Women in Neurosurgery: Historical Path to Self-Segregation and Proposal for an Integrated Future.

Despite the rising percentage of women accessing the medical profession over the last few decades, surgical specialties are still largely male-dominated; in particular, a remarkable gender disparity is evident in neurosurgery, where only 19% of practitioners are females. Although women may be reluctant to choose a challenging specialty like neurosurgery due to concerns around how to balance family and career, it must be admitted that prejudices against female neurosurgeons have been deeply rooted for long, prompting many to give up and switch track to less demanding subspecialties. Among those who have persisted, many, if not most, have experienced difficulties in career progression and received unequal treatment in comparison with their male counterparts. In 1989, a group of 8 female neurosurgeons founded Women in Neurosurgery (WINS), an organization that aimed to guarantee inclusivity in neurosurgery, encouraging a better and more egalitarian working environment. Thereafter, WINS sessions were regularly promoted at international conferences, offering female neurosurgeons a platform to report issues related to gender discrimination. Over recent years, the mission of WINS sessions in national and international conferences has taken an unexpected deviation; they have progressively become supplementary scientific sessions with only women neurosurgeons as speakers, thus paving the road to a form of self-segregation. This tendency has also resulted in the establishment of sections of only female neurosurgeons within some national societies. Although there remains a faction that fiercely supports the WINS mindset of reserved spaces for women, such segregation is an upsetting prospect for those who believe that science and professionalism have no gender; a growing part of the global neurosurgical community believes that the conception of a "female neurosurgery" and a "male neurosurgery" is misguided and counterproductive and consider the existence of the WINS as anachronistic and no longer necessary.

Intercostal or ulnar nerve: Which donor nerve is to be used for reanimation of elbow flexion?

BACKGROUND: In total brachial plexus injury, intercostal nerves (ICNs) are used as donor nerves to restore the elbow flexion; albeit in upper brachial plexus injury (BPI), ulnar nerve provides a source of motor axons for this purpose. The present study set out to compare the restoration of elbow flexion by using these two donor nerves. METHODS: Between 2010 and 2013, 24 adult patients with upper-middle BPI and 15 patients with total BPI undergoing elbow flexion restoration surgery were studied. Motor fascicle of flexor carpi ulnaris branch of ulnar nerve (mFCU nerve) procedure was utilized in upper-middle BPI, as well as transfer of ICN to biceps branch of the musculocutaneous nerve (MCN) in total BPI. Both techniques included sectioning, rerouting, and direct suturing of the biceps branch of the MCN. Follow-up consisted serial clinical examinations and EMG-NCV tests. Motor strength was recorded according to the British Medical Research Council grading system in that the results were reported as nonfunctional (grades M0-M2) and functional (grades M3-M5). RESULT: No significant difference was documented between the Oberlin procedure and ICN-MCN transfer in terms of reinnervation results (P = 0.6). However, a significant difference in restoration of muscle force was found between the mFCU (95.83%) and ICN-MCN transfers (66.66%) (P = 0.02). CONCLUSION: The evidence from the present study indicates that although ICN-MCN transfer is a viable method for reanimation of elbow flexion in BPI, mFCU nerve is a better donor if exists.

Intramuscular compared with subcutaneous transposition for surgery in cubital tunnel syndrome.

Background There is no consensus on the most effective surgical technique in the treatment of cubital tunnel syndrome. Anterior subcutaneous transposition (AST) and anterior intramuscular transposition (AIT) are common surgical treatments in this regard. The aim of this study was to compare the clinical outcomes of these two surgeries for cubital tunnel syndrome. Methods In a retrospective study, we compared surgical outcomes (pain, sensation, motor recovery, atrophy, and total satisfaction) in 40 patients undergoing AIT and 43 undergoing AST of the ulnar nerve. Results The patients undergoing AIT showed a significant improvement in all the outcomes after the surgery (P = 0); however, those undergoing AST only experienced an improvement in pain and sensation after the surgery (P = 0). Comparing the two surgeries, we found that there was a high total satisfaction with AIT compared with AST (P = 0). When we independently compared each outcome in the two groups, we found that the muscle force recovery was significantly improved in the AIT group compared with the AST group (P = 0). Conclusions AIT is preferable to AST for the surgical treatment of cubital tunnel syndrome. In particular, AIT achieves a better motor recovery of the ulnar nerve compared with AST.

Maternal SSRI exposure increases the risk of autistic offspring: A meta-analysis and systematic review.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressants used to preclude maternal pregnancy depression. There is a growing body of literature assessing the association of prenatal exposure to SSRIs with autism spectrum disorder (ASD). The present systematic review and meta-analysis reviewed the medical literature and pooled the results of the association of prenatal exposure to SSRIs with ASD. METHODS: Published investigations in English by June 2016 with keywords of selective serotonin reuptake inhibitors, SSRI, autism spectrum disorder, ASD, pregnancy, childhood, children, neurodevelopment were identified using databases PubMed and PMC, MEDLINE, EMBASE, SCOPUS, and Google Scholar. Cochran's Q statistic-value (Q), degree of freedom (df), and I2 indices (variation in odds ratio [OR] attributable to heterogeneity) were calculated to analyze the risk of heterogeneity of the within- and between-study variability. Pooled odds ratio (OR) and 95% confidence interval (CI) were reported by a Mantel-Haenszel test. RESULTS: There was a non-significant heterogeneity for the included studies ([Q=3.61, df=6, P=0.730], I2=0%). The pooled results showed a significant association between prenatal SSRI exposure and ASD (OR=1.82, 95% CI=1.59-2.10, Z=8.49, P=0.00). CONCLUSION: The evidence from the present study suggests that prenatal exposure to SSRIs is associated with a higher risk of ASD.

Mitochondrial DNA G13708A variation and multiple sclerosis: Is there an association?

BACKGROUND: Multiple sclerosis (MS) is considered a pathogenetic enigma. Recently, efforts to implicate genetics in human susceptibility to MS have identified an important role of mitochondrial DNA (mtDNA). G13708A is a common mtDNA variation associated with MS in specific populations. This study tested the hypothesis that the mtDNA G13708A variation is associated with MS in an Iranian population. MATERIALS AND METHODS: Blood samples were collected from 100 MS patients and 100 unrelated healthy controls. DNA was extracted using a salting-out method, followed by polymerase chain reaction (PCR) amplification. For assessment of restriction fragment length polymorphism (RFLP), PCR products were restricted by restriction enzyme Mva I. Thereafter, the restriction products were assessed by means of an ultraviolet (UV) transilluminator following electrophoresis with 3% agarose gel. Accuracy of the genotyping procedure was assessed by direct sequencing. RESULTS: The mtDNA G13708A variation was found in 17 cases (17%) and 19 controls (19%) (P=0.7, OR: 0.8, 95% CI: 0.3-1.9). CONCLUSION: The findings of the present study fail to support the hypothesis that the G13708A mtDNA variation is associated with MS in the selected Iranian population.

The role of ultrasound in the visualization of the ingested medications in acute poisoning - a literature review.

In the patients with medication poisoning, diagnosis and treatment may be complicated due to the decreased level of consciousness or lack of the patient cooperation. In this review, we tried to assess the role of ultrasonography in detection of the ingested medication in the stomach of the patients with suspected medication poisoning. Of the studies performed in this regard, only one managed to determine the extended phenytoin capsules in the stomach of a poisoned patient. In actual acute poisoning - even in the hands of an experienced ultrasonographer - detection of the medications in the patients' stomach seems to be difficult due to the presence of the food or lack of the water in their stomach. Also, after dissolution of the tablets or capsules or their passage from the pylorus, they can not further been visualized by ultrasound. We, therefore, conclude that ultrasonography is not an appropriate tool for diagnosis of the medication ingestion in acute poisoning.