Epilepsy surgery for children with epileptic spasms: A systematic review and meta-analysis with focus on predictors and outcomes.

To conduct a systematic review of the literature regarding rates and predictors of favorable seizure outcome after resective surgery for epileptic spasms (ES) in pediatric patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed. We searched PubMed, EMBASE, and Cochrane CENTRAL for articles published on the prevalence or incidence of epileptic spasm since 1985. Abstract, full-text review, and data extraction were conducted by two independent reviewers. Meta-analysis was performed to assess overall seizure freedom rate. Subject-level analysis was performed on a subset of studies to identify prognostic indicators. A total of 21 retrospective studies (n = 531) were included. Meta-analysis of all studies demonstrated a pooled seizure freedom rate of 68.8%. Subject-level analysis on 18 studies (n = 360) demonstrated a significant association between duration of spasms and recurrence of spasms after surgery, with an estimated increased risk of 7% per additional year of spasms prior to operation. Patients who underwent resective surgery that was not a hemispherectomy (i.e., lobectomy, lesionectomy, etc.) had an increased recurrence risk of 57% compared to patients who had undergone hemispherectomy. Resective surgery results in seizure freedom for the majority of pediatric patients with epileptic spasms. Patients who undergo hemispherectomy have lower risk of recurrence than patients who undergo other types of surgical resection. Increased duration of spasms prior to surgery is associated with increased recurrence risk after surgery. PLAIN LANGUAGE SUMMARY: Children with epileptic spasms (ES) that do not respond to medications may benefit from surgical treatment. Our study reviewed existing research to understand how effective surgery is in treating ES in children and what factors predict better outcomes. Researchers followed strict guidelines to search for and analyze studies published since 1985, finding 21 studies with a total of 531 patients. They found that, on average, nearly 70% of children became seizure-free after surgery. Further individual analysis of 360 patients showed that longer duration of spasms before surgery increased the risk of spasms returning by 7% per year. Additionally, children who had less extensive surgeries, such as removal of only a specific part of the brain, had a 57% higher risk of seizure recurrence compared to those who had a hemispherectomy, which removed or disconnected half of the brain. Overall, the study concludes that surgery can often stop seizures, especially when more extensive surgery is performed and when the surgery is done sooner rather than later.

Assessing the job preferences of senior medical students for mandatory service: a discrete choice experiment.

AIM: To investigate the job preferences of senior medical students for mandatory service as general practitioners using discrete choice experiment. INTRODUCTION: Health workforce is directly associated with health service coverage and health outcomes. However, there is a global shortage of healthcare workers (HCWs) in rural areas. Discrete choice experiments can guide the policy and decision-makers to increase recruitment and retention of HCWs in remote and rural areas by determining their job preferences. The aim of this study is to investigate job preferences of senior medical students for mandatory service as general practitioners. METHODS: This cross-sectional survey was conducted among 144 medical students. To estimate students' preferences for different levels of job attributes, a mixed logit model was utilised. Simulations of job uptake rates and willingness to pay (WTP) estimates were computed. FINDINGS: All attributes had an impact on the job preferences of students with the following order of priority: salary, workload, proximity to family/friends, working environment, facility and developmental status. For a normal workload and a workplace closed to family/friends which were the most valued attributes after salary, WTPs were 2818.8 Turkish lira (TRY) ($398.7) and 2287.5 TRY ($323.6), respectively. The preference weights of various job characteristics were modified by gender, the presence of a HCW parent and willingness to perform mandatory service. To recruit young physicians where they are most needed, monetary incentives appear to be the most efficient intervention. Non-pecuniary job characteristics also affected job preferences. Packages of both monetary and non-monetary incentives tailored to individual characteristics would be the most efficient approach.

Evaluation of thyroid disease and thyroid malignancy in acromegalic patients.

BACKGROUND: Differences in epidemiological data from different geographical regions have made the prevalence of thyroid disease and thyroid cancer controversial. No previous study has investigated whether thyroid disease and thyroid cancer prevalence are higher in acromegalic patients than in the general population in Türkiye. The aim of this study is to determine the prevalence of thyroid disease and thyroid cancer in acromegaly and to compare it with the control group. METHODS: A total of 129 acromegalic patients (78 female, 51 male) and 247 control group patients (151 female, 96 male) were included in the study. Pituitary size, growth hormone (GH) and insulin-like growth factor (IGF)-1 levels in all patients with acromegaly and thyroid function tests, thyroid receptor autoantibody (TRAb), thyroid scintigraphy, thyroid ultrasonography (US), fine-needle aspiration cytology (FNAC) and histopathology findings after thyroidectomy were recorded. RESULTS: Thyroid lesions were present in 93 patients (72.1%) with acromegaly. While diffuse goiter (14.7%) and multinodular goiter (MNG) (47.3%) were significantly higher, Graves' disease (4.5%) was significantly lower in the acromegaly group compared to control group. The presence of thyroid lesions and thyroid nodules was significantly higher in patients with acromegaly (odds ratio 2.766; 95% CI 2.112-4.469, P<0.001 and OR 1.955; 95% CI 1.206-3.170, P=0.007). According to gender, the prevalence of thyroid lesions, MNG and thyroid cancer was significantly higher in female patients than in the control group. Thyroid cancer prevalence was found in 7% of acromegalic patients and the prevalence of thyroid cancer in the control group was 4.5%. CONCLUSIONS: It remains controversial whether the risk of thyroid cancer is increased or not in patients with acromegaly. In this study, there is no significant difference in thyroid cancer between acromegaly and control group, but thyroid lesions are significantly more common in acromegaly. Also, more research is required to determine if thyroid lesions are more prevalent in females with acromegaly.