Publications by authors named "Nuru Mohammed"

11 Publications

  • Page 1 of 1

Management of Pre-existing Ventriculoperitoneal Shunt in Posterior Vault Distraction for Lambdoid Craniosynostosis: A Case Report and Technical Note.

Cureus 2021 Jan 20;13(1):e12814. Epub 2021 Jan 20.

Neurosurgery, Norton Children's Hospital, Louisville, USA.

Posterior vault distraction osteogenesis (DO) is an emerging treatment option for craniosynostosis. Operative nuances detailing surgical management are being described with increasing use and experience. In this article, we discuss the surgical management of an 8-month-old male with a ventriculoperitoneal shunt (VPS) diagnosed with bilateral lambdoid craniosynostosis and Chiari I malformation. The patient underwent successful bilateral posterior fossa DO without surgical re-implantation of the shunt. Pre- and post-operative imaging confirmed no migration of the VPS. Intracranial volume increased by 20.1% and posterior fossa volume increased by 39.9%. Our experience illustrates that posterior vault DO can be done safely in the setting of a parieto-occipital VPS, in a single operative setting, without the need of additional procedures.
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http://dx.doi.org/10.7759/cureus.12814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894243PMC
January 2021

Tenosynovial Giant Cell Tumor of the Cervical Spine: Case Report and Review of the Literature.

Cureus 2020 Dec 23;12(12):e12232. Epub 2020 Dec 23.

Neurosurgery, University of Louisville School of Medicine, Louisville, USA.

Tenosynovial giant cell tumor (TGCT) is a rare entity that is not well described in the neurosurgical literature. We present a case of a 37-year-old woman with a diffuse subtype TGCT of the cervical spine, affecting the left cervical 6-7 facet joint, with co-incidental cervical trauma. Initial management consisted of subtotal resection and cervical stabilization with cervical 6 to 7 laminectomy, and cervical 4 to thoracic 2 posterior instrumented fusion. Gross total resection was achieved at a later date with a plan for postoperative radiation to prevent a recurrence. The patient was lost to follow-up for radiation treatment and returned 2.5 years later with minor symptoms and recurrence at the surgical site.
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http://dx.doi.org/10.7759/cureus.12232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821702PMC
December 2020

Delayed recurrence of acute subdural hematoma in a patient with plasminogen activator inhibitor mutation.

Surg Neurol Int 2020 18;11:292. Epub 2020 Sep 18.

Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States.

Background: Plasminogen activator inhibitor type I (PAI-1) is important for balancing the fibrinolytic effect of plasmin, and deficiency can result in increased risk of bleeding. We report a case of a patient with PAI-1 deficiency who presented with delayed spontaneous recurrence of an acute subdural hematoma (aSDH) after evacuation.

Case Description: A 29-year-old male presented with altered mental status (AMS) after a fall at a construction site with Glasgow Coma Scale (GCS 4T). His coagulation profile was normal, and brain computed tomography (CT) showed a left-sided aSDH. He underwent emergent evacuation of the hematoma. On postoperative day 2, he was started on heparin for venous thromboembolism (VTE) prophylaxis. His neurological examination improved and was discharged with no focal deficits. Three days later, he presented with sudden AMS (GCS 7T); CT head showed a large hematoma at the site of original surgery. The hematoma was evacuated emergently. On readmission, the family informed providers that the patient had a history of PAI-1 deficiency. Postoperatively, only mechanical VTE prophylaxis was used and the patient was started on oral TXA per hematology recommendation. The patient improved and was discharged with no focal deficit. On follow-up, he remained neurologically stable.

Conclusion: PAI-1 deficiency should be suspected in patients with delayed posttraumatic/surgical bleeding and a normal coagulation profile. If PAI-1 deficiency is evident or suspected, then a trial of antifibrinolytic agent should be used to treat and prevent recurrence of bleeding. Furthermore, chemical VTE prophylaxis should be avoided as it increases the risk for bleeding.
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http://dx.doi.org/10.25259/SNI_180_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568130PMC
September 2020

Knowledge and practice of cervical cancer screening and associated factors among reproductive age group women in districts of Gurage zone, Southern Ethiopia. A cross-sectional study.

PLoS One 2020 18;15(9):e0238869. Epub 2020 Sep 18.

Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.

Background: Cervical cancer is a malignant tumor of the lower-most part of the uterus and major cause of morbidity and mortality among women's in the world. Its high mortality rate in the globe can be reduced through comprehensive approaches' that include; primary prevention, early diagnosis, effective screening, and treatment packages. This study was aimed to assess the knowledge and practice of cervical cancer screening and its associated factors among reproductive age group women in districts of Gurage zone, Southern Ethiopia, 2019.

Methods: A community-based cross-sectional study design was conducted from March 1-30, 2019. A total of 268 respondents were selected using a systematic sampling technique. Data was collected using pretested, semi-structured, and interviewer-administered questionnaires. Data were entered into Epi data version 3.1software and exported to SPSS 24 for analysis. Bivariate and multivariate analyses with a 95% confidence level was done and variables (P <0.05) were deemed statistically significant.

Result: A total of 260 respondents participated in the study with a response rate of 97%. About 3.8% of the respondents had experiences cervical cancer screening and 26.2% of respondents had good knowledge. Early age at first sex [AOR = 6.05 (95%CI; 1.167-31.36)], having information about cervical cancer [(AOR = 10.2 (95% CI 1.9-96.4)], and multiple sexual partners [AOR = 3.96 (95% CI; 1.48-10.58)] were factors affecting the practice of cervical cancer screening. Being uneducated [AOR = 15.5 (95%CI; 3.82-62.967)], family history of cervical cancer [AOR = 14.158 (95%CI;3.88-51.7)], having plans to screen for cervical cancer [AOR = 0.352 (95%CI;.175-.710)], menarcheal age [AOR = 2.63 (95%CI;1.28-5.37)] and age at first sex [AOR = 3.17 (95%CI;1.283-7.837)] were factors affecting knowledge of cervical screening.

Conclusion: The study findings indicate that respondents' practice and knowledge of cervical cancer is mainly affected by early age at first sex, having information about cervical cancer, multiple sexual partners, Educational status, family history of cervical cancer, having plans to screen for cervical cancer, age at first sex and age of menarche. Therefore, all concerned bodies need to focus on women in the reproductive age group to increase the level of knowledge and practice of cervical cancer screening through appropriate interventions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238869PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500695PMC
November 2020

Intraoperative CT for Neuronavigation Guidance and Confirmation of Foramen Ovale Cannulation for Glycerol Trigeminal Rhizotomy: A Technical Report and Case Series.

Cureus 2020 May 13;12(5):e8100. Epub 2020 May 13.

Neurosurgery, University of Louisville School of Medicine, Louisville, USA.

Glycerol rhizotomy was originally described as an initial surgical treatment for trigeminal neuralgia after the failure of medical therapy. Here we describe its use as a salvage procedure, typically after failure of multiple other modalities including microvascular decompression, stereotactic radiosurgery, and/or other percutaneous procedures. Foramen ovale cannulation as a "salvage procedure" may be complicated by lack of cerebrospinal fluid (CSF) return despite adequate cannulation of the foramen ovale, making conventional fluoroscopic confirmation of adequate needle placement less certain. In this article, we describe the application of intraoperative CT, fused with high-resolution preoperative CT/MRI for neuronavigation to accurately cannulate the foramen ovale and Meckel's cave for glycerol rhizotomy. Intraoperative CT, again fused with high-resolution preoperative CT and MRI studies, was then used to confirm accurate trajectory through the foramen ovale and the adequate location of the needle tip in Meckel's cave before injecting glycerol. We present our initial experience with 14 patients who underwent glycerol rhizotomy by these techniques depending on intraoperative CT. It appears that intraoperative CT-guided neuronavigation provides a practical, reliable, and accurate route to the foramen ovale and aids in the confirmation of adequate needle placement even when there is a lack of CSF return. These methods may be especially useful for difficult cannulations typical in salvage procedures. In an era of feasible intraoperative guidance, with advanced stereotactic planning software allowing the fusion of intraoperative CT with high-resolution preoperative CT and MRI datasets, these techniques can be applied to foramen ovale cannulation for glycerol rhizotomy without major modification.
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http://dx.doi.org/10.7759/cureus.8100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292704PMC
May 2020

Insurance expansion associated with reduced use of emergency psychiatric services.

Am J Emerg Med 2021 02 27;40:220-221. Epub 2020 May 27.

Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America.

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http://dx.doi.org/10.1016/j.ajem.2020.05.074DOI Listing
February 2021

The Path to U.S. Neurosurgical Residency for Foreign Medical Graduates: Trends from a Decade 2007-2017.

World Neurosurg 2020 05 19;137:e584-e596. Epub 2020 Feb 19.

Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA. Electronic address:

Objective: The increasing competitiveness of the neurosurgical residency match has made it progressively difficult for foreign medical graduates (FMGs) to match in neurosurgery. We compared FMG to U.S. medical graduate (USMG) match rates in neurosurgery and identified factors associated with match outcomes for FMGs in neurosurgery.

Methods: Retrospective review of American Association of Neurological Surgeons membership data and Association of American Medical Colleges Charting the Outcomes match reports (2007-2017).

Results: Across 1857 neurosurgical residents (USMG: 91.1%, FMG: 8.9%), average FMG match rates were 24% (range, 15%-35%) versus 83% (range, 75%-94%; P < 0.001) for USMG. FMGs were more male (89.5% vs. 82.0%, P = 0.016), older (33.9 vs. 31.8 years, P = 0.008), and more likely to take research year(s) before matching (95.8% vs. 78.5%, P < 0.001). FMGs had greater publications (5 vs. 2, P < 0.001) and H-indices (3 vs. 1, P < 0.001). The number of matched USMGs increased by 3.3 annually, whereas that of matched FMGs remained unchanged (β = 0.07). Compared with USMGs, FMGs were less likely to match to National Institutes of Health (NIH) Top 40 (32.7% vs. 47.5%, P < 0.001) and Doximity Top 20 (20.0% vs. 29.0%, P = 0.014) programs. FMGs with prior U.S. neurosurgery program affiliation were more likely to match at NIH and Doximity Top 20 programs (P < 0.05). For NIH programs, FMGs were older (35.3 vs. 32.0, P = 0.011), had higher H-indices (5 vs. 2, P < 0.001), publications (7 vs. 2, P < 0.001), and were more likely to take research year(s) (94.4% vs. 76.0%, P = 0.002) than USMGs. FMGs had similar patterns for matching into Doximity Top 20 programs.

Conclusions: Although FMGs have lower match rates into U.S. neurosurgery residencies than USMGs, several demographic, professional, and academic factors could increase the chances of successful FMG neurosurgical match.
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http://dx.doi.org/10.1016/j.wneu.2020.02.069DOI Listing
May 2020

Repair of a large primary subtemporal encephalocele in a 3-year-old child: case report.

J Neurosurg Pediatr 2019 Oct 18:1-6. Epub 2019 Oct 18.

1Department of Neurological Surgery, University of Louisville School of Medicine.

Primary encephaloceles (PEs) present only rarely in the temporal region; in the rare instance that they project through the floor of the middle fossa they are secondary. In this case report the authors report on the management of a giant PE extending through the floor of the middle fossa.An 8-month-old boy presented to the authors' service with a large PE projecting into his neck through a missing left middle fossa floor; the lesion was causing significant meta-, dys-, and hypoplasia of the structures of the anterolateral neck on that side. Surgical goals for this patient included the following: 1) removal of potentially epileptogenic and dysfunctional tissue; 2) preservation of cranial nerves; 3) prevention of cognitive decline or iatrogenic deficit; 4) prevention of CSF leak; 5) reconstruction of skull base; 6) prevention of airway and swallowing compromise; and 7) cosmesis. After a multidisciplinary evaluation with ENT, plastic surgery, and neurology, an operation was performed using a preauricular infratemporal approach when the patient was 3 years old. Gliotic tissue was resected and amygdala, hippocampus, and middle cerebral artery were preserved.The immediate results of the operation showed good immediate outcome. Seizure freedom and neurodevelopment outcomes remain to be seen at follow-up.
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http://dx.doi.org/10.3171/2019.8.PEDS19266DOI Listing
October 2019

High methionine, low folate and low vitamin B6/B12 (HM-LF-LV) diet causes neurodegeneration and subsequent short-term memory loss.

Metab Brain Dis 2018 12 9;33(6):1923-1934. Epub 2018 Aug 9.

Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA.

Methionine is an essential amino acid found in rich quantities in average American diet such as meats, fish and eggs. Excessive consumption of such food often exceeds the normal requirement of the methionine in our body; which found to be related to the development of neurodegenerative disorders. However, the mechanistic pathways of methionine's influence on the brain are unclear. The present study is focus on the effects of high methionine, low folate and low vitamin B6/B12 (HM-LF-LV) diet on the dysfunction of neuronal and vascular specific markers in the brain. C57BL6/J male mice (8-10 week old) were fed with HM-LF-LV diet for a 6 week period. Cognitive function of mice was determine by measuring short-term memory using a Novel Object Recognition test (NORT). Neuronal dysfunction were evaluate by measuring the levels of Neuronal nuclear antigen (NeuN), Neuron-specific-enolase (NSE) and Fluoro-jade C(FJC) fluorescence; while cerebrovascular disruption were evaluate by assessing levels of endothelial junction proteins Vascular Endothelial-Cadherin (VE-Cadherin) and Claudin-5 in harvested brain tissue. Cerebrovascular permeability was assess by evaluating microvascular leakage of fluorescently labeled albumin in vivo. Endothelial and Neuronal Nitric Oxide Synthase (eNOS, nNOS) regulation and vascular inflammation (ICAM: intercellular adhesion molecules) were also evaluate in brain tissue. All assessments were conduct at weekly intervals throughout the study duration. NORT showed a significant temporal decrease in short-term memory of mice fed on HM-LF-LV diet for 6 weeks compared to the wild-type control group. Our experimental data showed that neuronal dysfunction (decreased NeuN levels and increased FJC positive neurons in brain) was more prominent in HM-LF-LV diet fed mice compared to normal diet fed control mice. In experimental mice, cerebrovascular disruption was found to be elevated as evident from increased pial venular permeability (microvascular leakage) and decreased in VE-Cadherin expression compared to control. Slight decrease in nNOS and increase in eNOS in experimental mice suggest a trend towards the decrease in potential for neuronal development due to the long-term HM-LF-LV diet fed. Collectively, our results suggest that a diet containing high methionine, low folate and low vitamin B6/B12 results in increased neuronal degeneration and vascular dysfunction, leading to short-term memory loss. Interestingly, significant neuronal damage precedes vascular dysfunction.
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http://dx.doi.org/10.1007/s11011-018-0298-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712979PMC
December 2018

Homocysteine as a Pathological Biomarker for Bone Disease.

J Cell Physiol 2017 Oct 12;232(10):2704-2709. Epub 2017 Apr 12.

Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky.

In the last few decades, perturbation in methyl-group and homocysteine (Hcy) balance have emerged as independent risk factors in a number of pathological conditions including neurodegenerative disease, cardiovascular dysfunction, cancer development, autoimmune disease, and kidney disease. Recent studies report Hcy to be a newly recognized risk factor for osteoporosis. Elevated Hcy levels are known to modulate osteoclastgenesis by causing detrimental effects on bone via oxidative stress induced metalloproteinase-mediated extracellular matrix degradation and decrease in bone blood flow. Evidence from previous studies also suggests that the decreased chondrocytes mediated bone mineralization in chick limb-bud mesenchymal cells and during the gestational period of ossification in rat model. However, Hcy imbalance and its role in bone loss, regression in vascular invasion, and osteoporosis, are not clearly understood. More investigations are required to explore the complex interplay between Hcy imbalance and onset of bone disease progression. This article reviews the current body of knowledge on regulation of Hcy mediated oxidative stress and its role in bone remodeling, vascular blood flow and progression of bone disease. J. Cell. Physiol. 232: 2704-2709, 2017. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/jcp.25693DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576446PMC
October 2017

Incidence and correlates of low birth weight at a referral hospital in Northwest Ethiopia.

Pan Afr Med J 2012 4;12. Epub 2012 May 4.

Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Ethiopia.

Background: Weight at birth is a good indicator of the newborn's chances for survival, growth, long-term health and psychosocial development. Low birth weight (LBW) babies are significantly at risk of death, contributing to the high perinatal morbidity and mortality in developing countries. Hence, this study aims to assess the incidence and associated factors of low birth weight (LBW) in Gondar University Hospital deliveries.

Methods: A cross-sectional study, conducted on 305 live births from May 1- July 30, 2010. Information on independent variables was collected from the mothers just before discharge using a structured interview questionnaire. Neonatal weight was measured using standard beam balance. Both interviews and weight measurements were done by two trained midwives. Gestational age was determined by last normal menstrual period and/or ultrasound examinations.

Results: The mean and standard deviations of the birth weights were 2976 ± 476 grams. Incidence of LBW (birth weight <2500 grams) was 17.1% (95%CI 13.3%, 21.6%). LBW was associated with first delivery (AOR=2.85), lack of antenatal care follow up (AOR= 5.68) or infrequent visits and being HIV positive (AOR=3.22). More female newborns were with low birth weight than males though the difference was not significant after controlling for potential confounders in the multivariate analysis.

Conclusion: There is a high incidence of LBW. Efforts should to enhance national antenatal care utilization in general, and particularly in Gondar, should be encouraged as its absence is closely associated with LBW.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396870PMC
December 2012