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OBJECTIVE: Our purpose was to synthesize evidence in the literature to determine the diagnostic accuracy of cone-beam CT (CBCT) for the detection of intracranial hemorrhage (ICH) and hemorrhage types, including intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH), and intraventricular hemorrhage (IVH). METHODS: We performed a meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Our protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO-CRD42021261915). Systematic searches were last performed on April 30, 2024, in EMBASE, PubMed, Web-of-Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases. Inclusion criteria were (1) studies reporting diagnostic metrics of CBCT for ICH and (2) studies using a reference standard to determine ICH. Exclusion criteria were (1) case reports, abstracts, reviews and (2) studies without patient-level data. Pooled estimates and 95% confidence intervals (CIs) were calculated for diagnostic odds ratios (DORs), sensitivity, and specificity using random-effects and common-effects models. Mixed methods appraisal tool was used to evaluate risk of bias. RESULTS: Seven studies were included in the meta-analysis yielding 466 patients. Mean or median age ranged from 54 to 75 years. Female patients represented 51.4% (222 of 432) in reported studies. Multidetector CT was the reference standard in all studies. DOR, pooled sensitivity, and pooled specificity for ICH were 5.28 (95% CI: 4.11-6.46), 0.88 (95% CI: 0.79-0.97), and 0.99 (95% CI: 0.98-1.0). Pooled sensitivity for IPH, SAH, and IVH was 0.98 (95% CI: 0.95-1.0), 0.82 (95% CI: 0.57-1.0), and 0.78 (95% CI: 0.55-1.0). Pooled specificity for IPH, SAH, and IVH was 0.99 (95% CI: 0.98-1.0), 0.99 (95% CI: 0.97-1.0), and 1.0 (95% CI: 0.98-1.0). DISCUSSION: CBCT had moderate DOR and high pooled specificity for ICH and hemorrhage types. However, pooled sensitivity varied by hemorrhage type, with the highest sensitivity for IPH, followed by SAH and IVH.

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BACKGROUND: Although patients with COVID-19 have a higher risk of acute ischemic stroke (AIS), the impact on stroke outcomes remains uncertain. AIMS: To determine the clinical outcomes of patients with AIS and COVID-19 (AIS-COVID+). METHODS: We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Our protocol was registered with the International Prospective Register of Systematic Reviews (CRD42020211977). Systematic searches were last performed on June 3, 2021 in EMBASE, PubMed, Web-of-Science, Scopus, and CINAHL Databases. INCLUSION CRITERIA: (1) studies reporting outcomes on AIS-COVID+; (2) original articles published in 2020 or later; (3) study participants aged ≥18 years. EXCLUSION CRITERIA: (1) case reports with <5 patients, abstracts, review articles; (2) studies analyzing novel interventions. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Random-effects models estimated the pooled OR and 95% confidence intervals (95% CI) for mortality, modified Rankin Scale (mRS) score, length of stay (LOS), and discharge disposition. RESULTS: Of the 43 selected studies, 46.5% (20/43) reported patients with AIS without COVID-19 (AIS-COVID-) for comparison. Random-effects model included 7294 AIS-COVID+ and 158 401 AIS-COVID-. Compared with AIS-COVID-, AIS-COVID+ patients had higher in-hospital mortality (OR=3.87 (95% CI 2.75 to 5.45), P<0.001), less mRS scores 0-2 (OR=0.53 (95% CI 0.46 to 0.62), P<0.001), longer LOS (mean difference=4.21 days (95% CI 1.96 to 6.47), P<0.001), and less home discharge (OR=0.31 (95% CI 0.21 to 0.47), P<0.001). CONCLUSIONS: Patients with AIS-COVID had worse outcomes, with almost fourfold increased mortality, half the odds of mRS scores 0-2, and one-third the odds of home discharge. These findings confirm the significant impact of COVID-19 on early stroke outcomes.

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Background: The SARS-CoV-2 gold standard detection method is an RT-qPCR with a previous step of viral RNA extraction from the patient sample either by using commercial automatized or manual extraction kits. This RNA extraction step is expensive and time demanding. Objective: The aim of our study was to evaluate the clinical performance of a simple SARS-CoV-2 detection protocol based on a fast and intense sample homogenization followed by direct RT-qPCR. Results: 388 nasopharyngeal swabs were analyzed in this study. 222 of them tested positive for SARS-CoV-2 by the gold standard RNA extraction and RT-qPCR method, while 166 tested negative. 197 of those 222 positive samples were also positive for the homogenization protocol, yielding a sensitivity of 88.74% (95% IC; 83.83 - 92.58). 166 of those negative samples were also negative for the homogenization protocol, so the specificity obtained was 97% (95% IC; 93.11 - 99.01). For Ct values below 30, meaning a viral load of 103 copies/uL, only 4 SARS-CoV-2 positive samples failed for the RNA extraction free method; for that limit of detection, the homogenizer-based method had a sensitivity of 97.92% (95% CI; 96.01 - 99.83). Conclusions: Our results show that this fast and cheap homogenization method for the SARS-CoV-2 detection by RT-qPCR is a reliable alternative of high sensitivity for potentially infectious SARS-CoV-2 positive patients. This RNA extraction free protocol would help to reduce diagnosis time and cost, and to overcome the RNA extraction kits shortage experienced during COVID-19 pandemic.

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Background Platelets are commonly administered to trauma patients to reverse the effects of pre-injury anti-platelet drugs if these individuals are judged to be at risk for ongoing bleeding (i.e., traumatic brain injury). In the U.S. blood banks, platelets are maintained at room temperature and are not infused prior to 72 hours storage due to rigorous screening methods. Recent work suggested that cold refrigerated platelets may be effective at restoring platelet function. We hypothesized that refrigerated platelets might be superior to room temperature platelets in reversing aspirin and clopidogrel-induced platelet dysfunction. Methods Using a cross-over design, 10 healthy, adult subjects underwent platelet removal by apheresis, received anti-platelet drugs (aspirin 325 mg and clopidogrel 75 mg) daily for three days, and then had return of their own platelets (about 3 x 1011 platelets). Five subjects were randomly assigned to receive platelets stored at 4°C, and five received platelets stored at room temperature. One month later, this entire process was repeated with each subject receiving platelets stored by the alternative method. Thus, subjects served as their own controls. At multiple time points during the study in vivo platelet function was assessed by bleeding times, which were measured by a single observer blinded to patient group. Results Bleeding times rose dramatically after anti-platelet drugs were given, but remained well above the normal range (seven minutes) despite reinfusion of platelets. There were no differences in platelet function according to the method of storage. Conclusions Transfusion with autologous platelets appears to be ineffective in reversing the anti-platelet effects of aspirin and clopidogrel. Cold refrigerated platelets were no more effective than room temperature stored platelets in restoring platelet function. This abstract was presented at American College of Surgeons-clinical congress, Boston 10-22-2018. (Khoury L, Cohn S, Panzo M. Inability to Reverse Aspirin and Clopidogrel-Induced Platelet Dysfunction with Platelet Infusion. Journal of the American College of Surgeons. 2018. 227. S265. DOI: 10.1016/j.jamcollsurg.2018.07.546).

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Background It is essential for physicians to master the ability to deliver high-quality oral presentations. Despite this, little time is dedicated throughout residency for training and refining this important skill. In order to solve this issue, we set out to design and implement a course which will improve the oratory skills of the resident physicians. Methods Senior surgical residents (postgraduate years three and four) were involved in a single-elimination tournament with the audience voting for the top presenters. Faculty provided feedback on oration, slide layout and overall presentation format throughout the course. Baseline and post-course survey responses were evaluated to assess a change in presentation skills after the "oratory course". Results Seven senior residents participated as competitors. Seventeen other junior and chief residents (postgraduate years 1, 2 and 5) were involved as audience members along with several attending physicians, physician assistants and medical students. Both the presenters and audience appreciated a statistically significant improvement in communication skills and slide layout (p < 0.01). Conclusion The use of a structured course in public speaking and presentation skills proved to be effective in developing oratory skills in surgical residents when used in conjunction with an entertaining format.

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BACKGROUND: Physicians are required to assume a leadership role as part of their career. For most, this is not an innate characteristic and must be developed throughout their medical training. There are few residency courses designed to assist in the enhancement of these leadership skills. We created and implemented a novel course on leadership, utilizing weekly presentations designed to stimulate discussions and improve the leadership qualities of trainees. METHODS: Senior residents provided leadership lectures stimulated by assigned readings from the book "The Founding Fathers on Leadership." The traits and characteristics demonstrated throughout course readings and discussions were subsequently incorporated into everyday resident activities. Baseline and post-course survey responses were evaluated to assess changes in leadership qualities. RESULTS: Seven senior (postgraduate year (PGY) 3-5) participated as course leaders. All seven filled out pre- and post-course surveys. Seventeen junior residents (PGY 1-2) were involved as audience members. Significant pre- and post-course differences were noted in the following areas: feelings of increased encouragement of personal development (4.86 vs. 5.43, p=0.03); increased team participation in decision-making (4.00 vs. 4.57, p=0.03); increased ease of obtaining answers to difficult questions (4.57 vs. 5.23, p=0.047); increased team member work (4.86 vs. 5.71, p=0.047), and a sense of leading a more balanced life (3.86 vs. 4.43, p=0.03). CONCLUSION: The initiation of a novel leadership course for senior surgical residents led to an enjoyable experience, resulting in enhanced leadership skills for all participants. We believe this process resulted in a more cohesive, efficient, communicative, and supportive residency program.