Cerebral Venous Sinus Thrombosis in a Patient With Alcohol Withdrawal Symptoms: A Case Report and Literature Review.

INTRODUCTION: Cerebral Venous Sinus Thrombosis (CVST) remains a challenge to diagnose due to its rarity and nonspecific symptomatology. We have found alcohol withdrawal can display symptoms similar to CVST. We present a unique case of intraparenchymal hemorrhage secondary to an extensive CVST in a patient presenting with symptoms suggestive of alcohol withdrawal. CASE REPORT: A 33-year-old woman with a history of alcohol dependence presented with a worsening headache and right upper dental pain. She denied any trauma and attributed the headache to alcohol withdrawal. She denied consuming alcohol in the last 24 hours but reported a daily intake of 20 oz of whiskey. Physical examination noted dental caries and a normal neurological examination. Laboratory values indicated leukocytosis with neutrophilia and microcytic anemia. Computed tomography brain without contrast was conducted to rule out head trauma, revealing a 1.2 cm intraparenchymal hemorrhage in the left frontal lobe with local edema. Neurosurgery recommended a computed tomography angiography, which demonstrated contrast filling defects consistent with CVST (confirmed by magnetic resonance venography). The patient was admitted to the intensive care unit; during her hospital course, further testing revealed heterozygous methylenetetrahydrofolate reductase mutation and elevated homocysteine levels. Patient underwent acute treatment with enoxaparin bridged to apixaban. Patient was discharged on day 7 neurologically intact with the improvement of all symptoms. CONCLUSION: This unique presentation of CVST alongside alcohol withdrawal symptoms highlights the importance of recognizing atypical presentations of CVST in higher-risk patient populations. A heightened index of suspicion for the wide range of presentations of CVST is necessary to assess, diagnose, and treat at-risk patients.

Academic Radiology in the United States: Defining Gender Disparities in Faculty Leadership and Academic Rank.

RATIONALE AND OBJECTIVES: Female physicians in academic medicine have faced barriers that potentially affect representation in different fields and delay promotion. Little is known about gender representation differences in United States academic radiology departments, particularly within the most pursued subspecialties. PURPOSE: To determine whether gender differences exist in United States academic radiology departments across seven subspecialties with respect to academic ranks, departmental leadership positions, experience, and scholarly metrics. MATERIALS AND METHODS: In this cross-sectional study from November 2018 to June 2020, a database of United States academic radiologists at 129 academic departments in seven subspecialties was created. Each radiologist's academic rank, departmental leadership position (executive-level - Chair, Director, Chief, and Department or Division Head vs vice-level - vice, assistant, or associate positions of executive level), self-identified gender, years in practice, and measures of scholarly productivity (number of publications, citations, and h-index) were compiled from institutional websites, Doximity, LinkedIn, Scopus, and official NPI profiles. The primary outcome, gender composition differences in these cohorts, was analyzed using Chi2 while continuous data were analyzed using Kruskal-Wallis rank sum test. The adjusted gender difference for all factors was determined using a multivariate logistic regression model. RESULTS: Overall, 5086 academic radiologists (34.7% women) with a median 14 years of practice (YOP) were identified and indexed. There were 919 full professors (26.1% women, p < 0.01) and 1055 executive-level leadership faculty (30.6% women, p < 0.01). Within all subspecialties except breast imaging, women were in the minority (35.4% abdominal, 79.1% breast, 12.1% interventional, 27.5% musculoskeletal, 22.8% neuroradiology, 45.1% pediatric, and 19.5% nuclear; p < 0.01). Relative to subspecialty gender composition, women full professors were underrepresented in abdominal, pediatric, and nuclear radiology (p < 0.05) and women in any executive-level leadership were underrepresented in abdominal and nuclear radiology (p < 0.05). However, after adjusting for h-index and YOP, gender did not influence rates of professorship or executive leadership. The strongest single predictors for professorship or executive leadership were h-index and YOP. CONCLUSION: Women academic radiologists in the United States are underrepresented among senior faculty members despite having similar levels of experience as men. Gender disparities regarding the expected number of women senior faculty members relative to individual subspecialty gender composition were more pronounced in abdominal and nuclear radiology, and less pronounced in breast and neuroradiology. Overall, h-index and YOP were the strongest predictors for full-professorship and executive leadership among faculty. KEY RESULTS: ● Though women comprise 34.7% of all academic radiologists, women are underrepresented among senior faculty members (26.1% of full professors and 30.6% of executive leadership) ● Women in junior faculty positions had higher median years of practice than their male counterparts (10 vs 8 for assistant professors, 21 vs 13 for vice leadership) ● Years of practice and h-index were the strongest predictors for full professorship and executive leadership.

The future of COVID-19: A vaccine review.

The COVID-19 pandemic has impacted individuals, families, and communities for well over a year, and has brought light to how a broad range of social, economic, and historically relevant factors take massive tolls on the health and well-being of underserved communities around the world. This literature review aims to bring light to the current landscape of vaccines, disparities that exist in COVID-19 response, the historical relevance of the ongoing pandemic, and what needs to be accomplished for a more prepared response to potential future pandemics. It will be shown that as the world continues become more interconnected, amplification of international cooperation and well-funded response organizations are imperative to provide more equitable care in future health crises. The synthesis of current research will be helpful to researchers analyzing historical trends in the COVID-19 pandemic and individuals interested in better understanding and advocating for underserved communities across the globe.