Factors Favoring the Development of Chronic Subdural Hematoma After Traumatic Acute Subdural Hematoma in the Elderly.

INTRODUCTION: Traumatic acute subdural hematoma (TASDH) is by far the most common traumatic brain injury in elderly patients presented to the emergency department, and a number of those treated conservatively will develop chronic subdural hematoma (CSDH). The factors contributing to chronicity were not well studied in the elderly; therefore, we retrospectively analyzed our elderly patients with acute subdural hematomas to identify the risk factors which might contribute to the development of subsequent CSDH. METHODS: A retrospective analysis of 254 patients with TASDH admitted between 2012 and 2016 to our level 2 trauma department in a community hospital was collected. Data include age, sex, comorbid conditions, CT findings, anticoagulant therapy, surgical interventions, disposition after discharge, and mortality. Data on those readmitted within the first 2 months with the diagnosis of CSDH were also studied (group A), and compared to those not readmitted (group B). Multiple logistic regression was used to determine the risk factors associated with readmission at P ≤ .05. Institutional review board approval was obtained for this study. RESULTS: There were 254 patients who were admitted with TASDH, 144 male (56.7%) and 110 female (43.3%), with the mean age of 71.4 (SD ± 19.38) years. Only 37 patients (14.6%) went for surgery in their initial admission. A total of 14 patients (5.6%) were readmitted subsequently with the diagnosis of CSDH within two months of initial discharge (group A). Only four patients (28.5%) were on anticoagulant therapy and these patients went for emergency craniotomy for evacuation of hematoma. All 14 patients had a history of coronary artery disease and hypertension and only 5 (35.7%) were diabetic. Review of head CT on initial admission of those patients revealed 4 patients (28.5%) had multiple lesions and 4 (28.5%) had tentorial/falax bleeding and 4 (28.5%) had a shift. The initial size and thickness of the bleeding was 1.4-5 mm. The adjusted model identified diabetes, race, and initial disposition as significant risk factors (P < .05). CONCLUSION: Risk associated with the transformation of TASDH to CSDH is difficult to assess in those group of elderly patients because of the small number; however, diabetes, race, and initial disposition to home pointed toward a risk for future development of CSDH and those patients should be followed clinically and radiographically over the next few months after discharge, particularly those on anticoagulant therapy.

Reduced pediatric urgent asthma utilization and exacerbations during the COVID-19 pandemic.

The COVID-19 pandemic has had a profound impact on healthcare access and utilization, which could have important implications for children with chronic diseases, including asthma. We sought to evaluate changes in healthcare utilization and outcomes in children with asthma during the COVID-19 pandemic. We used electronic health records data to evaluate healthcare use and asthma outcomes in 3959 children and adolescents, 5-17 years of age, with a prior diagnosis of asthma who had a history of well-child visits and encounters within the healthcare system. We assessed all-cause healthcare encounters and asthma exacerbations in the 12-months preceding the start of the COVID-19 pandemic (March 1, 2019-February 29, 2020) and the first 12 months of the pandemic (March 1, 2020-February 28, 2021). All-cause healthcare encounters decreased significantly during the pandemic compared to the preceding year, including well-child visits (48.1% during the pandemic vs. 66.6% in the prior year; p < .01), emergency department visits (9.7% vs. 21.0%; p < .01), and inpatient admissions (1.6% vs. 2.5%; p < .01), though there was over a 100-fold increase in telehealth encounters. Asthma exacerbations that required treatment with systemic steroids also decreased (127 vs. 504 exacerbations; p < .01). Race/ethnicity was not associated with changes in healthcare utilization or asthma outcomes. The COVID-19 pandemic corresponded to dramatic shifts in healthcare utilization, including increased telehealth use and improved outcomes among children with asthma. Social distancing measures may have also reduced asthma trigger exposure.

Open-Circuit Photovoltage Exceeding 950 mV with an 840 mV Average at Sb2S3-Thianthrene+/0 Junctions Enabled by Thioperylene Anhydride Back Contacts.

Covalently attached perylene monolayers serve as back contacts for Sb2S3 photoelectrochemical cells with a thianthrene+/0 front, rectifying contact. Covalent attachment of perylenetetracarboxylic dianhydride, PTCDA, to Si(111) utilizes an anhydride-to-imide conversion at surface-attached amines. For Sb2S3 solar absorbers, we hypothesized that a terminal thioperylene anhydride, i.e., S=C-O-C=S, formed from thionation of the terminal perylene anhydride would serve as a soft, electron-selective and hole-blocking back contact. We explored several routes to convert carbonyls to thiocarbonyls on surface-attached perylene anhydrides including Lawesson's reagent, P4S10, and a P4S10-pyridine complex. Here, P4S10 in toluene yielded the highest conversion as quantified by thioperylene-anhydride-S-to-imide-N ratios in X-ray photoelectron spectroscopy (XPS). Spectra demonstrated minimal residual reagent as determined by the absence of quantifiable phosphorus following sonication and rinsing. Photoelectrochemistry yielded an average |V oc| = 840 ± 90 mV with the highest value of 952 mV under ELH-simulated AM1.5G illumination for chemical-bath-deposited Sb2S3 in the strongly oxidizing thianthrene+/0 redox couple when thioperylene-anhydride-tethered surfaces formed the back contact. Sb2S3 absorbers in which perylene anhydride, esters, thionoesters, and thiols form the back contact yielded significantly decreased |V oc| magnitudes vs Sb2S3 on perylene-thioanhydride-terminated surfaces. We attribute the large V oc to the combination of favorable sulfur-functionalized surfaces for deposition, charge transfer properties of the perylene layer, and use of the thianthrene+/0 redox couple.

A 3D printed smartphone adaptor for nasolaryngoscopy.

OBJECTIVE: The objective of this project is to create a three-dimensional (3D) printed smartphone adaptor for flexible nasolaryngoscopy (FNL) to provide an affordable alternative to commercial options and a better fit than generic telescope phone adaptors. METHOD: We designed an adaptor using computer aided software to connect an iPhone XS to an Olympus Rhino-Laryngo Fibre Scope. We experimented with various 3D printing materials and iterative designs to create a case that allowed for quality recording of a nasolaryngoscope exam using the iPhone's built in ×2 telescopic zoom lens. RESULTS: Our 3D printed adaptor provides a cost-effective alternative to commercially available FNL smartphone adaptors and is capable of capturing high-quality images and videos of the nasopharynx and larynx. These images are useful for senior clinician review, decrease the need for repeat examination, can be utilized for education, avail telehealth review, and provides a way to digitally record examinations to electronic medical records for future comparison without the need for an endoscopy tower. CONCLUSION: Smartphone adaptors for FNL have been established to be of clinical value. Despite being simple devices, they continue to be expensive. This potentially limits access to junior clinicians, who stand to gain most from the ability to review images of examinations with senior colleagues. Our 3D printed smartphone case provides a cost-effective alternative, with a better fit than generic adaptors, at a print cost of $29 AUD. This is $131 AUD less than the next cheapest commercial alternative. The files are freely available for use and modification. LEVEL OF EVIDENCE: 4.

Skull base anatomy and surgical safety in isolated and CHARGE-associated bilateral choanal atresia.

INTRODUCTION: Bilateral choanal atresia (BCA) is associated with a high incidence of congenital abnormalities that include skull base anomalies and defects. Surgical repair of BCA is necessary in the early neonatal period and any altered anatomy of the adjacent skull base will heighten the risk of intracranial injury. This risk may be further increased in patients with CHARGE syndrome. OBJECTIVES: To measure surgically relevant nasal and skull base dimensions in neonates with BCA in order to determine whether any difference exists between isolated and CHARGE syndrome associated subgroups, thereby optimizing the safety of surgical repair. METHODS: A retrospective review of medical charts and computed tomography was undertaken at a tertiary pediatric hospital of all neonates diagnosed with BCA between 2004 and 2016. Isolated and CHARGE syndrome subgroups of BCA were identified from clinical records and CT data was analyzed and compared between the two. The skull base parameters measured were choanal width, choanal height, mid-nasal skull base height and skull base slope. RESULTS: Of the 13 patients included, 3 had CHARGE syndrome and 10 had isolated BCA. Whilst the difference in mid-nasal height approached significance for the two groups, numbers were too small for a statistical difference to be identified. The mean value for choanal width in the isolated BCA group was significantly less the largest series of normative data available in the literature for comparison (p < 0.001). No skull base anomalies were noted in either group. CONCLUSION: While this is a small study with limited numbers, it is the first that has attempted to identify and measure the posterior nasal and skull base anatomy most pertinent to avoiding skull base injury in the surgical management of BCA.

Airway obstruction secondary to large thyroid adenolipoma.

Adenolipoma of the thyroid gland is a rare benign neoplasm composed of normal thyroid and mature adipose tissue. Ordinarily, only a small amount of fat exists in a normal thyroid gland. CT and MRI may differentiate between benign and malignant lesions, and fine-needle aspirate often assists diagnosis. Surgical excision for adenolipoma is considered curative. We report the case of a 67-year-old man presenting with a large neck lump and evidence of airway obstruction. Imaging revealed a 97 × 70 mm left thyroid mass with retropharyngeal extension and laryngotracheal compression. Hemithyroidectomy was performed with subsequent histology confirming a large thyroid adenolipoma. The patient's symptoms resolved and he remains asymptomatic with no sign of recurrence 2 years postsurgery.

Parental satisfaction with paediatric care, triage and waiting times.

OBJECTIVE: The present study aims to determine parental and guardian's perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. METHODS: A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. RESULTS: One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate than urgent, less-urgent or non-urgent patients. CONCLUSION: On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients' expectations and perceptions.