OBJECTIVETraumatic brain injury (TBI)—the “silent epidemic”—contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the authors sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups.METHODSOpen-source epidemiological data on road traffic injuries (RTIs) were used to model the incidence of TBI using literature-derived ratios. First, a systematic review on the proportion of RTIs resulting in TBI was conducted, and a meta-analysis of study-derived proportions was performed. Next, a separate systematic review identified primary source studies describing mechanisms of injury contributing to TBI, and an additional meta-analysis yielded a proportion of TBI that is secondary to the mechanism of RTI. Then, the incidence of RTI as published by the Global...

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Estimating the global incidence of traumatic brain injury

A new method for the treatment of scoliosis is described in which a metal system of rods and hooks is implanted, and distraction and compression forces applied, to correct the curve and stabilize the treated segments in the corrected position by skeletal fixation. The technique and principles of this method of treatment and a summary of the preliminary results are given.

JBJS classics: Treatment of scoliosis: Correction and internal fixation by spine instrumentation

Fibrous dysplasia is an annoying and intriguing benign bone lesion. It is not a neoplasia, but a developmental abnormality. It can present in a monostotic or polyostotic form. The polyostotic form generally is more severe and tends to be unilateral, the monostotic is fortunately more common. Albright's syndrome consists of cutaneous pigmentation, polyostotic fibrous dysplasia, and precocious puberty in girls. Other endocrine abnormalities have been noted with the polyostotic form. Fibrous dysplasia overall has a slight female preponderance. Radiographically, the appearance is somewhat variable. The lesion is usually diaphyseal. The cortex is expanded, with the "ground glass" appearance of the medullary canal. Calcification may be present. Radionuclide scans are markedly positive, out of proportion to the radiographic appearance. Microscopically, fibrous dysplasia has a very characteristic appearance, with irregular strands of osteoid and bone in a background of fibrous tissue. The lesions of fibrous dysplasia are difficult to treat. Curettage is ineffective, especially in childhood. If cancellous graft is placed, it will be absorbed. Enneking and Gearen recommended replacement of the lesion with cortical allograft, which would resist absorption by the host bone and provide structural stability. Guile noted that the lesion never healed, and the only way to improve function was with valgus osteotomy of the proximal femur to improve the biomechanics, essentially ignoring the lesion. Vascularized bone grafting has been reported as effective for lesions of the upper limb.

顎骨에 發生한 fibrous dysplasia의 一症例

OBJECTIVEWorldwide disparities in the provision of surgical care result in otherwise preventable disability and death. There is a growing need to quantify the global burden of neurosurgical disease specifically, and the workforce necessary to meet this demand.METHODSResults from a multinational collaborative effort to describe the global neurosurgical burden were aggregated and summarized. First, country registries, third-party modeled data, and meta-analyzed published data were combined to generate incidence and volume figures for 10 common neurosurgical conditions. Next, a global mapping survey was performed to identify the number and location of neurosurgeons in each country. Finally, a practitioner survey was conducted to quantify the proportion of disease requiring surgery, as well as the median number of neurosurgical cases per annum. The neurosurgical case deficit was calculated as the difference between the volume of essential neurosurgical cases and the existing neurosurgical workforce capacity.R...

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Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change.

Stress, anxiety, and depression are some of the most important research and practice challenges for psychologists, psychiatrists, and behavioral scientists. Due to the importance of issue and the lack of general statistics on these disorders among the Hospital staff treating the COVID-19 patients, this study aims to systematically review and determine the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients. In this research work, the systematic review, meta-analysis and meta-regression approaches are used to approximate the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients. The keywords of prevalence, anxiety, stress, depression, psychopathy, mental illness, mental disorder, doctor, physician, nurse, hospital staff, 2019-nCoV, COVID-19, SARS-CoV-2 and Coronaviruses were used for searching the SID, MagIran, IranMedex, IranDoc, ScienceDirect, Embase, Scopus, PubMed, Web of Science (ISI) and Google Scholar databases. The search process was conducted in December 2019 to June 2020. In order to amalgamate and analyze the reported results within the collected studies, the random effects model is used. The heterogeneity of the studies is assessed using the I2 index. Lastly, the data analysis is performed within the Comprehensive Meta-Analysis software. Of the 29 studies with a total sample size of 22,380, 21 papers have reported the prevalence of depression, 23 have reported the prevalence of anxiety, and 9 studies have reported the prevalence of stress. The prevalence of depression is 24.3% (18% CI 18.2–31.6%), the prevalence of anxiety is 25.8% (95% CI 20.5–31.9%), and the prevalence of stress is 45% (95% CI 24.3–67.5%) among the hospitals’ Hospital staff caring for the COVID-19 patients. According to the results of meta-regression analysis, with increasing the sample size, the prevalence of depression and anxiety decreased, and this was statistically significant (P < 0.05), however, the prevalence of stress increased with increasing the sample size, yet this was not statistically significant (P = 0.829). The results of this study clearly demonstrate that the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients is high. Therefore, the health policy-makers should take measures to control and prevent mental disorders in the Hospital staff.

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The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: a systematic review and meta-regression.

Traumatic Spinal Injury: Global Epidemiology and Worldwide Volume.

Learning Curve and Minimally Invasive Spine Surgery.

COVID-19 is a global pandemic and has become a major public health burden worldwide. With already fragile healthcare systems it can have long lasting effects in developing countries. Outbreaks especially a pandemic situation evokes fear related behaviors among healthcare professionals and there is always an increased risk of mental health disorders. Therefore, this study aims to determine knowledge and perception about this pandemic, prevalence and factors associated with anxiety/depression among frontline physicians of Pakistan. Data were collected through an online survey released in the last week of March-2020. 389 frontline physicians from all four provinces and 65 cities of Pakistan participated. Survey questionnaire consisted of 4 parts including informed consent section, demographic section, knowledge and perception about COVID-19 pandemic and assessment of depression through World Health Organization Self-reporting questionnaire (SRQ-20). A score of 8 or above on SRQ-20 was used as cut-off to label the participant as depressed. Data was analyzed using SPSS version22. A 43% prevalence of anxiety/depression among frontline physicians of Pakistan was reported. Almost all the doctors had moderate to high knowledge score. Majority of participants marked N-95 mask as “essential” during aerosol generating procedures, assessing patients with respiratory symptoms, in COVID patient-care area, ER triage and direct care of COVID-19 patient. Only 12% of the doctors were fully satisfied with the provision of PPEs and almost 94% felt unprotected. In multivariable model, assessing more than five COVID suspects/day (aOR = 2.73, 95% CI: 1.65–4.52), working 20 h/week or less (aOR = 2.11, 1.27–3.49), having children among household members (aOR = 1.58, 95% CI: 1.00–2.50) and moderate to low knowledge of the infection (aOR = 2.69, 95% CI: 1.68–4.31) were found to be independent predictors of anxiety/depression among physicians. Anxiety/depression among more than a third of frontline doctors of Pakistan warrants the need to address mental health of doctors caring for patients during this pandemic; control modifiable factors associated with it and explore the effectiveness of interventions to promote psychological well-being of physicians.

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COVID-19 pandemic- knowledge, perception, anxiety and depression among frontline doctors of Pakistan.

Objective To observe the prevalence of anxiety and depression in chronic low back pain population at a tertiary care centre Methods The prospective cross-sectional study was conducted using convenience sampling at the Department of Neurosurgery, at Liaquat National Hospital, Karachi, Pakistan, from January to June 2010 The prevalence of anxiety and depression in chronic low back pain patients was studied according to specified age and gender groups using Hospital Anxiety and Depression Scale Results Of the 140 patients in the study, 66 (4714%) were females and 74 (5285%) were malesThe average age of the patients was 4302+/-1334 years The average duration of symptoms was 429+/-33 years Abnormal level of anxiety and depression were found in 77 (55%) and 68 (4857%) patients respectively Out of them 54 (385%) and 51 (364%) were borderline abnormal for anxiety and depression respectively, while 23 (164%) and 17 (121%) were abnormal for anxiety and depression respectively Among the males, there were 20 (1428%) and 23 (1642%) patients with abnormal levels of the corresponding numbers among the females were 57 (4071%) and 45 (3214%) There was a significant association in anxiety (p 005) Conclusion Individuals with chronic low back pain were at high risk to experience anxiety and depressionThis risk was higher for females

Association between chronic low back pain, anxiety and depression in patients at a tertiary care centre.

STUDY DESIGN Prospective observational study. PURPOSE To assess the clinical outcome after early versus late decompression for traumatic cervical cord injury. OVERVIEW OF LITERATURE Traumatic spinal cord injury is common globally with the most tragic outcomes in the cervical spine. Although recent studies have shown that early decompression results in more favourable outcome, its authority is yet to be established. METHODS Study on 98 patients with a traumatic cervical cord injury was conducted over a period of 5 years. The patients who were operated on within 24 hours of the onset of the primary injury (n=34) were classified as the early group, and those who were operated on after 24 hours of the onset of the injury (n=64) were categorized as the late group. The outcome of both the groups was assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at the 6-month follow-up. RESULTS The patients in the early group were operated on at a mean time of 18.4 hours (range, 13-24 hours) while patients were operated on at a mean time of 52.7 hours (range, 31-124 hours) in the late group. At the 6-month follow-up, 7 (23.3%) in the early group and 5 (8.7%) in the late group showed >2 grade improvement in the AIS. CONCLUSIONS The results of patients undergoing decompression within 24 hours of the injury are better than those who are operated on later. An attempt should be made to decompress the traumatic cervical spine early in all possible cases.

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Salman Sharif

Papers

Traumatic Spinal Injury: Global Epidemiology and Worldwide Volume.

Learning Curve and Minimally Invasive Spine Surgery.

COVID-19 pandemic- knowledge, perception, anxiety and depression among frontline doctors of Pakistan.

Association between chronic low back pain, anxiety and depression in patients at a tertiary care centre.

Clinical Outcome in Patients with Early versus Delayed Decompression in Cervical Spine Trauma