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Good afternoon. Uh Good evening. Good morning from wherever you are joining from, welcome to the Zoom Academic Meeting of the Department of Pediatric Surgery in East London. Uh Today's uh meeting is also a global initiative for children's surgery, pediatric neurosurgery webinar. And we are really happy uh that uh doctor of Professor Elam, ok, has agreed to uh give us her perspective about the management of hydrocephalus comparison of perspectives around the globe. So, uh Professor O is uh the Director of Global Child Health at her Institute, which is the Institute of Arkansas for Medical Sciences. She is a pediatric neurosurgeon by profession. She's a professor of pediatric neurosurgery at the Arkansas Children's Hospital in Little Rock, Arkansas USA. She did her graduation from Marmara University School of Medicine in Istanbul, Turkey. She did a neurosurgery residency at Yale University School of Medicine and completed in 2010 and she completed a pediatric neurosurgery fellowship at the British Columbia Children's Hospital in Vancouver Canada in 2011. Sh her main interests are surgical management of spina bifida hydrocephalus on which she's going to talk to us today, craniosynostosis. And she's involved in various clinical and research projects quality improvements initiatives and advocacy in pediatric neurosurgery. She is an active member of the International Society of Pediatric Neurosurgery American Association of Neurological Surgeons Congress of Neurological Surgeons and representative of the about two associations at the Pedia uh uh American College of Surgeons and American Academy of Pediatrics. She's also an active senior member of Global initiative for children's surgery, pediatric neurosurgery group. She has volunteered as a pediatric neurosurgeon in conflicting zones, low income and crisis settings. She is passionate advocate for global child health equity in child health care and health care education and above all, what I have realized in the last couple of months of our interactions. She's very simple. She's very humble and she has no airs about being such qualified and skilled pediatric neurosurgeon. So im welcome. I will stop share. You can share and you can sh uh share your slides and share your experience. Thank you. Thank you so much for this introduction. Um It is, you're very kind, you have very kind words. Um I know that there is a lot more experience in senior members in the audience. I'm humbled by them and um I, I'm thankful to my mentors and to you guys and to my students who helped me out along the way. It is a great privilege to be here. Thank you so much for the invitation. Um And I see my mentor Nel Doctor Nelson Zanon is also here. So it's very exciting for me as well to be here. Let me start sharing. Here we go. Do you see it yet? Are we all good? Yeah, you can just go in. Yeah. Perfect sl and you can go in the slide uh show more. Thank you. OK, perfect. So doctor uh Professor Chit asked me to talk about hydrocephalus specifically, but we wanted to talk about Hydrocephalus in comparison of perspectives and practices around the globe. Well, I do not uh you know, claim to be an expert and I know that there are a lot of you who take care of these patients more than me, maybe or more experienced than me. But I would like to give you my humble opinions and some of this is my own personal opinion. Certainly, you know, I backed it with science and articles and like pop published uh published data, but uh please feel free to interact during the talk. And then uh I'm I'm very curious to hear your opinions and solutions at the very end in addition to questions as well. Um but we are gonna mainly talk about hydrocephalus around the globe. And I would like to talk about um some of the um solutions, some of the etiology, some of the epidemiology as well. I have no disclosures to make. But as doctor Chit was saying, I am a humble servant for Children. I work for the wellbeing of Children and locally and globally. At least I try like all of us. But I also want to start by start by saying that I really, I'm not coming from a very, very rich um resourceful background myself. I am Turkish originally and you know, raised up in, with humble means in a, in a country where it was developing at the time. And so I would like to call it developing or almost developed. But, you know, I work in United States though, I work in United States. I wanna give you a few uh facts about where I work. I work in Arkansas in uh Little Rock is the capital city of Arkansas. It's uh you know, south mid uh state in the United States. And it's not actually a very resourceful place. 41% of Arkansas live in rural counties. So we're actually a rural state. The infant mortality rate in Arkansas is about 7.6 infants dead for 1000 live births, which is above the national average in United States. And we still have 23% of our babies going to uh bed hungry every night and facing foot hardship. So our health care setting is not as resourceful, is not as rich though certainly. When compared to some other places around the globe, we we we're thankful for the resources that we have in Arkansas. Significant percentage of the Children rely on government subsidized government Medicaid and ours programs who pay for their wellbeing, health care, education and food. And I work with multiple organizations as Doctor Chits has uh has uh mentioned in the, in the very beginning, I try to work and service the wellbeing of the Children. Our objective for this talk was to discuss what we know about hydrocephalus globally. By reviewing of course epidemiology, you have to know the epidemiology and then etiology to be able to treat uh the diseases and get better outcomes. So we're gonna, you know, talk hopefully briefly and I would not wanna, you know, lengthen the talk by talking too much, which I tend to do sometimes. But we're gonna discuss about epidemiology, etiology, diagnosis, treatment outcomes and the cost. We would like to compare the challenges faced by high-income countries and low and middle income countries in managing hydrocephalus. These are some of the photos, these are pictures of my patients. But you, I'm sure know this picture of the baby, which is like all over the internet. You can just check GPT then Google it. That's a very classic picture that has been on the website for a baby with hydrocephalus with sunsetting eyes. That is extreme hydrocephalus. Unfortunately. So what is hydrocephalus? And basically hydro is water. Cephalus is head in Greek. Of course, like most of our terms comes from Greek and Latin. The term was used as early as by hypocrite, hypocrite and he was describing as the hydrocephalus as nuclear fraction of the brain, then gallon of Pergamon used it and then described it as four kinds of hydrocephalus, meaning external outside of the brain accumulation in the brain fluid collections surround the bra brain. So we knew about hydrocephalus. So since the ancient times, certainly avicenna knew about it and it says and described CSF as a fluid having a similar quality as a clear water. And Abu Qassem al Zahra, we also, you know, looked into the reasons and theology of the hydrocephalus, but mainly it was basal who brought it to the scientific community by saying, help me God while he was treating a baby with a with hydrocephalus, it was a problem then and it's still a problem. Now, the overall incidence of pediatric hydrocephalus is unknown. It's because of lack of state sponsored registries, logs and record. It is difficult to, to, to find the incidence and prevalence. But we have some estimates.