Factors Affecting the Choice of Neurosurgery as a Future Career: A Cross-Sectional Study

Introduction Selecting a specialty is a very important and stressful decision that students must make, as it will have a lasting impact on their professional lives. Medical students could gain insight into a variety of specialties during their clinical years, especially the work environment in different specialties. Numerous factors can influence this decision, such as work-life balance, lifestyle, and gender differences. The goal of our study is to demonstrate the different factors, both attractive and deterrent, that influence neurosurgery selection as a future specialty among students. Also, we will consider the exposure-related geographical distribution of the neurosurgery field regarding conferences and workshops, as well as the availability of university professors and their impact on the interest of students in the specialty. Methods A cross-sectional study spanning from June 2023 to September 2023 was conducted among students at medical colleges across the Kingdom of Saudi Arabia. All medical students from the second medical year up to the internship were invited to take part in the study. Non-medical students, first-year medical students, and incomplete questionnaires were excluded. Employing a stratified random sampling technique, we ensured diverse representation, eventually gathering data from 1141 participants. Results The study involved a diverse group of 1141 medical students and interns, with an average age of 21.7 years. Among them, 683 (59.9%) were female. Approximately half of the participants, 572 (50.1%), express an interest in pursuing a career in neurosurgery, and a significant portion of respondents find neurosurgery appealing due to its challenging nature (50.9%). On the other hand, stress emerged as the most significant deterrent factor (50.3%). Among educational levels, interns, 39 (28.3%), showed the least interest, while second-year students, 193 (64.8%), exhibited the highest interest (p < 0.001*). The analysis revealed statistically significant gender differences in factors. Specifically, a higher percentage of females found "interested in neuroscience" to be the most attractive factor compared to males (18.2% vs. 15.5%, p < 0.001*). Regarding deterring factors, a greater percentage of males found "risk" as the most deterring factor compared to females (19.2% vs. 17.1%, p = 0.001*). Conclusion We found no significant age variation in the most attractive factors; however, significant gender differences in attractive and deterrent factors were observed. The "risk" associated with neurosurgery was the most deterring factor for students across different cumulative grade point average (CGPA) ranges and for students from the eastern and central areas. Our findings suggest that most factors are consistently attractive or deterring across different educational and clinical levels, emphasizing the stability of these perceptions throughout medical education. We propose innovative educational initiatives with increased faculty participation to implement the curricula with early exposure of students to neurosurgery.

Barriers to Accessing Neurosurgical Services: A Cross-Sectional Study of Public and Patient Perspectives in Saudi Arabia

INTRODUCTION

Neurosurgical care is paramount for addressing various neurological conditions. However, several factors may hinder individuals from accessing these services. This study aimed to identify the factors that deter Saudi citizens from receiving neurosurgical care, emphasizing perceived barriers and sociodemographic influences.

METHODS

Utilizing a cross-sectional research design, this study surveyed 1,795 participants from five distinct regions in Saudi Arabia, capturing a wide demographic range including age, gender, education, occupation, and residence. Stratified random sampling was adopted to ensure representation across different socioeconomic backgrounds. Data was collected using structured online questionnaires in both Arabic and English, which assessed demographic characteristics, patient experiences, perceived barriers, and satisfaction related to neurosurgical services.

RESULTS

The majority of the participants (79.6%) reported never accessing neurosurgical services, and 28.8% indicated difficulties in accessing them. Most participants expressed neutral feelings (38.1%) or satisfaction (23.4%) with neurosurgical service accessibility, though a significant minority expressed dissatisfaction (9.0%) or strong dissatisfaction (4.3%). Concerning factors for selecting neurological services, the expertise and reputation of healthcare professionals were paramount, while cost and proximity were lesser concerns. Significant perceived barriers included financial constraints and prolonged appointment waiting times. Results also revealed a relationship between sociodemographic characteristics and perceived barriers: females, certain age groups (25 to 34 and above 65), those with higher education levels, retired individuals, and residents of the Northern Province and urban areas reported higher perceived barriers. Regression analysis identified gender, education level, employment status, and residency as significant predictors of perceived barriers.

CONCLUSION

This study underscores the prominent barriers faced by Saudi citizens in accessing neurosurgical care, with financial constraints and waiting times being paramount. Additionally, sociodemographic factors play a crucial role in the perception of these barriers. As healthcare disparities persist, targeted interventions, policy reforms, and educational campaigns are essential to bridge the gap and ensure equitable neurosurgical care access across all demographic segments in Saudi Arabia.

Prevalence of Low Back Pain and Associated Risk Factors among Saudi Arabian Adolescents: A Cross-Sectional Study

Low back pain is the most prevalent musculoskeletal condition. Studies on adolescent low back pain are scarce, with no research to determine its prevalence in Saudi Arabia. This study aimed to assess the prevalence and associated risk factors of low back pain in Saudi Arabian adolescents. This cross-sectional study was conducted among Saudi Arabian high school students, which included demographic data, medical and low back pain history. The completed survey by 2000 participants showcased 57.9% of students experiencing low back pain in the last 12 months. This included 31.2% men and 26.7% women. This study found a link between low back pain and age, clinical symptoms of diabetes, heart disease, lung disease, thyroid disease, arthritis, and back surgery, a family history of low back pain, as well as smoking. There is substantial prevalence of low back pain in Saudi Arabian adolescents. This study identified several modifiable and non-modifiable risk factors stemming from adolescent low back pain.

Pattern of Antibiotic Prescription for Orofacial Infections among Dentists: A Narrative Review of Literature

Bacterial infections are common in dental and oral clinical practice. It is been estimated that about 10% of total antibiotic prescriptions are related to dental infections. Combination of amoxicillin-clavulanate and plain amoxycillin is the most commonly used drug by dentists across the world. Three general considerations were recognized in this literature review—Empirical antibiotic prescription by dentists without a culture test; concomitant prescription of antibiotics with non-steroidal anti-inflammatory drugs which may ultimately affect the bioavailability of the former drug; and the increased antimicrobial resistance amongst oral pathogens. Since decades, antibiotics have been prescribed for the treatment of odontogenic infections and non-odontogenic oral infections, and for focal infections and sepsis prophylaxis. Renal failure, liver failure, and pregnancy are situations that require special attention when considering an antibiotic prescription. This review attempted to contribute to the rational use and abuse of antibiotics while focusing on the general characteristics of these drugs.

Visnagin prevents isoproterenol-induced myocardial injury by attenuating oxidative stress and inflammation and upregulating Nrf2 signaling in rats

Oxidative tissue injury and inflammatory responses play major roles in cardiovascular diseases and heart failure. Visnagin (VIS) is a natural bioactive component of Ammi visnaga, with promising radical scavenging and anti-inflammatory activities. This study explored the protective effect of VIS against isoproterenol (ISO)-induced acute myocardial injury and oxidative stress in rats. VIS was supplemented for 14 days, and the rats received ISO (100 mg/kg) twice at an interval of 24 h. ISO-induced myocardial injury was characterized by elevated serum CK-MB, LDH, and troponin-I associated with increased heart weight and several histopathological changes. ISO increased reactive oxygen species (ROS), malondialdehyde (MDA), NF-κB p65, TNF-α, IL-6, and decreased glutathione and antioxidant enzymes in rats' hearts. VIS prevented myocardial injury and ameliorated the cardiac function markers, ROS, MDA, NF-κB p65, and pro-inflammatory cytokines in ISO-intoxicated rats. In addition, VIS decreased Bax mRNA and caspases, and upregulated Nrf2, HO-1, Bcl-2, and PPARγ. Molecular docking simulations revealed the binding method of VIS to NF-κB, Keap1, and PPARγ. In conclusion, VIS protects against ISO-induced acute myocardial injury by attenuating oxidative tissue injury and reducing key inflammatory and apoptosis markers. In vivo and in silico results showed that activation of Nrf2/HO-1 signaling and PPARγ mediates the cardioprotective effect of VIS.

Galangin attenuates diabetic cardiomyopathy through modulating oxidative stress, inflammation and apoptosis in rats

Cardiovascular complications are the leading cause of morbidity in diabetes. Oxidative stress and inflammation are implicated in the development and progression of diabetic cardiomyopathy (DCM). This study explored the cardioprotective effect of galangin (Gal), a natural flavonoid with radical-scavenging and anti-inflammatory activities, in diabetic rats. An experimental diabetic rat model was achieved by a single injection of 50 mg/kg streptozotocin. Gal (15 mg/kg) was administered daily for six weeks and the samples were then collected. Diabetic rats exhibited hyperglycemia, increased glycosylated hemoglobin, triglycerides and cholesterol levels and reduced serum insulin. Serum troponin I, CK-MB and LDH were increased in diabetic rats. Furthermore, hearts of diabetic rats were characterized by elevated malondialdehyde, protein carbonyl, NF-κB p65, TNF-α, IL-1β, iNOS, IL-6, Bax, caspase-3 and 8-Oxo-dG, and decreased superoxide dismutase, catalase, reduced GSH, and Bcl-2. Gal ameliorated hyperglycemia, dyslipidemia, and heart function markers, and prevented histopathological alterations in diabetic rats. In addition, Gal attenuated cardiac oxidative injury, inflammation and apoptosis, and boosted antioxidant defenses. In conclusion, Gal has a protective effect on cardiomyopathy by attenuating hyperglycemia, dyslipidemia, oxidative stress and inflammation in diabetic rats.

Genome-wide association studies reveal novel loci associated with carcass and body measures in beef cattle

Genomic selection has an essential role in the livestock economy by increasing selection productivity. Genomics provides a mechanism to increase the rate of genetic gain using marker-assisted selection. Various quantitative trait loci (QTL) associated with body, carcass and meat quality traits in beef cattle have been found. It is widely accepted that QTL traits in livestock species are regulated by several genes and factors from the environment. Genome-wide association studies (GWAS) are a powerful approach in identifying QTL and to establish genomic regions harboring the genes and polymorphisms associated with specific characteristics in beef cattle. Due to their impact on economic returns, growth, carcass and meat quality traits of cattle are frequently used as essential criteria in selection in breeding programs., GWAS has been used in beef cattle breeding and genetic program and some progress has been made. Furthermore, numerous genes and markers related to productivity traits in beef cattle have been found. This review summarizes the advances in the use of GWAS in beef cattle production and outlines the associations with growth, carcass, and meat quality.

Sequence analysis and pathogenicity of Avian Orthoavulavirus 1 strains isolated from poultry flocks during 2015-2019

Background

Newcastle disease (ND) causes severe economic losses in poultry industry worldwide. Egyptian poultry industry suffered from severe economic losses since the isolation of Velogenic Newcastle disease virus (vNDV) genotype VIId in 2011 and up till now despite the use of different vaccination programs. So, this study aimed to isolate and characterize the vNDV from a total of 120 poultry flocks from ten provinces in the Egyptian Delta region with a history of respiratory manifestation, high mortalities or a decrease in egg production between 2015 and 2019. Seventy-three samples’ allantoic fluid (73/120, 60.8%) were positive for hemagglutination with chicken RBCs. These samples were submitted to molecular examination using qRT-PCR specific primers for AOAV-1, highly pathogenic avian influenza (HPAI-H5), low pathogenic avian influenza (LPAI-H9) and infectious bronchitis virus (IBV).

Results

Fifty samples (50/120: 41.6%) were confirmed positive for AOAV-1, based on genetic analysis of matrix and fusion protein. The co-infection rate of other respiratory viral diseases examined was 1.6, 14.1, and 4.1%, for HPAI-H5, LPAI-H9, and IBV, respectively. Biologically, the intracerebral pathogenicity index of ten selected AOAV-1 isolates ranged from 1.70 to 1.98, which indicated the velogenic nature of these isolates. All the sixteen sequenced isolates were AOAV-1 genotype VII.1.1. The full F gene sequence of six examined AOAV-1 VII.1.1 isolates contained the seven neutralizing epitopes, and the glycosylation motif of six-potential sites for N linked glycosylation at residues 85, 191, 366, 447, 471, and 541.

Conclusion

It could be concluded that the high prevalence of AOAV-1 genotype VII.1.1 in the Egyptian chicken flocks despite the intensive vaccination with live and killed ND vaccines, as all the 16 isolates tested were belonged to this genotype. Homologous vaccination is badly needed to control and reduce the spread of AOAV-1 genotype VII.1.1infection in Egyptian poultry flocks.

Psoriatic inflammation causes hepatic inflammation with concomitant dysregulation in hepatic metabolism via IL-17A/IL-17 receptor signaling in a murine model

Psoriatic inflammation has been shown to be associated with cardiovascular dysfunction and systemic inflammation. Recently, psoriasis has also been linked to hepatic disorders, however underlying mechanism connecting the two are unknown. IL-17A being a central pro-inflammatory cytokine in the pathogenesis of psoriasis may be involved in hepatic inflammation through its receptor and downward signaling; however so far no study has investigated IL-17A related signaling in the liver during psoriasis in a murine model. Therefore, this study explored psoriasis-induced hepatic inflammation and concurrent metabolic changes. Mice were applied topically imiquimod (IMQ) to develop psoriatic inflammation. Additionally mice were also treated either with IL-17A or anti-IL17A antibody to explore the role of IL-17 related signaling in liver. Mice were then assessed for hepatic inflammation through assessment of inflammatory/oxidative stress markers (IL-17RC, NFκB, IL-6, MCP-1, IL-1β, GM-CSF, ICAM-1, iNOS, lipid peroxides and myeloperoxidase activity) as well as hepatic injury (alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase) and protein/lipid metabolic biomarkers (total proteins, albumin, total bilirubin, triglycerides, HDL cholesterol, and total cholesterol). IMQ treatment led to hepatic inflammation as evidenced by increased pro-inflammatory cytokines and oxidative stress with concomitant dysregulation in hepatic protein/lipid metabolism. Treatment with IL-17A further aggravated, whereas treatment with anti-IL17A antibody ameliorated IMQ-induced changes in hepatic injury/inflammation and protein/lipid metabolism. Our study shows for the first time that psoriatic inflammation leads to hepatic inflammation which results in dysregulated protein/lipid metabolism through IL-17RC/NFκB signaling. This could result in increased risk of cardiovascular dysfunction in patients with psoriasis.