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1.
Trials ; 23(1): 242, 2022 Mar 29.
Article in English | MEDLINE | ID: covidwho-2079532

ABSTRACT

BACKGROUND: The rapidly increasing number of elderly (≥ 65 years old) with TBI is accompanied by substantial medical and economic consequences. An ASDH is the most common injury in elderly with TBI and the surgical versus conservative treatment of this patient group remains an important clinical dilemma. Current BTF guidelines are not based on high-quality evidence and compliance is low, allowing for large international treatment variation. The RESET-ASDH trial is an international multicenter RCT on the (cost-)effectiveness of early neurosurgical hematoma evacuation versus initial conservative treatment in elderly with a t-ASDH METHODS: In total, 300 patients will be recruited from 17 Belgian and Dutch trauma centers. Patients ≥ 65 years with at first presentation a GCS ≥ 9 and a t-ASDH > 10 mm or a t-ASDH < 10 mm and a midline shift > 5 mm, or a GCS < 9 with a traumatic ASDH < 10 mm and a midline shift < 5 mm without extracranial explanation for the comatose state, for whom clinical equipoise exists will be randomized to early surgical hematoma evacuation or initial conservative management with the possibility of delayed secondary surgery. When possible, patients or their legal representatives will be asked for consent before inclusion. When obtaining patient or proxy consent is impossible within the therapeutic time window, patients are enrolled using the deferred consent procedure. Medical-ethical approval was obtained in the Netherlands and Belgium. The choice of neurosurgical techniques will be left to the discretion of the neurosurgeon. Patients will be analyzed according to an intention-to-treat design. The primary endpoint will be functional outcome on the GOS-E after 1 year. Patient recruitment starts in 2022 with the exact timing depending on the current COVID-19 crisis and is expected to end in 2024. DISCUSSION: The study results will be implemented after publication and presented on international conferences. Depending on the trial results, the current Brain Trauma Foundation guidelines will either be substantiated by high-quality evidence or will have to be altered. TRIAL REGISTRATION: Nederlands Trial Register (NTR), Trial NL9012 . CLINICALTRIALS: gov, Trial NCT04648436 .


Subject(s)
Brain Injuries, Traumatic , COVID-19 , Hematoma, Subdural, Acute , Aged , Hematoma, Subdural, Acute/diagnosis , Hematoma, Subdural, Acute/surgery , Humans , Multicenter Studies as Topic , Neurosurgical Procedures , Randomized Controlled Trials as Topic , Trauma Centers
2.
World Neurosurg ; 2022 Sep 14.
Article in English | MEDLINE | ID: covidwho-2076840

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has sparked interest in telemedicine, resulting in an increase in neurosurgical publications focused on it. We summarize this new literature to evaluate telemedicine applications to neurosurgery. METHODS: A systematic literature review was performed in accordance with the PRISMA guidelines by searching PubMed, Embase, and Scopus for journal articles published after January 1, 2020. All journal articles that included data after the start of COVID-19 and evaluated any aspect of telemedicine relevant to outpatient neurosurgical visits were included. The premise and key findings of each included study were extracted, as well as patient and provider satisfaction with and preference for telemedicine. RESULTS: Thirty-seven articles met the inclusion criteria. Four studies proposed and evaluated a remote neurologic examination. Two studies reported similar postvisit outcomes between remote and in-person visits. Twenty-four studies reported a combination of patient and provider opinions toward telemedicine. Of 9834 patients and 116 providers, 82.4% and 65.2% were satisfied overall with telemedicine, respectively. Of 3526 patients and 168 providers, 57.0% and 66.5% preferred telemedicine to in-person visits, respectively. CONCLUSIONS: Overall, most patients and providers have a high opinion of telemedicine for outpatient visits, and increasing evidence suggests that remote visits yield favorable clinical outcomes. The high rates of patient and provider satisfaction and preference may be considered for further adoption of remote neurosurgical visits beyond the COVID-19 era.

3.
Brain Spine ; 2: 100925, 2022.
Article in English | MEDLINE | ID: covidwho-2075948

ABSTRACT

•Pandemic conditions imposed withholding or withdrawing neurosurgical treatment.•Variation exist in the management of intracranial haemorrhage or TBI during a pandemic.•Triaging guidelines for neurosurgical patients need to be established.

4.
BMJ Open ; 12(9): e062030, 2022 09 21.
Article in English | MEDLINE | ID: covidwho-2064154

ABSTRACT

INTRODUCTION: Concussion is a complex pathophysiological process with a wide range of non-specific signs and symptoms. There are currently no objective diagnostic tests to identify concussion, and diagnosis relies solely on history and examination. Recent research has identified a unique panel of microRNAs (miRNAs) that distinguish between concussed and non-concussed rugby players. This study aims to assess the diagnostic utility of salivary miRNAs in concussion for a sample of UK National Health Service patients and whether well-established sports-related concussion (SRC) assessment tools may be translated into the emergency department (ED). METHODS AND ANALYSIS: Concussion in Non-athletes: Assessment of Cognition and Symptomatology is a single-centre, prospective, two-phase cohort study. The concussed cohort will consist of participants with maxillofacial trauma and concurrent concussion. The control cohort will consist of participants with isolated limb trauma and no evidence of concussion. Participants will be recruited in the ED and saliva samples will be taken to identify the presence of miRNAs. The SRC assessments being investigated include the Sports Concussion Assessment Test, Fifth Edition (SCAT5), the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the ImPACT Quick. Follow-up will be at 24-48 hours in-hospital and remotely via telephone and email at 14 days and 6 months. ETHICS AND DISSEMINATION: Ethical approval was granted in February 2021 by the West Midlands Coventry & Warwickshire Research Ethics Committee (ref 20/WM/0299). The investigators intend to submit their study findings for publication in peer-reviewed journals and to disseminate study findings via presentation at academic meetings. The results will also form part of a doctorate thesis, registered at the University of Birmingham.


Subject(s)
Athletic Injuries , Brain Concussion , MicroRNAs , Athletic Injuries/diagnosis , Athletic Injuries/psychology , Brain Concussion/diagnosis , Brain Concussion/psychology , Cognition , Cohort Studies , Humans , Neuropsychological Tests , Prospective Studies , State Medicine
5.
Pharmaceutical Journal ; 306(7949), 2022.
Article in English | EMBASE | ID: covidwho-2064945
6.
Journal of Neurosurgical Anesthesiology ; 34(4):490, 2022.
Article in English | EMBASE | ID: covidwho-2063005

ABSTRACT

Background: The Catalan Health Care National Department (CatSalut) launches distinct safety phone questionnaires (PLAENSA program) every three years to some random selected patients from all public hospitals in order to benchmark PREMs. Written surveys tend to be the most cost effective and reliable approach. Our aim was to know more precisely the measured experience of our surgical attended patients, using and/or adapting some questions obtained from one specific PLAENSA Survey (patients undergoing hospital admission for any pathology). Selected questions focused with emotional aspects (appropriate care, pain control, and privacy), information (before and after surgery) and overall satisfaction. Method(s): Through an encrypted on-line platform (LimeSurvey) we created the surveys, sent the e-mails and analyzed the results. Starting on 2019, we continued with the project during 2020 and 2021, the COVID- 19 pandemic years. We started sending the surveys to patients operated on the first semester of 2019 and 2021. On 2020, with the COVID-19 pandemic, the scheduled surgery diminished until summer, so we launch the surveys at the end of October. We compared Neurosurgical patients' responses with overall results. Result(s): Answers to the survey are described in Table 1. Main results of some selected questions may be seen in Fig. 1. Conclusion(s): Patients demand receiving more comprehensive and understandable information and more involvement in several steps of their perioperative journey. We need well-informed patients at the center of the care process. In our opinion, on-line surveys are a good tool to connect with patients and give them a space to explain their opinions, feelings and experiences. In our randomly included populations, patient experiences did not vary during the pre-pandemic year compared to the two years of the pandemic. However, the percentage of responses in 2021 was lower than the previous ones. (Figure Presented).

7.
Chest ; 162(4):A1485-A1486, 2022.
Article in English | EMBASE | ID: covidwho-2060829

ABSTRACT

SESSION TITLE: Actionable Improvements in Safety and Quality SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The overall mortality rate for patients ‘transfered’ to the medical intensive care units is thought to be significantly higher than the mortality rate amongst those admitted directly. (1) It has also been suggested that uninsured critically ill patients have a higher probability of being ‘transferred’ to other hospitals as well as a higher mortality rate. (2, 3) We aim to determine whether insurance coverage impacts the transfer of critically ill patients. METHODS: This study was conducted at a quaternary care hospital which is also a regional transfer center. We accessed the public data for the year 2020 through our institutions Transfer Center Dashboard, System Analytics. The two aspects of transferred patients we focused upon were: 1) Hospital service (subspecialty care required) and 2) Financial class. Major subspecialties included in the study were: Pulmonology, Internal Medicine, Neurosurgery, Cardiology, and Neurology. Our study was a patient safety project, hence it qualified for IRB exemption. We classified the percentage of transfers as ‘Accepted’, ‘Declined’, or ‘Canceled’;and determined the insurance status of the patient. RESULTS: We found a total of 3552 patients transfers were initiated. 31.9% (1136) transfer patients were accepted, 46.79% (1662) transfers were declined, and 21.23% (754) were canceled due to reasons including unsafe transfer, acceptance at other institutions, or death prior to transfer. Major categories for transfers were Pulmonology (16.1%), other Internal Medicine related diseases (15.3%), and Neurosurgery (11.8%) were the subspecialties with the highest rate of transfers. In terms of financial class, we determined that 44.81% (n=509) of the ICU transfers had no insurance, 27.81% (n=316) had Medicare support, and 17.81% (n=202) had managed care through a health maintenance organization (HMO);the remaining 9.59% had other insurance plans. We used a binomial test to determine the probability of a transfer under no insurance (p) with the formula p + q=1, across the total number of transfer requests (n). K was the number of actual transfers that occurred. Total transfer requests were n=3552, actual transfers were k=1136 and transfers without insurance were 509/44.8%, converted into p=0.45 with a resulting q of 0.55.For z-test, we used the formula z = ((K - np) +- 0.5) / √npq = 15.58. Our one-tailed probability of exactly, or fewer than, 1136(K) out of 3552(n) was p <.000001. Our study was limited because of the COVID-19 pandemic occurring in the same year. CONCLUSIONS: Based on our results, we conclude that the ‘uninsured’ patients are more susceptible to getting transferred to other institutions. CLINICAL IMPLICATIONS: Critically ill ‘uninsured’ patients are selctively subjected to be transfered to other hospitals for higher level of care. These transfers may have significant health implications thereby resulting in higher morbidity and mortality in unisured populations. DISCLOSURES: No relevant relationships by Joodi Akhtar No relevant relationships by Sahar Fatima Advisory Committee Member relationship with Astra Zeneca Please note: 24 months Added 03/16/2022 by FAISAL MASUD, value=Honoraria Advisory Committee Member relationship with Teleflex Please note: 12 months Added 03/16/2022 by FAISAL MASUD, value=Consulting fee Advisory Committee Member relationship with La Jolla Please note: 12 months Added 03/16/2022 by FAISAL MASUD, value=Consulting fee No relevant relationships by Iqbal Ratnani No relevant relationships by Salim Surani No relevant relationships by Anza Zahid

8.
World Neurosurg ; 166: e915-e923, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2050069

ABSTRACT

OBJECTIVE: Interfacility transfers represent a large proportion of neurosurgical admissions to tertiary care centers each year. In this study, the authors examined the impact of the COVID-19 pandemic on the number of transfers, timing of transfers, demographic profile of transfer patients, and clinical outcomes including rates of surgical intervention. METHODS: A retrospective review of neurosurgical transfer patients at a single tertiary center was performed. Patients transferred from April to November 2020 (the "COVID Era") were compared with an institutional database of transfer patients collected before the COVID-19 pandemic (the "Pre-COVID Era"). During the COVID Era, both emergent and nonemergent neurosurgical services had resumed. A comparison of demographic and clinical factors between the 2 cohorts was performed. RESULTS: A total of 674 patients were included in the study (331 Pre-COVID and 343 COVID-Era patients). Overall, there was no change in the average monthly number of transfers (P = 0.66) or in the catchment area of referral hospitals. However, COVID-Era patients were more likely to be uninsured (1% vs. 4%), had longer transfer times (COVID vs. Pre-COVID Era: 18 vs. 9 hours; P < 0.001), required higher rates of surgical intervention (63% vs. 50%, P = 0.001), had higher rates of spine pathology (17% vs. 10%), and less frequently were admitted to the intensive care unit (34% vs. 52%, P < 0.001). Overall, COVID-Era patients did not experience delays to surgical intervention (3.1 days vs. 3.6 days, P = 0.2). When analyzing the subgroup of COVID-Era patients, COVID infection status did not impact the time of transfer or rates of operation, although COVID-infected patients experienced a longer time to surgery after admission (14 vs. 2.9 days, P < 0.001). CONCLUSION: The COVID-19 pandemic did not reduce the number of monthly transfers, operation rates, or catchment area for transfer patients. Transfer rates of uninsured patients increased during the COVID Era, potentially reflecting changes in access to community neurosurgery care. Shorter time to surgery seen in COVID-Era patients possibly reflects institutional policies that improved operating room efficiency to compensate for surgical backlogs. COVID status affeted time to surgery, reflecting the preoperative care that these patients require before intervention.


Subject(s)
COVID-19 , Neurosurgery , COVID-19/epidemiology , Humans , Pandemics , Patient Transfer , Retrospective Studies , Tertiary Care Centers
9.
Surg Neurol Int ; 13: 394, 2022.
Article in English | MEDLINE | ID: covidwho-2040624

ABSTRACT

Background: Spontaneous spinal subdural hematoma (SSDH) is a rare condition and causes of acute spinal cord compression, with symptoms varying from mild to severe neurological deficit. SSDH could occur as a consequence of posttraumatic, iatrogenic, or spontaneous causes, including underlying arteriovenous malformations, tumors, or coagulation disorder. Due to its rarity, it is difficult to establish standardized treatment. We present a rare case of SSDH in COVID-19 patient and course of treatment in COVID hospital. Case Description: A 71-year-old female patient was admitted due to instability, weakness of the left leg, and intensive pain in the upper part of thoracic spine as well as mild respiratory symptoms of COVID-19. She was not on pronounced anticoagulant therapy and her coagulogram at admission was within normal range. MRI revealed acute subdural hematoma at the level C VII to Th III compressing the spinal cord. The patient underwent a decompressive Th I and Th II laminectomy and hematoma evacuation. Post-operative MRI revealed a satisfactory decompression and re-expansion of the spinal cord. COVID-19 symptoms remained mild. Conclusion: SSDH represents a neurological emergency, possibly leading to significant deficit and requires urgent recognition and treatment. One of the main difficulties when diagnosing is to consider such condition when there is no history of anticoagulant treatment or previous trauma. Since high incidence of coagulation abnormalities and thromboembolic events was described COVID-19 patients, when considering the pathology of the central nervous system, the bleeding within it due to COVID-19 should be taken into account, in both brain and spine.

10.
International Journal of Travel Medicine and Global Health ; 10(2):83-87, 2022.
Article in English | CAB Abstracts | ID: covidwho-2040689

ABSTRACT

Introduction: The COVID-19 pandemic has widely affected medical tourism on a global scale, thereby reducing the number and volume of medical services. Given the importance of this topic, the present study aimed to determine the challenges of medical tourism after the prevalence of COVID-19 in the field of neurosurgery.

11.
BMJ Case Rep ; 15(9)2022 Sep 16.
Article in English | MEDLINE | ID: covidwho-2038273

ABSTRACT

A man in his mid-40s presented to hospital with confusion, headache and feeling generally unwell. He had had a total resection of a grade IV astrocytic glioma 1 year prior. Initial observations, blood tests and CT head scan were unremarkable for acute features to explain the patient's presentation. However, an MRI head scan on this admission demonstrated a clear communicating hydrocephalus with new abnormal leptomeningeal enhancement, consistent with leptomeningeal metastatic infiltration by glioma. Lumbar puncture cytology and biochemistry supported this interpretation. As a small district general hospital in rural Wales, we discuss the experience of diagnosis and coordination of specialist input from a multidisciplinary team. We share the challenges of managing leptomeningeal disease in the COVID-19 pandemic, in the context of the additional risks this presents with chemotherapy-induced immunosuppression.


Subject(s)
Antineoplastic Agents , Astrocytoma , COVID-19 , Meningeal Neoplasms , Astrocytoma/complications , Astrocytoma/diagnostic imaging , Astrocytoma/therapy , COVID-19 Testing , Humans , Male , Meningeal Neoplasms/complications , Meningeal Neoplasms/diagnostic imaging , Meningeal Neoplasms/therapy , Pandemics
12.
HemaSphere ; 6:2850-2851, 2022.
Article in English | EMBASE | ID: covidwho-2032128

ABSTRACT

Background: There is universal concern about the inappropriate use of fresh frozen plasma (FFP). Earlier investigations have indicated that FFP may be associated with high rates of inappropriate transfusion, with some studies indicating rates of up to 50% non-compliance with established guidelines. The current British Committee for Standards in Haematology (BCSH) guidelines on the use of FFP aim to reinforce the message regarding avoidance of its inappropriate use. Aims: Audit the use of appropiate FFP in the context of the COVID pandemia. Methods: Retrospective analysis of requests for plasma transfusion in adults, in our institution, between January/2020 and January/2022, This audit was undertaken to determine current use of FFP and to see if any improvements in the use of this component in relation to recommended guidance. May be we use more FFP due to covid situation. The data was obtained by consulting the Integrated System of Blood Banks. Results: During the study period, 98 units of FFP were used for 'acute' episodes including management of acute COVID complications. Only 67% of these transfusion episodes were deemed appropriate, based on the BSH criteria. This also means that 13 units of FFP may have been wasted. FFP is used by both medical and surgical specialties with general surgery, general medicine and neurosurgery being the main users. During the study period, 98 units of FFP were used for 'acute' episodes including management of acute COVID complications. Only 67% of these transfusion episodes were deemed appropriate, based on the BSH criteria. This also means that 13 units of FFP may have been wasted. FFP is used by both medical and surgical specialties with general surgery, general medicine and neurosurgery being the main users. 159 requests for plasma were registered in the analyzed period. In most cases (98), the reason was hemorrhage due to multiple factor deficiencies, including liver disease, trauma, lung disease or a massive transfusion. Prophylactic/therapeutic replacement of congenital factor XI deficiency, associated with bleeding episodes, was indicated in 2 situations. In 1 case, the indication was treatment of HUS and 2 cases of HELLP syndrome. In 7 cases, there was an overlapping of indications. In 7 cases, plasma was administered in unforeseen situations, such as for the correction of laboratory abnormalities without clinical manifestations (4 cases) or for prophylaxis of invasive techniques without abnormal coagulation tests (2 cases). Summary/Conclusion: The proportion of inappropriate requests is similar between surgical and non-surgical specialties and also when broken down into individual departments, the number of inappropriate requests consistently outnumbers appropriate requests across all departments. FFP continues to be frequently used in the absence of bleeding and / or evidence of abnormal coagulation, thus highlights the need for concerted efforts in the education of clinicians who prescribe FFP. In the analysis of the indications for plasma prescription, it is concluded that in 17 % cases the indication was not complete adequately or justifable. 7% of cases given FFP had no record of post-transfusion coagulation data. Following this work, dissemination coupled with education was undertaken. The use of FFP for Warfarin reversal has correctly indicated (> 95%). it may suggest that an education programmes directed at specific aspects of practice do influence clinical behaviour over needs to be addressed.

13.
Annals of Clinical and Experimental Neurology ; 16(2):5-14, 2022.
Article in Russian | Scopus | ID: covidwho-2026891

ABSTRACT

Introduction. Treatment with MRI-guided focused ultrasound (MRgFUS) is a new, non-invasive surgical technique for treating extrapyramidal movement disorders. This article presents the first use of MRgFUS in Russia for treating patients with essential tremor (ET). Materials and methods. Patients (n = 26;17 men and 9 women) aged 21-82 years (median age 46.0 years) and with severe and refractory ET, underwent MRg- FUS thalamotomy (ExAblate 4000, Insightec). One side was treated in 22 patients (left thalamus in 18 and right thalamus in 6), both sides were treated concurrently in two patients, and both sides were treated consecutively in two patients. Tremor was assessed using the Clinical Rating Scale for Tremor (CRST). Because international clinical specialists could not visit Russia due to the COVID-19 pandemic, MRgFUS was performed via telehealth on May 5, 2020, in a world first. Results. A satisfactory result was achieved in 25 (96%) out of 26 patients. CRST scores improved by 64.7% on the side of the operation, by 10.2% on the control side, and by 37.5% overall. Intraoperative side effects included headache during sonication (42.3%), vertigo (15.4%), nausea (11.5%), vomiting (7.7%), numbness (3.8%), ataxia (3.8%), and pathological response to cold exposure (3.8%). The symptoms resolved immediately after surgery. Unstable gait was noted in five patients, which completely resolved two weeks after surgery. Median postoperative follow-up duration was 109 days [53;231], with a maximum of 625 days. No relapses (if the hyperkinesia had completely disappeared) or increased tremor (if reduced after surgery) were observed. Conclusion. The efficacy of MRgFUS for ET was 96%, with no long-term complications. Both bilateral concurrent and bilateral consecutive MRgFUS thalamotomy is possible, but its efficacy and safety should be assessed in a randomized study. In a world first, MRgFUS was successfully implemented using telehealth. © 2022, Annals of Clinical and Experimental Neurology.

14.
British Journal of Neuroscience Nursing ; 18(4):165-168, 2022.
Article in English | CINAHL | ID: covidwho-2025621

ABSTRACT

Aims: To assess the quality of documentation of patients with a visual impairment within a neurosurgery department to see if they have a corresponding vision alert within their medical notes. Methods: Retrospective case note analysis over 3 years of neurosurgical patients diagnosed with a space occupying lesion involving the anterior fossa near the optic apparatus was conducted. Post-surgical clinical assessment validated by formal visual assessment revealed 56 patients had a visual impairment diagnosis. Visual acuity and visual field mean deviations in the best eye were studied, along with the documentation of a vision alert. A total of nine patients did not meet the inclusion criteria and were removed from the study. Results: Out of 47 patients, four were found to have a severe sight impairment. Only 11 (23.40%) patients had a vision alert on their medical records. Out of the 47 patients with a visual impairment, three patients certified as sight impaired and severely sight impaired (75%) did not have a vision alert on their medical record. Conclusions: Although visual impairment was common in this study population, most patients had useful vision. Documentation to alert clinicians and carers about visual impairment was poor and needs improvement.

15.
J Neurosurg Pediatr ; : 1-7, 2022 Aug 26.
Article in English | MEDLINE | ID: covidwho-2022560

ABSTRACT

OBJECTIVE: COVID-19 has not only impacted healthcare systems directly via hospitalizations and resource utilization, but also indirectly via adaptations in healthcare practice, such as the evolution of the academic environment and the rise of telemedicine and virtual education. This void in clinical responsibilities has been filled with academic productivity in various fields. In this study the authors investigate the influence of COVID-19 on the academic focus within pediatric neurosurgery. METHODS: All data were obtained from the Journal of Neurosurgery: Pediatrics (JNS Peds). The number of submissions for each month from January 2017 to December 2021 was collected. Data including number of publications, publication level of evidence (LOE), and COVID-19-related articles were collected and verified. Each publication was categorized by manuscript and LOE according to adaptations from the Canadian Task Force on Periodic Health Examination. Publication groups were categorized as pre-COVID-19 (January 2017-February 2020), peri-COVID-19 (March 2020-July 2020), and post-COVID-19 (August 2020-December 2021). Statistical analysis was performed to compare pre-COVID-19, peri-COVID-19, and post-COVID-19 academic volume and quality. RESULTS: During the study time period, a total of 3116 submissions and 997 publications were identified for JNS Peds. Only 2 articles specifically related to COVID-19 and its impact on pediatric neurosurgery were identified, both published in 2021. When analyzing submission volume, a statistically significant increase was seen during the shutdown relative to pre-COVID-19 and post-shutdown time periods, and a significant decrease was seen post-shutdown relative to pre-COVID-19. LOE changed significantly as well. When comparing pre-COVID-19 versus post-COVID-19 articles, a statistically significant increase was identified only in level 4 publications. When analyzing pre-COVID-19 versus post-COVID-19 (2020) and post-COVID-19 (2021), a statistically significant decrease in level 3 and increases in levels 4 and 5 were identified during post-COVID-19 (2020), with a rebound increase in level 3 and a decrease in level 5 during post-COVID-19 (2021). CONCLUSIONS: There was a significant increase in manuscript submission during the initial pandemic period. However, there was no change during subsequent spikes in COVID-19-related hospitalizations. Coincident with the initial surge in academic productivity, despite steady publication volume, was an inverse decline in quality as assessed by LOE.

16.
Journal of Neurology, Neurosurgery and Psychiatry ; 93(9), 2022.
Article in English | ProQuest Central | ID: covidwho-2020212

ABSTRACT

A 50 year old Afro-Caribbean gentleman with a background of Ro52 and MDA5 antibody positive anti- synthetase syndrome on prednisolone and mycophenolate mofetil presented with a tight band like pain around his thorax and abdominal pain. Examination identified severe dysaesthesia with a T6 spinal level, as well as lower limb and truncal weakness. MRI showed an expansile T2 hyperintense lesion from C7 to T8 with patchy enhancement in keeping with a NMOSD. He had no optic nerve involvement, confirmed by OCT. The weakness and dysaesthesia responded rapidly to high dose methylprednisolone however he developed constipation, recurrent neuropathic pain and tonic spasms. Serum AQP4 antibodies were present. At presentation serum CK was also raised.Up to 25% of patients with NMOSD have co-existing autoimmunity. However, there are very few reports of anti-synthetase syndrome and NMOSD. Ro-antibodies are well documented in studies on Sjögren’s disease and transverse myelitis. Patients with autoimmune connective tissue diseases who develop neurological symptoms should be investigated for neurological autoantibodies too as they are at risk of multiple autoimmune disorders. Furthermore, neurologists should be observant to other systems when presented with a patient with NMOSD as they may have other diseases which are currently asymptomatic or minimally symptomatic.

17.
Archives of Disease in Childhood ; 107(Suppl 2):A210-A211, 2022.
Article in English | ProQuest Central | ID: covidwho-2019869

ABSTRACT

836 Figure 1 Origin by age[Figure omitted. See PDF] 836 Table 1Patient Culture and AbxConclusionSuppurative intracranial infections are rare but serious neurological diseases. This cohort demonstrated a decrease in the incidence of Paediatric Suppurative Brain Infection in 2020-2021 of 78% (p<0.003). This correlated with the first year of the SARS-CoV-2 pandemic.This audit supports a high clinical suspicion for brain abscess in children with a recent infection, particularly sinusitis. Ceftriaxone and Metronidazole are an adequate first line empiric treatment, with adjustment according to sensitivities.The emerging patterns in this audit are supported by similar, larger studies;this data presents valuable information for the management of paediatric intracranial infections and informs further studies.ReferencesPaediatric focal intracranial suppurative infection: a UK single-centre retrospective cohort study, Van der Velden et al.Clinical and Microbiologic Features Guiding Treatment Recommendations for Brain Abscesses in Children, Felsenstein et al.

18.
Archives of Disease in Childhood ; 107(Suppl 2):A118-A119, 2022.
Article in English | ProQuest Central | ID: covidwho-2019850

ABSTRACT

AimsTo present a case of a previously well child with rapidly progressing idiopathic intracranial hypertension (IIH) requiring a lumboperitoneal shunt after a Covid-19 infection.MethodsA fifteen-year-old girl presented to the Children’s Emergency Department on 23th October 2021 with a history of headaches (temporal, periorbital and occipital) and reduced visual acuity. These started following a Covid-19 infection on 30th September. She was reviewed by ophthalmology in view of deteriorating visual acuity (right eye>left eye). Bilateral papilloedema and haemorrhages were noted on examination. Her visual acuity was 6/24 unaided in the right eye and 6/7.5 unaided in the left eye. During the admission her visual acuity deteriorated to 6/36 pinhole in the right eye and 6/12 pinhole in the left eye. In the right eye she lost colour vision and developed a relative afferent pupillary defect. She received acetazolamide and intravenous methylprednisolone before being transferred to Birmingham Children’s Hospital neurosurgical ward for a lumboperitoneal shunt.There has been a significant improvement since surgery. On 22nd November there was resolving papilloedema and haemorrhages. She had normalised colour vision and resolution of the afferent pupillary reflex. Her visual acuity was 0.275 in the right eye and 0.100 in the left eye (LogMAR). However, persistent deficits could have significant consequences such as the ability to obtain a driving licence.ResultsAn MRI showed bilateral papilloedema of the optic discs. An MRV showed narrowing of the bilateral traverse sinuses with gradual tapering suggestive of high intracranial pressure. Raised intracranial pressures were confirmed by lumbar puncture on two separate occasions. The pressures were beyond the limit of the manometer used (34cm H2O).ConclusionShe had two well recognised risk factors;female gender and increased BMI so is within the high-risk group. However, she had no pathognomonic signs/symptoms of IIH or Ophthalmic complaints before COVID-19, meaning this was a rapidly progressing case that coincided with a Covid-19 infection.It is not possible to declare a cause and effect relationship in this case, but there is some emerging reports of Covid-19 positive patients with refractory headaches having isolated raised intracranial pressures within the adult population.1 2The Covid-19 pandemic has also precipitated indirect consequences. Weight gain as a result of lockdown was reported, which increased her risk of IIH.ReferencesSilva MTT, Lima MA, Torezani G, et al. Isolated intracranial hypertension associated with COVID-19. Cephalalgia. 2020;40(13):1452-1458. doi:10.1177/0333102420965963Ilhan B, Cokal BG, Mungan Y. Intracranial hypertension and visual loss following COVID-19: A case report. Indian J Ophthalmol. 2021;69(6):1625-1627. doi:10.4103/ijo.IJO_342_21

19.
World Neurosurg ; 2022 Aug 24.
Article in English | MEDLINE | ID: covidwho-2016195

ABSTRACT

BACKGROUND: Webinars offer novel educational opportunities beyond those of traditional, in-person experiences. BRAINterns is an open-access webinar-based education platform created to replace opportunities lost during the coronavirus disease 2019 pandemic. This program previously showed the efficacy of webinars to expand access to careers in medicine, and in particular, neurosurgery. BRAINterns 2.0 was established to assess the durability of Web-based learning. METHODS: A modified 4-week webinar series was held during July 2021. A retrospective exit survey was distributed to participants and responses analyzed. RESULTS: A total of 16,045 people registered for BRAINterns 2.0, representing 103 countries. Survey responses were received from 3765 participants (23% response rate). New, first-time registrants comprised 66% of participants, with the rest being returning participants. A total of 342 students participated in a dedicated module delivered entirely in Spanish. Females represented 81% of respondents. Participants identified that desirable elements of the program were opportunities to hear from women (53%) and people of color (44%) in health care. Participants heard about the series through TikTok (n = 1251; 33%), Instagram (n = 1109; 29%), Facebook (n = 637; 17%), and word of mouth (n = 708; 19%) with assistance from an ambassador program. CONCLUSIONS: Webinar-based education programs continue to be of interest to students in an increasingly digital world. Social media, and specifically the use of educational ambassadors, are effective to improve visibility of educational programs across a diverse population of students. Understanding the desires of participants is critical to building a successful online education platform.

20.
World Neurosurg ; 166: e731-e740, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2016194

ABSTRACT

OBJECTIVE: To explore the worldwide impact of a virtual neurosurgery-neuroscience lecture series on optimizing neurosurgical education with tele-teaching. METHODS: A retrospective analysis was performed from our Zoom database to collect data from October 15, 2020, to December 14, 2020, and from September 27, 2021, to December 13, 2021. A comparative analysis of participants in the 2 different time frames was performed to investigate the impact of tele-teaching on neurosurgical education worldwide. To evaluate participant satisfaction, the yearly continuing medical education reports of 2020-2021 were analyzed. Data related to the distribution of lectures by subspecialties were also described. RESULTS: Among the 11 lectures of the first period, 257 participants from 17 countries in 4 different continents were recorded, with a mean of 64 (standard deviation = 9.30) participants for each meeting; 342 attendees participated from 19 countries in 5 continents over the 11 lectures of the second part, with an average of 82.8 (standard deviation = 14.04) attendees; a statistically significant increase in participation between the 2 periods was identified (P < 0.001) A total of 19 (2020) and 21 (2021) participants submitted the continuing medical education yearly survey. More than 86.4% of overall responses considered the lectures "excellent." The main topics reported during lectures in 2020-2021 were related to brain tumors (33.7%) and education (22.1%). CONCLUSIONS: The COVID-19 pandemic has increased the need to introduce new educational approaches for teaching novel ways to optimize patient care. Our multidisciplinary Web-based virtual lecture series could represent an innovative tele-teaching platform in neurosurgical training.


Subject(s)
COVID-19 , Education, Medical, Undergraduate , Neurosurgery , Humans , Neurosurgery/education , Pandemics , Retrospective Studies
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