. Environ Sci Pollut Res Int 2017; 24:3506-3518. [PMID: 27878484 DOI: 10.1007/s11356-016-8083-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
The treatment of large volumes of olive mill wastewater is presently a challenge. This study reports the technical and economical feasibility of a sequential treatment of olive mill wastewater comprising a dissolved air flotation pre-treatment and nanofiltration. Different pilot nanofiltration assays were conducted in a concentration mode up to different volume reduction factors (29, 45, 58, and 81). Data attained demonstrated that nanofiltration can be operated at considerably high volume reduction factors and still be effective towards the removal of several components. A flux decline of approximately 50% was observed at the highest volume reduction factor, mainly due to increase of the osmotic pressure. Considerably high rejections were obtained across all experiments for total suspended solids (83 to >99%), total organic carbon (64 to 99%), chemical oxygen demand (53 to 77%), and oil and grease (67 to >82%). Treated water was in compliance with European legal limits for discharge regarding total suspended solids and oil and grease. The potential recovery of phenolic compounds was evaluated and found not relevant. It was demonstrated that nanofiltration is economically feasible, involving operation costs of approximately 2.56-3.08 €/m3, depending on the working plan schedule and volume reduction factor, and requiring a footprint of approximately 52 m2 to treat 1000 m3 of olive mill wastewater.
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Affiliation(s)
- S Sanches
- iBET, Instituto de Biologia Experimental e Tecnológica, Apartado 12, 2780-901, Oeiras, Portugal
| | - M C Fraga
- iBET, Instituto de Biologia Experimental e Tecnológica, Apartado 12, 2780-901, Oeiras, Portugal
- REQUIMTE/Chemistry Department, Faculdade de Ciências e Tecnologia, UNL, Caparica, Portugal
| | - N A Silva
- Adventech - Centro Empresarial e Tecnológico, Rua de Fundões, 151, 3700-121, São João da Madeira, Portugal
| | - P Nunes
- Adventech - Centro Empresarial e Tecnológico, Rua de Fundões, 151, 3700-121, São João da Madeira, Portugal
| | - J G Crespo
- REQUIMTE/Chemistry Department, Faculdade de Ciências e Tecnologia, UNL, Caparica, Portugal
| | - V J Pereira
- iBET, Instituto de Biologia Experimental e Tecnológica, Apartado 12, 2780-901, Oeiras, Portugal.
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Fraga JS, Silva NA, Lourenço AS, Gonçalves V, Neves NM, Reis RL, Rodrigues AJ, Manadas B, Sousa N, Salgado AJ. Unveiling the effects of the secretome of mesenchymal progenitors from the umbilical cord in different neuronal cell populations. Biochimie 2013; 95:2297-303. [PMID: 23851197 DOI: 10.1016/j.biochi.2013.06.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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: 03/30/2013] [Accepted: 06/19/2013] [Indexed: 12/11/2022]
Abstract
It has been previously shown that the secretome of Human Umbilical Cord Perivascular Cells (HUCPVCs), known for their mesenchymal like stem cell character, is able to increase the metabolic viability and hippocampal neuronal cell densities. However, due to the different micro-environments of the distinct brain regions it is important to study if neurons isolated from different areas have similar, or opposite, reactions when in the presence of HUCPVCs secretome (in the form of conditioned media-CM). In this work we: 1) studied how cortical and cerebellar neuronal primary cultures behaved when incubated with HUCPVCs CM and 2) characterized the differences between CM collected at two different conditioning time points. Primary cultures of cerebellar and cortical neurons were incubated with HUCPVCs CM (obtained 24 and 96 h after three days of culturing). HUCPVCs CM had a higher impact on the metabolic viability and proliferation of cortical cultures, than the cerebellar ones. Regarding neuronal cell densities it was observed that with 24 h CM condition there were higher number MAP-2 positive cells, a marker for fully differentiated neurons; this was, once again, more evident in cortical cultures. In an attempt to characterize the differences between the two conditioning time points a proteomics approach was followed, based on 2D Gel analysis followed by the identification of selected spots by tandem mass spectrometry. Results revealed important differences in proteins that have been previously related with phenomena such as neurl cell viability, proliferation and differentiation, namely 14-3-3, UCHL1, hsp70 and peroxiredoxin-6. In summary, we demonstrated differences on how neurons isolated from different brain regions react to HUCPVCs secretome and we have identified different proteins (14-3-3 and hsp70) in HUCPVCs CM that may explain the above-referred results.
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Affiliation(s)
- J S Fraga
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
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Oliveira AL, Sousa EC, Silva NA, Sousa N, Salgado AJ, Reis RL. Peripheral mineralization of a 3D biodegradable tubular construct as a way to enhance guidance stabilization in spinal cord injury regeneration. J Mater Sci Mater Med 2012; 23:2821-2830. [PMID: 22903600 DOI: 10.1007/s10856-012-4741-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 08/02/2012] [Indexed: 06/01/2023]
Abstract
Spinal cord injuries (SCI) present a major challenge to therapeutic development due to its complexity. Combinatorial approaches using biodegradable polymers that can simultaneously provide a tissue scaffold, a cell vehicle, and a reservoir for sustained drug delivery have shown very promising results. In our previous studies we have developed a novel hybrid system consisting of starch/poly-e-caprolactone (SPCL) semi-rigid tubular porous structure, based on a rapid prototyping technology, filled by a gellan gum hydrogel concentric core for the regeneration within spinal-cord injury sites. In the present work we intend to promote enhanced osteointegration on these systems by pre-mineralizing specifically the external surfaces of the SPCL tubular structures, though a biomimetic strategy, using a sodium silicate gel as nucleating agent. The idea is to create two different cell environments to promote axonal regeneration in the interior of the constructs while inducing osteogenic activity on its external surface. By using a Teflon cylinder to isolate the interior of the scaffold, it was possible to observe the formation of a bone-like poorly crystalline carbonated apatite layer continuously formed only in the external side of the tubular structure. This biomimetic layer was able to support the adhesion of Bone Marrow Mesenchymal Stem Cells, which have gone under cytoskeleton reorganization in the first hours of culture when compared to cells cultured on uncoated scaffolds. This strategy can be a useful route for locally stimulate bone tissue regeneration and facilitating early bone ingrowth.
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Affiliation(s)
- A L Oliveira
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Taipas, Guimarães, Portugal.
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Cognard C, Januel AC, Silva NA, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol 2007; 29:235-41. [PMID: 17989374 DOI: 10.3174/ajnr.a0817] [Citation(s) in RCA: 229] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DAVFs (dural arteriovenous fistulas) represent one of the most dangerous types of intracranial AV shunts. Most of them are cured by arterial or venous embolization, but surgery/radiosurgery can be required in case of failure. Our goal was to reconsider the endovascular treatment strategy according to the new possibilities of arterial embolization using non polymerizing liquid embolic agent. MATERIALS AND METHODS Thirty patients were included in a prospective study during the interval between July 2003 and November 2006. Ten of these had type II, 8 had type III, and 12 had type IV fistulas. Sixteen presented with hemorrhage. Five had been treated previously with other embolic materials. RESULTS Complete angiographic cure was obtained in 24 cases. Of these 24 cures, 20 were achieved after a single procedure. Cures were achieved in 23 of 25 patients who had not been embolized previously and in only 1 of 5 previously embolized patients. Among these 24 patients, 23 underwent a follow-up angiography, which has confirmed the complete cure. Partial occlusion was obtained in 6 patients, 2 were cured after additional surgery, and 2 underwent radiosurgery. Onyx volume injected per procedure ranged from 0.5 to 12.2 mL (mean, 2.45 mL). Rebleeding occurred in 1 completely cured patient at day 2 due to draining vein thrombosis. One patient had cranial nerve palsy that resolved. Two ethmoidal dural arteriovenous fistulas were occluded. All 10 of the patients with sinus and then CVR drainage were cured. CONCLUSION Based on this experience, we believe that Onyx may be the treatment of choice for many patients with intracranial dural arteriovenous fistula (ICDAVF) with direct cortical venous reflux (CVR). The applicability of this new embolic agent indicates the need for reconsideration of the global treatment strategy for such fistulas.
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Affiliation(s)
- C Cognard
- Department of Neuroradiology, Hopital Purpan, University of Toulouse, Toulouse, France.
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Furtado-de Mendonça JL, Canuto-Natal MR, Lopes-Viana S, Coimbra PPDA, Silva NA, Pessoa RCC, Viana MACB. [Human lagochilascariasis: emphasizing imaging findings]. Rev Neurol 2005; 41:702-4. [PMID: 16317642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Sato EI, Bonfá ED, Costallat LTL, Silva NA, Brenol JCT, Santiago MB, Szajubok JCM, Rachid-Filho A, Barros RT, Vasconcelos M. Lúpus eritematoso sistêmico: tratamento do acometimento cutâneo/articular. Rev Bras Reumatol 2004. [DOI: 10.1590/s0482-50042004000600010] [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: 11/21/2022] Open
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Sato EI, Bonfá ED, Costallat LTL, Silva NA, Brenol JCT, Santiago MB, Szajubok JCM, Rachid-Filho A, Barros RT, Vasconcelos M. Lúpus eritematoso sistêmico: tratamento do acometimento sistêmico. Rev Bras Reumatol 2004. [DOI: 10.1590/s0482-50042004000600011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Klein CH, Silva NA, Nogueira AR, Bloch KV, Campos LH. Hipertensão arterial na Ilha do Governador, Rio de Janeiro, Brasil: I. Metodologia. CAD SAUDE PUBLICA 1995; 11:187-201. [PMID: 14528326 DOI: 10.1590/s0102-311x1995000200003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este primeiro artigo (de uma série de dois) tem como finalidade apresentar os principais aspectos da metodologia empregada em um estudo de população para determinar a prevalência de Hipertensão Arterial na Ilha do Governador (região administrativa do município do Rio de Janeiro), e estudar sua relação com outros fatores de risco, inclusive para doenças cardiovasculares, assim como conhecer o seu estado de controle. São descritos com detalhes o delineamento amostral (amostragem de aglomerados em estratos, segundo renda média domiciliar) e os instrumentos de coleta de dados. São apresentados, ainda, indicadores de desempenho no trabalho de campo e do controle de qualidade.
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Affiliation(s)
- C H Klein
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública, Rio de Janeiro, RJ, 21041210, Brasil
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Abstract
The Sneddon's syndrome consists of neurologic manifestations associated to the presence of livedo reticularis and cyanosis of the extremities. The pathological process is an endothelial obliteration of arterioles, leading to a reticular appearance of the skin, despite the environment temperature. The authors present three new cases, caucasian males with 7, 16 and 54 years of age. The youngest started with hemilateralized motor seizures and showed a porencefalic area in the CT scan. The oldest had livedo reticularis, acrocyanosis and started with hemilateralized motor seizures, and a hemiparesis as sequela; CT scan with parasagittal infarct and occlusion presented of one anterior cerebral artery on angiography. The third patient started with hemifacial seizures, developed a labioglossolaringeal paresis and dysarthria as sequela; CT scan and MRI showed multiple infarcts, with multiple occlusions of cortical branches on angiography. The skin biopsies showed endothelial vascular hyperplasia in all cases. Only one (54 years old) patient had a positive IgG antiphospholipid antibodies. The Sneddon's syndrome seems not to be so rare and have to be considered in the etiological investigation of cerebral infarcts, mainly in young people.
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Pereira BA, Silva NA, Ximenes AC, Alvarenga SL, Barbosa VS. Cutaneous polyarteritis nodosa in a child with positive antiphospholipid and P-ANCA. Scand J Rheumatol 1995; 24:386-8. [PMID: 8610225 DOI: 10.3109/03009749509095186] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A case of juvenile cutaneous polyarteritis nodosa (cutaneous PAN) is presented. Since early infancy the child underwent attacks of fever and cutaneous rash that occasionally progressed to gangrene and amputations of distal portions of toes and fingers. Although occasional episodes of high blood pressure and persistence of moderate eosinophilia were present, the clinical pattern was mostly restricted to the musculoskeletal system and skin. The authors discuss the definition of the disease and its present therapeutic possibilities, calling attention to a feature not referred in previous reports: the unique co-existence of cutaneous PAN plus antiphospholipid antibodies (aPL) and perinuclear antineutrophil cytoplasmic antibodies (p-ANCA).
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Affiliation(s)
- B A Pereira
- Department of Internal Medicine/Rheumatology Unit, Hospital das Clínicas, Faculty of Medicine, Federal University of Goiás (HC-FMUFG), Brazil
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Camargo RM, Silva NA, Marques SA, Stolf HO, Dillon NL. [Microsporum nanum. Report of the 2d case of human infection in Brazil]. Rev Inst Med Trop Sao Paulo 1984; 26:165-9. [PMID: 6505515 DOI: 10.1590/s0036-46651984000300007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
É comunicado o segundo caso de infecção humana por Microsporum nanum no Brasil. A investigação epidemiológica visando determinar a fonte de infecção não obteve sucesso. O padrão dermatológico das lesões foi o de Tinea corporis clássica.
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Silva NA. [Therapeutic test of chloramphenicol pantothenate in non tuberculous bronchiopulmonary diseases]. Prensa Med Argent 1968; 55:961-4. [PMID: 5740860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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