Safety and timing of early therapeutic anticoagulation therapy after craniotomy.

Background: To date, there are few guidelines and studies to guide the timing of initiation of therapeutic anticoagulation (AC) after craniotomy. The goal of this study was to assess the timing, safety, and outcomes of patients following the administration of therapeutic AC after craniotomy. Methods: A retrospective case-control study was performed evaluating all craniotomy patients from August 2017 to July 2021. Cases were selected if they received therapeutic AC within ten days of craniotomy. Nineteen out of 1013 craniotomy patients met the inclusion criteria. Indications for therapeutic AC were diverse, including deep venous thrombosis, pulmonary embolism, dural venous sinus thrombosis, mechanical heart valve, and left ventricular thrombus. Results: The mean and median time to therapeutic AC were 5.35 and 5 days, respectively. Three patients developed intracerebral hemorrhage (ICH) that was stable on repeat imaging and did not require any surgical intervention or result in new neurologic deficits. There was no significant association between therapeutic AC and postoperative ICH (P = 0.067). Conclusion: This study demonstrated that the initiation of therapeutic AC in postoperative craniotomy patients from postoperative days 2 to 10 did not result in any major complications. A prospective study is warranted to clarify the indications and safety of therapeutic AC after craniotomy.

Persistent brainstem abscess requiring repeat microsurgical drainage: case report.

In this paper, we present a patient who was treated for a pontine abscess at our institution. This patient underwent sub-occipital craniotomy for microscopic abscess drainage after which cultures grew Streptococcus intermedius. She was treated with antibiotics but failed to show clinical improvement and was taken back to the operating room for repeat abscess drainage. Clinical improvement was seen after the second operation. This case report describes open surgical technique as a safe and effective way of treating brainstem abscess.

Violent trauma as an indirect impact of the COVID-19 pandemic: A systematic review of hospital reported trauma.

INTRODUCTION: The COVID-19 pandemic has exacerbated many social conditions associated with violence. The objective of this systematic review was to examine trends in hospital reported violent trauma associated with the pandemic. METHODS: Databases were searched in using terms "trauma" or "violence" and "COVID-19," yielding 4,473 records (2,194 de-duplicated). Exclusion criteria included non-hospital based studies and studies not reporting on violent trauma. 44 studies were included in the final review. RESULTS: Most studies reported no change in violent trauma incidence. Studies predominately assessed trends with violent trauma as a proportion of all trauma. All studies demonstrating an increase in violent trauma were located in the United States. CONCLUSIONS: A disproportionate rise in violence has been reported within the US. However, most studies examined violent trauma as a proportion of all trauma; results may reflect relative changes from lockdowns. Future studies should examine rates of violent trauma to provide additional context.

The impact of chronic stress on the predictors of acute stress-induced eating in women.

Chronic stress is associated with palatable food intake and thus, the development of obesity. This may be due to chronic stress disrupting the regulatory effects of the hypothalamic pituitary adrenal (HPA) axis on stress-induced eating. Thus, the primary objective of the current study was to investigate how chronic stress (CS) and cortisol stress reactivity affect eating behaviors following acute stress. Exploratory analyses also sought to determine the distinct psychophysiological factors driving acute stress-induced eating in women with high versus low CS. Women with high (n = 21) and low (n = 14) perceived CS were subjected to the Trier Social Stress task and a rest period on two separate days in order to assess HPA axis and subjective psychological responses to acute stress. Following either stress or rest, participants portioned and consumed snack foods. Women displaying high cortisol reactivity to acute stress ate a smaller percentage of the food they poured than low cortisol reactors, but only in the low CS group. Additionally, stress-induced eating behaviors were associated with cortisol stress reactivity, depressive symptoms, and hunger for women with low CS, but only with a reduction in negative affect for women with high CS. Results indicated that chronic stress may disrupt HPA axis regulation of acute stress-induced consummatory behavior in favor of affective regulation. Replication in women across the weight spectrum may yield a greater understanding of how chronic stress affects the mechanisms underlying acute stress-induced eating, and inform prevention and treatment efforts for conditions related to stress and obesity.

Childhood Obesity Screening and Treatment Practices of Pediatric Healthcare Providers.

This study evaluated physicians' childhood obesity screening and treatment practices. A 26-question survey was delivered to pediatric providers in-person or via mail, e-mail, or fax throughout Louisiana. Fifty-seven providers completed the survey, the majority in primary care clinics. Five providers met at least four of seven clinical guidelines, but no provider met all of the guidelines. Whereas 88% of providers screened for obesity, 7% met guidelines for referring patients with obesity to weight management services. Six providers offered interventions that included all recommended components (i.e. dietary, physical activity, and behavioral counseling). One intervention met intensity guidelines (i.e. >25 hours delivered over at least six months). Barriers to offering services included lack of reimbursement and poor compliance by families. Solutions to overcome treatment barriers should be identified to increase the provision of health care services for children with obesity.