Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Nov 2020
ReviewDyspneic and non-dyspneic (silent) hypoxemia in COVID-19: Possible neurological mechanism.
SARS-CoV-2 mainly invades respiratory epithelial cells by adhesion to angiotensin-converting enzyme 2 (ACE-2) and thus, infected patients may develop mild to severe inflammatory responses and acute lung injury. Afferent impulses that result from the stimulation of pulmonary mechano-chemoreceptors, peripheral and central chemoreceptors by inflammatory cytokines are conducted to the brainstem. Integration and processing of these input signals occur within the central nervous system, especially in the limbic system and sensorimotor cortex, and importantly feedback regulation exists between O2, CO2, and blood pH. ⋯ Thus, SARS-CoV-2-associated neuronal damage may influence the control of respiration by interacting in neuromodulation. This would open up possible lines of study for the progress in the central mechanism of COVID-19-induced hypoxia. Future research is desirable to confirm or disprove such a hypothesis.
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Clin Neurol Neurosurg · Nov 2020
Multicenter Study Observational StudyThe longitudinal impact of COVID-19 pandemic on neurosurgical practice.
This observational cross-sectional multicenter study aimed to evaluate the longitudinal impact of the coronavirus disease 2019 (COVID-19) pandemic on neurosurgical practice. ⋯ Our study demonstrated that the COVID-19 pandemic decreased the number of procedures performed in neurosurgery practice. The load of emergency neurosurgery procedures did not change throughout the three periods, which reflects the need to designate ample resources to cover emergencies. Notably, with strict screening for COVID -19 infections, neurosurgical procedures could be safely performed during the early pandemic phase. We recommend to restart performing neurosurgical procedures once the pandemic gets stabilized to avoid possible post pandemic health-care system intolerable overload.
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Clin Neurol Neurosurg · Nov 2020
Burnout and career satisfaction among attending neurosurgeons during the COVID-19 pandemic.
The novel coronavirus SARS-CoV-2 (COVID-19) pandemic has posed significant changes to physician workflow and healthcare delivery. This national survey investigated the impact of the pandemic on burnout and career satisfaction among U.S. attending neurosurgeons. ⋯ Factors related to the novel COVID-19 pandemic have contributed to changes in workflow among U.S. attending neurosurgeons. Despite these changes, we report decreased burnout and high career satisfaction among U.S. neurosurgeons. Understanding modifiable stressors among neurosurgeons during the pandemic may help to identify effective future interventions to mitigate burnout and improve career satisfaction.
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Clin Neurol Neurosurg · Nov 2020
Disparities in inpatient costs and outcomes after elective anterior cervical discectomy and fusion at safety-net hospitals.
Characterizing disparities that exist at safety-net hospitals is crucial for crafting national healthcare reform policies. Healthcare disparities in performing elective neurosurgical procedures like anterior cervical discectomy and fusion (ACDF) at safety-net hospitals have not yet been examined. ⋯ Safety net hospitals had greater inpatient costs, but no greater LOS or odds of inpatient adverse events after elective ACDF. These results demonstrate a need for policies that reduce the cost of performing ACDFs at SNHs.
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Clin Neurol Neurosurg · Nov 2020
Case ReportsTraumatic vs Spontaneous Cerebrospinal Fluid Hypotension Headache: Our experience in a series of 137 cases.
To analyze and compare differences between epidemiological and clinical aspects, as well as radiologic findings and treatment, in a series of adult patients with traumatic intracranial hypotension (TIH) and spontaneous intracranial hypotension (SIH) treated at our institution in order to identify predictors of recurrence. ⋯ SIH and TIH can no longer be likened, since there is considerable variability in clinical presentation, imaging findings, response to treatment and recurrence rates. Anatomical abnormalities underlying SIH leaks are often complex and not simply a disruption of normal structures as encountered in TIH, which could explain why treatment success is poor and recurrence rates remain high.