Introduction: Spontaneous intracranial hypotension due to a spinal cerebrospinal fluid leak causes orthostatic headaches and impacts quality of life. Successful closure rates are often reported, whereas data on long-term outcome are still scarce. Methods: Between April 2020 and December 2022 surgically treated patients completed the Headache Impact Test-6 prior to surgery and at 14 days, three months, six months, and 12 months postoperatively. In addition to the Headache Impact Test-6 score, we extracted data related to orthostatic symptoms. Results: Eighty patients were included. Median Headache Impact Test-6 score preoperatively was 65 (IQR 61–69), indicating severe and disabling impact of headaches. At three months headache impact significantly improved to 49 (IQR 44–58) (p < 0.001) and remained stable up to 12 months (48, IQR 40–56), indicating little to no impact of headaches on quality of life. The need to lie down “always” or “very often” was reduced from 79% to 23% three months postoperatively (p < 0.001). Conclusions: Surgical closure of spinal CSF leaks significantly improves the impact of headaches in the long term. At least three months should be expected for recovery. Despite permanent closure of the CSF-leak, a quarter of patients still have relevant long-term impairment, indicating the need for further research on its cause and possible treatment.

Visceral leishmaniasis (VL) in Nepal is found in 61 out of 75 districts including areas previously listed as non- endemic. This study focused on the role of housing conditions and its immediate environment in VL transmission, to limit future transmissions, ensure sustainable vector control and support the VL elimination program. The objective was to explore the risk factors in rural housing-and land lot typologies contributing to clinical VL occurrence and transmission. Housing structures and land lots were examined based on characteristics as risk factors of VL transmission in a case-control analysis. VL cases from 2013–2017 were identified based on the existing database from the Epidemiology and Disease Control Division and District Public Health Office from the plain Terai area (Morang, and Saptari districts) and hilly area (Palpa district) of Nepal. Two hundred and three built environments were analyzed (66 cases and 137 controls). Inferential statistics and logistic regression analysis were performed to determine the association of risk factors with VL. The risk factors with the highest odds of VL were: bamboo walls (adjusted odds ratio (AOR)- 8.1, 95% CI 2.40–27.63, p = 0.001), walls made of leaves/branches (AOR- 3.0, 95% CI 0.84–10.93, p = 0.090), cracks in bedroom walls (AOR- 2.9, 95% CI 0.93–9.19, p = 0.065), and placing sacks near sleeping areas (AOR- 19.2, 95% CI 4.06–90.46, p <0.001). Significant outdoor factors were: lots with Kadam trees (AOR- 12.7, 95% CI 3.28–49.09, p <0.001), open ground-outdoor toilets (AOR- 9.3, 95% CI 2.14–369.85, p = 0.003), moisture in outdoor toilet sheds (AOR- 18.09, 95% CI 7.25–451.01, p = 0.002), nearby- open land (AOR- 36.8, 95% CI 3.14–430.98, p = 0.004), moisture inside animal sheds (AOR- 6.9, 95% CI 1.82–26.66, p = 0.005), and surrounding animals/animals wastes particularly goats (AOR- 3.5, 95% CI 1.09–10.94, p = 0.036). Certain housing and surrounding environmental conditions and characteristics are risk factors for VL. Hence, elimination and educational programs should include the focus on housing improvement and avoidance of risk factors. Longitudinal interventional studies are required to document temporal relationships and whether interventions on these factors will have an impact on Leishmania transmission or burden. Visceral leishmaniasis (VL) is a fatal disease if not treated in time. It is the disease of the poorest people. Poor housing and sanitation around the house are considered as the risk factors for the occurrence of VL. The main objective of our research was to explore multiple risk factors from different housing and land lot- typologies for VL occurrence and transmission through a case-control study. Some of our results reveal that inside the dwelling the likelihood of having clinical VL was substantially enhanced by providing suitable breeding sites for the insect vectors; as an example: the probability of getting VL disease was about ten times higher when there were sacks (empty or filled) near sleeping areas. Also cracks in walls and floors were found to contribute to vector transmission but also particular wall structures such as bamboo walls, and finishes such as animal manure were shown to be optimal for vector breeding. Furthermore, certain animals and plant types in the immediate environment seem to attract the vectors and to have a substantial effect on VL occurrence. Thus, given the alarming increase of VL in previously non-endemic areas of Nepal, these findings, among others, will allow readers and policymakers to better understand the “hidden” VL transmission factors, and will–hopefully- encourage initiating future studies.

Epidermoid lesions account for 1% of intracranial neoplasms. Surgical management is challenging due to their adhesion to critical neurovascular structures and tendency for recurrence. The current study examines surgical outcomes, extent of resection, and recurrence rates during long-term follow-up. A retrospective analysis was conducted on patients treated for epidermoid lesions between 2000 and 2021, focusing on clinical and radiological outcome and long-term symptom development. Among 55 patients (56.4% male), the majority harbored lesions in the cerebellopontine angle (75.3%). The mean age at surgery was 41.3 years, with an average follow-up of 82 months. Total removal was achieved in 61% of cases, with 75% of them remaining recurrence-free. In comparison, 35% of near-total removal and 25% of subtotal removal remained recurrence-free. Immediate symptom improvement was similar after total and non-total removal (12.6% vs. 10.5%), but long-term improvement was higher after total removal (43% vs. 27%). Transient cranial nerve deficits occurred in 25% of total and in 32% of non-total removal cases, with similar rates of minor complications. Total removal provided better long-term symptom control and lower recurrence rates without significantly increasing neurological deficits, supporting it as the preferred surgical strategy while maintaining functional preservation.

Background: As visceral leishmaniasis (VL) has recently expanded in previously non-endemic areas of Nepal, the health system is facing new challenges. Female community health volunteers(FCHVs) are playing an important role for VL elimination in Nepal. This study aimed to analyze the actual and potential role of FCHVs for VL elimination program as well as community awareness of the disease (VL) and protective measures. Methods: We used a concurrent embedded mixed methods design. Qualitative data were collected through in-depth interviews and focus group discussions with FCHVs of 22 VLendemic villages of 3 districts. Concurrently quantitative data were collected through formal interviews of 203 household heads of the same villages. Results: FCHVs are able to perform their duties in an efficient way with the support of their families and specific incentives. FCHVs in the VL-endemic region have a good ability to recognize the VL suspects and refer to health facilities. The feedback by the district health office on referred patients was weak thus missing the opportunity of involving FCHVs in the 6-months follow up. In houses with a previous VL case knowledge levels of prevention and treatment ofVL were significantly better than in houses without a previous VL case. More people in houses with a former VL patient were aware on VL transmission. Conclusion: FCHVs are playing an important role for VL elimination in Nepal through detection of suspected cases and referral and may play a role in vector surveillance.

Pediatric traumatic brain injury (TBI) is a significant problem of public health importance worldwide. Large population-based studies on the effect of birth order on health phenomena are exceedingly rare. This study examines the relationship between birth order and risk for pediatric TBI among sibling groups. We performed a retrospective cohort study following 59,469 Finnish newborns from 1987 until age 18 years. Data on first diagnosis of TBI was recorded within the 1987 Finnish Birth Cohort (FBC). Compared with first born siblings, later born siblings had an increased risk of TBI during the follow-up period (hazard ratio [HR] 1.02; 95% confidence interval [CI] 0.91–1.14 for second born, HR 1.09; 95% CI 0.95 1.26 for third born, HR 1.28; 95% CI 1.08–1.53 for fourth or higher). When adjusted for sex and maternal age at child’s birth, HRs (95% CIs) for TBI during the follow-up period were 1.12 (0.99–1.26) for second born, 1.31 (1.12–1.53) for third born and 1.61 (1.33–1.95) for fourth born or higher children, respectively. Within this large register-based population-wide study, order of birth modified risk for pediatric TBI among sibling groups. Taken together, these study findings may serve to stimulate further inquiry into genetic, psychological, or psychosocial factors which underlie differences in risk and depth of effect within and between sibling groups.

Neurosurgery residents in Germany face numerous challenges including receiving comprehensive surgical training with adequate learning opportunities, achieving balanced work life equilibrium, maintaining a positive work environment and navigating career prospects. The objectives of this study are to assess overall satisfaction with the training program, identify factors contributing to dissatisfaction, explore various dimensions of the training program, evaluate the psychological well-being of residents, and ascertain their preferences for future subspecialties. A questionnaire-based survey was conducted anonymously among neurosurgery residents from various training hospitals, nationwide. The survey utilized a quantitative questionnaire as data collection tool. The data collection took place from June 2021 to January 2023. The survey encompassed 120 neurosurgery residents, with a gender distribution of 55 % male and 45 % female. The respondents were primarily from university hospitals (53 %), followed by community hospitals (38 %) and private hospitals (9 %). In terms of training program satisfaction, 37 % reported moderate satisfaction, 39 % indicated below-moderate satisfaction, and 28 % experienced above-moderate satisfaction. The predominant causes of dissatisfaction identified were insufficient surgical exposure (reported by 39 % of respondents), suboptimal educational content (38 %), and inadequate research opportunities (32 %). Additionally, 24 % of respondents highlighted psychological stress, and 36 % reported frequent experiences of burnout. A majority (63 %) indicated a workload of 60-80 h weekly. About half of the residents indicated a future specialization interest in neurosurgical oncology. The results of the survey findings provide valuable insights into the challenges and aspirations of neurosurgery trainees in Germany. These results serve as a basis for improving the training system, enhancing the working environment, and guiding future planning in this field. To optimize the training of residents, it is important to address issues such as limited surgical and research opportunities and psychological well-being. The expressed interest in subspecializing offers guidance for shaping the training program's future direction.