Gender Differences in Perception of Neurosurgery as a Career Choice in Pakistan: A Nationwide Cross-Sectional Survey.

BACKGROUND: A low neurosurgeon-to-patient ratio persists to be a problem in many developing nations including Pakistan. Concurrent gender disparities further exacerbate the challenges posed by the already limited workforce. An understanding of the perceptions of neurosurgery among female early career doctors is crucial in the evolution of the field in terms of both, workforce strength and inclusivity. METHODS: A cross-sectional study was conducted across public and private medical schools of Pakistan. A close-ended self-administered questionnaire was employed to assess subject-reported challenges and perceptions regarding neurosurgery. Statistical analysis was performed using SPSS version 28, and p< 0.05 was considered significant. The influence of these perceptions on the choice of neurosurgery as a career was determined by binary logistic regression analysis. RESULTS: Of the 387 responses received from over 45 institutions across the country, 55.6% were females and 44.4% were male respondents. Compared to men, women were more likely to opt out of neurosurgery due to fear of problems with parenting (p<0.001), absence of daycare facilities (p<0.001), lack of female role models (p=0.001), fear of gender discrimination (p<0.001), and the mental (p=0.04) and physical distress (p=0.008) associated with neurosurgery. Binary logistic regression revealed that these concerns were responsible for an increased likelihood of opting out of neurosurgery among female medical students and intern doctors. CONCLUSIONS: Significant differences exist in how male and female medical students perceive neurosurgery as a career choice. Interventions including availability of day care facilities for children, creation of inclusive workplace environment, and promotion of mentorship programs catering to women can help bridge this gap and contribute to evolution of the field of neurosurgery in the developing world.

A Case of COVID-19 Pneumonia Leading to Acute Respiratory Distress Syndrome (ARDS) and Multi-organ Failure Requiring Extracorporeal Membrane Oxygenation (ECMO) for Six Months and an Associated Critical Limb Ischemia.

This article presents the case of a 57-year-old woman with a history of rheumatoid arthritis who developed severe coronavirus disease 2019 (COVID-19) pneumonia that progressed to acute respiratory distress syndrome (ARDS) and multi-system organ failure. Despite initial slow progression and multiple hospital readmissions, her condition rapidly deteriorated, leading to full respiratory failure requiring intubation and ventilation. She was transferred to a specialized center where she underwent extracorporeal membrane oxygenation (ECMO) and hemodialysis for acute renal failure. Unfortunately, she remained dependent on ECMO for an extended period of six months. Although she made a gradual recovery, the prolonged critical care treatment resulted in critical ischemia of multiple extremities, necessitating a below-knee amputation (BKA) of her left lower extremity and transmetatarsal amputations of her right hand. This case reports one of the longest ECMO treatments for COVID-19 and associated comorbidities in the literature. Clinicians could include a longer duration of treatment and potential associated disabilities in the informed consent.

Recurrent Lactobacillus Rhamnoses Bacteremia and Complications in an Immunocompromised Patient With History of Probiotic Use: A Case Report.

The use of probiotics has been on the rise in the past few years. Increasing reports on Lactobacillus bacteremia-associated morbidity and mortality in immunocompromised patients have raised safety concerns about its use in this group. We present a case of a 79-year-old patient with a history of probiotic use who was admitted from the emergency department for acute-on-chronic diarrhea, acute hyponatremia, acute-on-chronic diastolic heart failure, and ambulatory dysfunction. His multiple co-morbidities include stage III chronic kidney disease, type II diabetes mellitus, chronic diastolic heart failure, Parkinson's disease, essential hypertension, atrial fibrillation, status post pacemaker placement, and status post bioprosthetic aortic valve replacement. He was diagnosed with a resistant case of Lactobacillus bacteremia during his admission, with multiple positive blood cultures positive for L. rhamnosus resistant to antibiotics therapy. Unfortunately, due to multiple complications related to Lactobacillus bacteremia, he transitioned to comfort care and ultimately passed away in a few weeks. Although probiotics are generally considered safe, their safety in immunocompromised patients is uncertain. Until more research is available to confirm their safety, caution should be taken when using them in this population. This study is an addendum to the few studies on this topic.

Acute Gastrointestinal Bleeding: A Report of Rare Presentation of Duodenal Metastasis From Cervical Squamous Cell Carcinoma.

We report a case of a 42-year-old gravida 3, para 4 woman from Puerto Rico with a history of cervical cancer who presented with dizziness, lethargy, and three days of bright red blood per rectum. Imaging evaluation showed a retroperitoneal lymph node mass with secondary metastasis to the duodenum. After she was stabilized with multiple blood transfusions and to mitigate her ongoing bleeding, she was transferred to a tertiary care hospital for possible embolization by interventional radiologists. However, she was deemed a poor candidate for an interventional procedure and decided to ultimately go home on hospice care. This case highlights the rarity of duodenal metastasis presenting as gastrointestinal bleeding due to cervical squamous cell cancer and further reinforces the need for human papillomavirus vaccination and cervical cancer screening. This case study also illustrates that even though cervical cancer rates are low in the United States, it is still deadly in many countries across the globe. As people continue to travel and migrate across borders, the risk of being lost to follow-up is on the rise.

Intracranial migration of a ventriculoperitoneal shunt.

OBJECTIVE: Total intracranial migration of the shunt is a rare complication of ventriculoperitoneal shunt placement for treatment of hydrocephalus. The authors report a case of total intracranial migration of ventriculoperitoneal shunt in a child with a very large head and discuss the possible causes and management.