A young man presenting with encephalopathy and seizures secondary to SARS-CoV-2.

COVID-19 has now emerged from a respiratory illness to a systemic viral illness with multisystem involvement. There is still a lot to learn about this illness as new disease associations with COVID-19 emerge consistently. We present a unique case of a neurological manifestation of a patient with structural brain disease who was COVID-19 positive and developed mental status changes, new-onset seizures and findings suggestive of viral meningitis on lumbar puncture. We also review the literature and discuss our case in the context of the other cases reported. We highlight the value of considering seizures and encephalopathy as one of the presenting features of COVID-19 disease.

Pediatric Telebehavioral Health: A Transformational Shift in Care Delivery in the Era of COVID-19.

The use of telebehavioral health has been expanding in the past decade to improve access to psychiatric care and address critical shortages in the psychiatric workforce. The coronavirus (COVID-19) pandemic forced a sudden shift from traditional in-person visits to alternative modalities. There are key factors associated with successful transitional and large-scale implementation of telehealth with existing resources. We describe the experience of a large health care system using telehealth technology, and we identify strategies and discuss considerations for long-term sustainability after the pandemic.

Innovations in Practice: Intensive crisis intervention for adolescent suicidal ideation and behavior - an open trial.

BACKGROUND: Adolescent suicide is a major public health concern worldwide. However, evidence regarding the effectiveness of interventions targeting youth suicide risk is limited. The purpose of this study was to assess the feasibility, acceptability, and clinical outcomes of Intensive Crisis Intervention (ICI), a cognitive-behavioral, family-centered treatment that provides an alternative to longer inpatient care. METHOD: Intensive Crisis Intervention was piloted over a two-year period with 50 adolescents (Mage  = 15.1 years; 86% Female; 78% Caucasian) admitted to an intensive crisis stabilization unit presenting with suicidal ideation and/or attempts. Data were collected at admission, 30 days, and 3 months post-admission to evaluate changes in suicidal ideation and functioning over time. RESULTS: Follow-up data were provided by 88% of study participants. At 3 months, the mean Suicidal Ideation Questionnaire-Junior score improved 34.2 points relative to baseline (effect size of 2.2, p < .0001). Significant improvements in functioning, high rates of consumer satisfaction and readiness for care transition upon discharge were also reported. CONCLUSION: Study findings set the stage for a larger, randomized controlled trial to examine the efficacy of ICI in targeting suicidal ideation and behavior in adolescents.

Neurosurgical Management of Sacral Tumors: Review of the Literature and Operative Nuances.

BACKGROUND: Sacral tumors present a significant challenge to the spine surgeon. As new techniques have evolved in recent years, these lesions have become more amenable to aggressive surgical treatment. Although sacral tumors make up only a small minority of spinal tumors, their surgical management warrants special consideration. METHODS: Based on our experience, we highlight 3 important surgical nuances specifically for the treatment of sacral tumors: preservation and maximization of neurologic function, protection of ventral abdominal and pelvic structures, and lumbopelvic fixation. RESULTS: Two cases of patients with sacral tumors treated at our institution are presented to illustrate these points. Both patients had successful postoperative courses, and remained pain free, well-fixated, and neurologically intact at 3-4 month follow-up. They had no evidence of biomechanical instability. CONCLUSIONS: To ensure a successful outcome, a goal-directed, methodical approach is required.

Biomechanical comparison of inside-outside screws, cables, and regular screws, using a sawbone model.

Our aim was to conduct a biomechanical comparison of the pull-out strengths of inside-outside (I/O) screws, cables, and bone screws to determine whether I/O screws provide greater pull-out resistance than cables or bone screws, and their effectiveness with the screw diameter. There is no remarkable biomechanical experimental study comparing the I/O technique with conventional spinal techniques. The diameter of the screw heads were also biomechanically tested to determine the optimal size that can be used. In this study, 45 blocks of 50x50x5 mm of "sawbone" (synthetic bone, model 1137, Pacific Research Laboratories, Vashon, WA, USA) were used as bone substitutes. Fifteen sets of 14-mm inside-outside Dynalok screws and nuts, 15 wire cables, and 15 bone screws were inserted into a separate sawbone block. An MTS Bionx materials testing machine was used to measure the load to failure of each implant. The mean values and standard deviations of each group were calculated and Student's t-test was used for comparison. The load to failure of the inside-outside screws was significantly greater than that of the cables (p<0.0000004) and the regular bone screws (p<0.000002). The results also revealed that increasing the diameter of the head of the screw also increases the resistance against the pull-out strengths. Thus, using a larger screw in occipitocervical stabilization provides safe and stable fixation of the occipital bone to the cervical spine. This study also proved that sawbone is a useful and reliable alternative to allogenic fresh cadaveric bone grafts or animal bones for certain biomechanical testing.