https://www.um.edu.mt/library/oar/handle/123456789/410 2026-05-22T10:42:45Z https://www.um.edu.mt/library/oar/handle/123456789/146399 Title: The global otolaryngology–head and neck surgery workforce Authors: Petrucci, Beatriz; Okerosi, Samuel; Patterson, Rolvix H.; Hobday, Sara B.; Salano, Valerie; Waterworth, Christopher J.; Brody, Robert M.; Sprow, Holly; Alkire, Blake C.; Fagan, Johannes J.; Tamir, Sharon Ovnat; Der, Carolina; Bhutta, Mahmood F.; Maina, Ivy W.; Pang, Jonathan C.; Daudu, Davina; Mukuzi, Allan G.; Srinivasan, Tarika; Pietrobon, Carolina A.; Nakku, Doreen; Seguya, Amina; Din, Taseer F.; Mbougo, Olga Djoutsop; Mokoh, Lilian W.; Jashek-Ahmed, Farizeh; Law, Tyler J.; Holt, Elizabeth A.; Bangesh, Ali Haider; Zemene, Yilkal; Ibekwe, Titus S.; Diallo, Oumar Raphiou; Alvarado, Jaqueline; Mulwafu, Wakisa K.; Fenton, John E.; Agius, Adrian M.; Doležal, Pavel; Mudekereza, Édouard Amani; Mojica, Karen M.; Rueda, Ricardo Silva; Xu, Mary Jue Abstract: Importance: A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective: To establish comprehensive workforce metrics for global otolaryngology–head and neck surgery (OHNS) with updated data from more countries/territories. Design, Setting, and Participants: A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main Outcome: The OHNS workforce per capita, stratified by income and region. Results: Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world’s population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and Relevance: This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians. 2023-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/146252 Title: Editor's choice – Sex related differences in indication and procedural outcomes of carotid interventions in VASCUNET Authors: Venermo, Maarit; Mani, Kevin; Boyle, Jonathan R.; Eldrup, Nikolaj; Setacci, Carlo; Jonsson, Magnus; Menyhei, Gabor; Beiles, Barry; Lattmann, Thomas; Cassar, Kevin; Altreuther, Martin; Thomson, Ian; Settembre, Nicla; Laxdal, Elin; Behrendt, Christian-Alexander; deBorst, Gert J. Abstract: Objective: It has been suggested that peri-operative complications after carotid surgery may be higher in women than in men. This assumption may affect the treatment patterns, and it is thus possible that carotid endarterectomy (CEA) is provided to women less often. The aim of the current VASCUNET study was to determine sex related differences in operative risk in routine clinical practice among non-selected patients undergoing carotid revascularisation.; Methods: Data on CEA and carotid artery stenting (CAS) from 14 vascular registries were collected and amalgamated. Comprehensive data were available for 223 626 carotid artery procedures; these were analysed overall and by country. The primary outcome was any stroke and or death within 30 days of carotid revascularisation. Secondary outcomes were stroke, death, or any major cardiac event or haemorrhage leading to re-operation.; Results: Of the procedures, 34.8% were done in women. The proportion of CEA for asymptomatic stenosis compared with symptomatic stenosiswas significantly higher amongwomen than men (38.4% vs. 36.9%, p<.001).The proportion of octogenarianswas higher among women thanmen who underwent CEA in both asymptomatic (21.2% vs. 19.9%) and symptomatic patients (24.3% vs. 21.4%). In the unadjusted analysis of symptomatic and asymptomatic patients, there were no significant differences between men and women in the rate of post-operative combined stroke and or death, any major cardiac event, or combined death, stroke, and any major cardiac event after CEA. Also, after stenting for asymptomatic or symptomatic carotid stenosis, there were no significant differences between men and women in the rate of post-operative complications. In adjusted analyses, sex was not significantly associated with any of the end points. Higher age and CAS vs. CEA were independently associated with all four end points.; Conclusion: This study confirmed that, in a large registry among non-selected patients, no significant sex related differences were found in peri-operative complication rates after interventions for carotid stenosis. 2023-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/139264 Title: Prevalence of childhood obesity among children and adolescents in Saudi Arabia : a systematic review Authors: Adam, Tasneem R.; Hamed, Ahmed M.; Mohammed, Heba Saad M.; Elsayed Elshareef, Tarteel Elryahi; Mushaeb, Hanan; Al Harbi, Awad Nafel A.; Bawarith, Boran M.; Almalki, Ahmed Abdullah Almaki; Alzaheb, Nawal; Alqarni, Abdulaziz Hassan; Abdelbaky, Mona Abstract: Childhood obesity is a growing public health concern worldwide, with significant implications for long-term health outcomes. Thus, the aim of this study is to highlight the prevalence and trend of obesity among children and adolescents in Saudi Arabia over the last 24 years. This systematic review included participants aged 2 to 19 years without systemic disease, reporting the prevalence of obesity using the Centers for Disease Control and Prevention (CDC) classification and BMI calculation, from studies in English or Arabic published between January 2000 and April 2024. We conducted a comprehensive search across multiple databases including ProQuest, Google Scholar, ISI Web of Science, Embase via Ovid, and MEDLINE via Ovid, and reviewed references of included studies. Data were extracted and quality assessed independently by two authors, with any disagreements resolved through discussion with a third reviewer, using the Newcastle-Ottawa Scale modified for this study. This systematic review included 21 studies from Saudi Arabia, published between 2006 and 2023, with participants aged 2 to 19 years. The studies involved a total of 63,512 subjects. Among children, the prevalence of overweight ranged from 5% to 29%, while obesity ranged from 3.8% to 49.7%, classified using CDC criteria. Quality assessment rated 10 studies as Very Good, 10 as Good, and one as Unsatisfactory. The systematic review of childhood obesity prevalence in Saudi Arabia over the past 24 years highlights alarming trends and significant public health implications. Our analysis emphasizes an increase in obesity rates among children and adolescents, revealing a complex link of socioeconomic, cultural, and lifestyle factors contributing to this epidemic. 2024-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/139263 Title: The safety and efficacy of hypertonic saline in achieving primary fascial closure following damage control laparotomy: a systematic review and meta-analysis Authors: Muscat, Neil; Shah, Shaneel; Zammit, Neill Abstract: Effective fluid management is critical in patients undergoing damage control laparotomy (DCL) for trauma and sepsis. Hypertonic saline (HTS) has been proposed as an alternative to isotonic fluids to enhance primary fascial closure rates and optimize fluid balance. This systematic review and meta-analysis aims to evaluate the efficacy and safety of HTS compared to isotonic fluids in patients undergoing DCL. A comprehensive literature search was conducted across multiple databases up to the 14 th of June 2024, identifying studies that compared HTS to isotonic fluids in adult patients undergoing DCL for trauma or sepsis. Eligible studies included randomized controlled trials and observational studies reporting outcomes such as early primary fascial closure (EPFC) rates, time to fascial closure, fluid requirements, electrolyte imbalances, renal function, and mortality. Data extraction and quality assessment were performed independently by two reviewers, and pooled analyses were conducted using fixed-effect models where appropriate. Four studies encompassing 375 patients met the inclusion criteria, with 100 patients receiving HTS and 275 receiving isotonic fluids. HTS administration was associated with a significantly higher EPFC rate compared to isotonic fluids (odds ratio (OR): 0.314; 95% confidence interval (CI): 0.142-0.696; p=0.004). The mean time to fascial closure was also significantly reduced in the HTS group by approximately eight hours (mean difference (MD): 8.007 hours; 95% CI: 5.558-10.596; p<0.001). Patients receiving HTS required significantly less total fluid over 48 hours (MD: 1.055 liters; 95% CI: 0.713-1.398; p<0.001). While HTS use led to higher peak sodium levels (MD: -4.318 mEq/L; 95% CI: -4.702 to -3.934; p<0.001), there were no significant differences in peak creatinine levels, need for inpatient renal replacement therapy, or 28-day mortality between the groups. HTS appears to be effective in improving EPFC rates and reducing both time to closure and overall fluid requirements in patients undergoing DCL for trauma and sepsis. Although associated with higher serum sodium levels, HTS did not increase the risk of renal dysfunction or mortality. These findings suggest that HTS is a safe and efficacious alternative to isotonic fluids in the management of critically ill patients requiring DCL. Further large-scale, randomized controlled trials are warranted to confirm these results and inform clinical guidelines. 2024-01-01T00:00:00Z