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Yes and good evening everyone. So, our pleasure today to present another session of our journal Club meeting the successful cooperation between our or and Egyptian Oretic Association. Today, two of our colleagues will present two, a nice paper. The first one will be presented uh by uh our colleague Mohamed Hiwa. It will be uh about prospective study of the rule of bladder scanning and residual volume measurement in improving diagnostic accuracy of cord equina syndrome. And second paper will be uh early versus delayed surgical decompression of acute traumatic spinal cord injury by our colleague, Minas Mohammed. Can you present your screen please? Mhm. It's clear for everyone. Sorry, it's clear it fully screen now. Yeah. Yeah. Yeah. Uh First of all, thanks for having me today. My name is Mohammed Abdullahi. I'm working in South Side and Sunderland Foundation Trust and thanks for present for the chance to present in the donut club. Uh Today's topic paper is about critical appraisal of the study on the bladder scanning on equina syndrome. The study overview, the title of the study is a, it's a prospective study of the rule of the bladder scanning and the post void residual volume measurement in improving diagnostic accuracy of the coquina syndrome. It was done by group of uh spine surgeons in Medical Center campus in Nottingham University Hospital. It's a tertiary spine uh hospital. It was presented in the journal club in the bone and joint journal uh 2020. The study is a prospective cohort study and the objective of the study was to assess the post void, void residual volume measurement versus the traditional red flags in the Coquina Syndrome diagnosis. The back background and rationale as old, we know that the coqui syndrome is a neurological emergency requiring early detection. Uh The traditional reflex symptoms have low specificity, the reflex, the known re reflex, like absent or weak, voluntary and sphincter contraction. The reduce in the anal tune the function of the bladder to initiate urination. Uh the bladder dysfunction is ok. But uh subjective uh presentation. The hypothesis hypothesis of the study is the post void residual volume is if 200 or more me is a better predictor of the cord syndrome than the the symptoms alone. Uh The method of the study, it was a single tertiary spinal center in UK. As I mentioned in Nottingham Uni University. It's NHS Trust. It is serving about four more than 4 million population and it receives uh referral from four district hospitals. Uh The sample size was 260 patients over 16 month. Uh The inclusion criteria was suspected could in a referral for MRI. And the exclusion criteria was the patient with trauma called compression lesions like malignancies or infections. Uh The measurement was uh boot void residual volume via ultrasound. And the clinical signs and the outcome of MRI. The analysis, sensitivity and speci specificity of and the predictive values of each. The key finding of the study that if the post void, post void residual volume of the urine is more than 200 mi. It strongly predict Qui syndrome on the MRI. The sensitivity was 94.1% and the specificity was 66.8%. Uh The boo predictive value was 29.9 and the negative predictive value was 89.7. While in the bilateral sciatica sensitivity was 32 only with low predictive value. 17. The cost saving by reducing unnecessary MRI S was of the one of the key finding of the study. The strength of the study is that it it it has the largest prospective study. It is, it is the largest prospective study on the corner syndrome diagnosis using the post void residual volume. It has a well defined inclusion and exclusion criteria. The prospective design, minimize the recall bias and there is a large la large sample si sample size 260 patient. The objective was clear to have a bladder scan measurement, the cost saving implications for the quino syndrome management. But still, there is some limitations and the criticism for the study. It was uh only in a single center study. It to limit the generalizability of the study and there is no blinding of the MRI assessors. There is potential bias because uh MRI assessor knows the uh outcome of the post void resi residual volume. It has a low boosted pre uh boosted predicted value 29.9. It has a false negative. Uh K cases was uh code false negatives. Uh It means that K cases was most void, uh residual volume less than 200 M. There is no long term follow up for the false negatives. And the, the comparison of the diagnostic methods found that as you see in the table that the sensitivity of the post void, which is the third uh down and the colon is, it shows that the sensitivity is 94.1% in comparison with the bilateral which is 32 and the C anesthesia is 73 and the specificity is still high for the post void residual volume. The clinical implication of uh the study should we do the post void residual volume? Should it replace the MRI? No, we still have to do the MRI but it increases the suspicion of uh coquina. Can the BVR help the tr? Yes, but should be cautious because some cases there is false negative. The post void volume was 200 milli or more increase the suspicion of uh quina. So we should do the urgent MRI within four hours. So if the postvoid residual volume, less than 200 milli, it decrease or lower the risk. But it doesn't rule out the Coqui syndrome. We require further validation before widespreading adoption of the study. This cost effectiveness considerations, the defer of MRI saved over 200,000 lb uh reducing the unnecessary urgent MRI optimizes the NHS resource allocation, the potential to lower vegetation risks by improving the diagnostic accuracy. Uh the conclusion and the final verdict of the study that it's useful to adjunct but the postvoid residual volume, more than 200 mill but not a standalone test. The MRI remains the gold standard uh investigation for the coquina. We need future research like doing a multicenter trials. Long term follow up for the cases uh supposed to void the residual volume may help risk stratification but must be used cautiously as all we know that most of the centers now use uh get to try it first time. Uh There is a pathway for suspected cold equina syndrome and most of the trust nowadays, it is approved by the National uh the Bridge Association of Spine Surgery. The British Association is called equina and uh image uh radiology uh society. It's an interactive pathway to help the diagnosis and treat the Cor Cor syndrome without it delay. And this was done this, this system is approved since October uh 2023. And our presentation, our presented paper today is 2020 which means that there is implication life in the, in the. Uh and it's a, the study. Today's study is one of the steps in the pathway of suspecting Qui syndrome. Uh Finally, discussion points uh for everyone you should ask yourself, uh would you use the post to assess the co syndrome risk in the practice? How should we address the false negatives? Should EDS adopt this as a triage tool? What further research is needed?