Daniela Perez Journal 2022-08-20T07:12:01-07:00 Open Journal Systems <p>Hello this is a demo</p> Pediatric Neurosurgery in Pakistan: Current Status and a Call-To- Action for Inclusion in The National Surgical Plan 2022-08-20T07:10:47-07:00 daniela perezchadid <p class="p1">The pediatric population in Pakistan is vulnerable to premature morbidity and</p> <p class="p1">mortality due to ineffective neurosurgical health system performance.</p> <p class="p1">Approximately 7 per 1000 children in Pakistan have epilepsy, cerebral palsy,</p> <p class="p1">and central nervous system infections. The ramifications are dire when this</p> <p class="p1">incidence rate is paired with a scarcity of skilled pediatric neurosurgeons,</p> <p class="p1">resources, and infrastructure. Traumatic Brain Injuries (TBI) are one of the</p> <p class="p1">leading causes of death in children under three years of age. 76% of which are</p> <p class="p1">avertible with timely surgical access. The National Surgical, Obstetric, and</p> <p class="p1">Anesthesia Plan (NSOAP) provides a framework to facilitate access to surgical</p> <p class="p1">treatment and improve surgical system resilience. This paper presents a</p> <p class="p1">commentary on the status of pediatric neurosurgery in Pakistan and a seminal</p> <p class="p1">framework for policy reform to advocate its inclusion in the NSOAP.</p> 2022-08-20T00:00:00-07:00 Copyright (c) 2022 Daniela Perez Journal The Role of the Pediatric Neurosurgeon in the Management of Hydrocephalus Internationally 2022-08-20T07:12:01-07:00 daniela perezchadid <p class="p1">The recent emphasis on surgery as an essential yet neglected component of global health</p> <p class="p1">care has drawn attention to the lack of pediatric neurosurgery in low- and middle-income</p> <p class="p1">countries (LMICs). Most LMICs have very few neurosurgeons able or willing to care for</p> <p class="p1">children, leaving few access to care for readily treatable conditions, like pediatric</p> <p class="p1">hydrocephalus and spina bifida. Herein, we review the role of pediatric neurosurgeons to</p> <p class="p1">improve hydrocephalus management and medical education in LMICs. A literature search on</p> <p class="p1">global pediatric neurosurgery was performed using the Pubmed database from the year 2000</p> <p class="p1">to October 5<span class="s1">th</span>, 2021. The majority of current pediatric neurosurgical efforts focus on the</p> <p class="p1">management of hydrocephalus. Endoscopic third ventriculostomy (ETV) with or without</p> <p class="p1">choroid plexus cauterization (CPC) has emerged as an effective alternative to</p> <p class="p1">ventriculoperitoneal (VP) shunting for CSF diversion in LMICs. Neurosurgical programs in</p> <p class="p1">LMICs are most successful when twinning is used to pair the program with an established</p> <p class="p1">center in a high-income country (HIC). Multiple international pediatric neurosurgical efforts</p> <p class="p1">aim to provide medical expertise, infrastructure, and surgical education to LMICs. The next</p> <p class="p1">step in developing sustainable surgery programs in LMICs includes establishing local training</p> <p class="p1">programs. Existing global pediatric neurosurgery programs are most successful when</p> <p class="p1">partnered to an experienced center in a HIC. A lack of funding, resources, and training</p> <p class="p1">programs all pose barriers to increasing the pediatric neurosurgical capacity in LMICs. Future</p> <p class="p1">global neurosurgery efforts may look to other neurosurgical conditions with high burdens of</p> <p class="p1">diseased in LMICs, like epilepsy.</p> <p class="p2">The Role of the Pediatric Neurosurgeon in the Management of</p> <p class="p2">Hydrocephalus Internationally</p> <p class="p3">&nbsp;</p> 2022-08-20T00:00:00-07:00 Copyright (c) 2022 Daniela Perez Journal Inositol for the Prevention of Neural Tube Defects: A Potential Opportunity for Advocacy in Global Pediatric Neurosurgery 2022-08-20T07:02:51-07:00 daniela perezchadid <p class="p1">Objective: Approximately 70-80% of neural tube defects (NTDs) are responsive to folate. Myoinositol</p> <p class="p1">has increasingly been identified as a potential solution to address folate-unresponsive</p> <p class="p1">NTDs. We provide a brief background of existing evidence regarding the role of myo-inositol in</p> <p class="p1">NTD prevention and describe its role in advocacy efforts focused on NTD prevention.</p> <p class="p1">Methods: A narrative review was performed.</p> <p class="p1">Results: Existing data regarding the efficacy of inositol supplementation is limited by low sample</p> <p class="p1">sizes and primarily observational study designs. Although advocacy efforts regarding NTDs have</p> <p class="p1">focused on folate fortification and supplementation, examining the data for inositol intake is</p> <p class="p1">worthwhile. After reviewing the data, we put forth that a series of criteria would need to be met</p> <p class="p1">even before considering advocacy and policy. First, the weight of evidence must favor increasing</p> <p class="p1">inositol intake. Second, the cost-effectiveness of inositol policy must be demonstrated. Third, the</p> <p class="p1">policy must be politically viable. Fourth, political priority for the policy must be generated. Fifth,</p> <p class="p1">synergy between existing folate policy efforts and inositol policy efforts must be generated. After</p> <p class="p1">that series of criteria are examined, advocacy may occur through neurosurgery-specific</p> <p class="p1">organizations, combined approaches with other surgical disciplines, and advocacy through</p> <p class="p1">collaborations of various clinical and research personnel.</p> <p class="p1">Conclusion: Inositol may represent an avenue for reducing the birth prevalence of folateunresponsive</p> <p class="p1">neural tube defects. Given their clinical roles in treatment of spina bifida</p> 2022-08-20T00:00:00-07:00 Copyright (c) 2022 Daniela Perez Journal