Search

Abstract Objective This study aims to analyze the distribution of otolaryngologists between urban and rural counties in Pennsylvania. Study Design Retrospective database. Setting American Academy of Otolaryngology–Head and Neck Surgery (AAO‐HNS) database and Centers for Medicare and Medicaid Services (CMS) Database. Methods The AAO‐HNS database (Entnet.org) and the CMS Database were used to identify otolaryngologists, their primary location, and their state of training. The 2023 Rural‐Urban Continuum Codes were used to classify metropolitan (codes 1‐3) and nonmetropolitan counties (codes 4‐9) and determine county populations. Results A total of 388 otolaryngologists were identified across 67 Pennsylvania counties (33 metropolitan, 34 nonmetropolitan), 80% of which were male. There were 354 otolaryngologists in metropolitan counties serving 11.2 million people, with an average of 2.4 otolaryngologists per 100,000 people (/100 k). The majority of otolaryngologists (n = 235, 60.6%) are located in counties designated by code 1. There were 34 otolaryngologists in nonmetropolitan counties serving 1.8 million people, with an average of 2.4 otolaryngologists/100 k. Montour County (code 6) is home to a large academic center and accounts for 14/34 otolaryngologists in the nonmetropolitan counties. With the exception of Montour County, the remaining nonmetropolitan counties averaged 1.0 otolaryngologist/100 k. Only 3 metropolitan counties did not have otolaryngologists compared to 19 nonmetropolitan counties without otolaryngologists. Most otolaryngologists received their residency training in Pennsylvania (n = 177). New York (n = 35) and Maryland (n = 24) were the second most common states for training. Conclusion There is a lack of otolaryngologists in rural counties of Pennsylvania, except in counties home to large academic centers.

Abstract Primary hyperparathyroidism (PHPT) is an endocrine disorder marked by elevated secretion of parathyroid hormone (PTH), which results in hypercalcemia and may cause complications in the kidneys and bones. Diagnosing this condition involves ruling out secondary causes and understanding the complexities of the laboratory values associated with PHPT. The disease has become more recognizable to clinicians in an earlier phase thanks to updated screening guidelines. At present, patients can be diagnosed with “classic,” “normocalcemic,” “normohormonal,” or “asymptomatic” PHPT. Many patients are diagnosed through incidental findings of elevated calcium levels or PTH levels during routine blood tests rather than through the presentation of classic symptoms. If asked, patients will invariably harbor subtle or subclinical manifestations despite the absence of overt symptoms. There is debate on whether truly asymptomatic hyperparathyroidism exists.1 We explore the definition and clinical patterns of asymptomatic hyperparathyroidism and propose concise recommendations for recognizing these patients.

Abstract Obstructive sleep apnea (OSA) is associated with multiple chronic comorbidities with treatments including continuous positive airway pressure (CPAP), upper airway surgery (UAS), and hypoglossal nerve stimulation (HNS). Given the complexity of the condition and multiple treatment options, there is an ongoing debate to determine the best management. O’Connor-Reina et al. recently published a paper titled “Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study.” In their study, the authors stated that OSA patients who received surgery had a 50% less chance of developing diabetes compared to patients who only received CPAP treatment. However, we would like to point out some limitations that warrant attention and caution interpretation of the findings by physicians and patients.

Abstract Objective To characterize the prevalence of inadequate health literacy among otolaryngology patients and assess the association of individual patient factors with inadequate health literacy. Study Design Cross‐sectional study. Setting Tertiary academic medical center otolaryngology clinic. Methods Adult patients presenting to the clinic were recruited from March to June 2022. Participants completed a validated health literacy questionnaire in the waiting room. Data on age, sex, race, insurance, county of residence, and language were extracted from the electronic medical record, linked to the survey responses, and deidentified for analysis. Logistic regression analyses assessed the association between inadequate health literacy and patient factors. Results Of 374 participants, the mean age was 54.8 years (SD = 17.8) and most were white (79%) and native English speakers (95%). The median health literacy score was 14.5 (Q1‐Q3: 12.0‐15.0) and 43 participants (12%) had inadequate health literacy. Bivariate analysis showed the odds of inadequate health literacy were 2.5 times greater for those with public insurance (95% confidence interval [CI]: 1.24‐5.20, P = .011), 3.5 times greater for males (95% CI: 1.75‐6.92, P

Abstract Objective Albumin is considered to be a surrogate marker for inflammation and nutritional status. Levels usually decrease after surgery but little is known about the predictive value of preoperative albumin levels in patients undergoing thyroidectomy. This study aimed to investigate the 30‐day incidence of postoperative outcomes in thyroidectomy patients with and without preoperative hypoalbuminemia. Study Design Retrospective cohort study. Setting TriNetX Database. Methods TriNetX, a federated deidentified database, was retrospectively queried to identify patients who underwent thyroidectomy. Postoperative outcomes within 30 days of thyroidectomy, based on International Classification of Disease, 10th Revision and Current Procedural Terminology codes, in patients with preoperative hypoalbuminemia (≤3.4 g/dL) (cohort 1) were analyzed and compared to patients without hypoalbuminemia (cohort 2). Results After propensity score matching, 2398 patients were identified in each cohort. Hypoalbuminemia patients were more likely to have postoperative pneumonia (odds ratio, OR: 3.472, 95% confidence interval, CI [2.016‐5.978]), acute renal failure (OR: 3.872, 95% CI [2.412‐6.217]), venous thromboembolism (OR: 1.766, 95% CI [1.016‐2.819]), and surgical site infection (OR: 2.353, 95% CI [1.282‐4.32]). Rates of recurrent laryngeal nerve injury were comparable between cohorts. Conclusion Patients undergoing thyroidectomy with preoperative hypoalbuminemia have a higher prevalence of postoperative complications compared to patients without preoperative hypoalbuminemia. While not routinely assessed, preoperative evaluation of serum albumin levels may help guide expectations and optimal management of thyroidectomy patients.

Head and neck cancers (HNC) are a biologically diverse set of cancers that are responsible for over 660,000 new diagnoses each year. Current therapies for HNC require a comprehensive, multimodal approach encompassing resection, radiation therapy, and systemic therapy. With an increased understanding of the mechanisms behind HNC, there has been growing interest in more accurate prognostic indicators of disease, effective post-treatment surveillance, and individualized treatments. This chapter will highlight the commonly used and studied biomarkers in head and neck squamous cell carcinoma.

Study Design: Retrospective Chart Review. Objective: The lifestyle of the Amish exposes them to unique mechanisms of injury, making them an important patient population from a facial trauma standpoint. This study analyzes the demographic and clinical risk factors of facial trauma in the Amish. Methods: This retrospective chart review identified all Amish patients presenting with facial trauma at a single institution between 2013-2023. Results: There were 87 Amish facial trauma patients. The median age was 9 years old, and 67.8% were male. Most injuries occurred on the road (41.4%), farm (28.7%), or at home (25.3%). The most frequent mechanisms were buggies (27.6%), falls (26.4%), and animals (18.4%). Fifty-eight patients sustained facial fractures, with orbital (n = 40), maxillary (n = 25), and nasal (n = 19) fractures being the most prevalent. The most common cause of facial fractures was buggy injuries (n = 17). Facial reconstruction was performed in 54.2% of buggy injuries, 31.3% of animal injuries, and 8.7% of falls. Patients with buggy injuries presented with the lowest Glasgow Coma Scale (GCS) scores (median 13.5) and had the longest inpatient hospital stay (median 3 days). Conclusions: Increased injury prevention efforts, especially towards buggy injuries, are necessary. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has altered innumerable lives. Although recent mass vaccinations offer a glimmer of hope, the rising death toll and new variants continue to dominate the current scenario. As we begin to understand more about SARS-CoV-2 infections, the territory of reinfections with COVID-19 remains unexplored. In this review, we will discuss several aspects of reinfection: (a) How is COVID-19 reinfection characterized? (b) Does prior literature differentiate between reinfection and reactivation? (c) What SARS-CoV-2 strains do the vaccines target and can they protect against new strains? Larger and longer timeline studies are needed to understand reinfection risks. With the ongoing distribution of the SARS-CoV-2 vaccines to provide protection, the understanding of the possibility for SARS-CoV-2 reinfection remains critical. Abbreviations CDC: Centers for Disease ControlSARS-CoV-2: Severe acute respiratory syndrome coronavirus 2COVID-19: Coronavirus disease 2019RT-PCR: Reverse Transcription Polymerase Chain ReactionPASC: Post-Acute Sequelae of SARS-CoV-2 infection

Objective: Hypoparathyroidism and associated hypocalcemia are well‐established complications following laryngectomy. This study further characterizes the rates of hypocalcemia in patients undergoing total laryngectomy (TL) with and without thyroidectomy and hemithyroidectomy. Study Design: Retrospective cohort study. Setting: TriNetX. Methods: We queried TriNetX, a deidentified patient database, to identify patients who underwent TL with and without thyroidectomy and hemithyroidectomy. Rates of hypocalcemia, low parathyroid hormone (PTH), calcium, and calcitriol supplementation were compared between groups with multivariable repeated measures logistic regression. Results: We identified 870 patients in the TL without thyroidectomy cohort, 158 patients in the hemithyroidectomy cohort, and 123 in the total thyroidectomy cohort. Rates of hypocalcemia differed between patients receiving total thyroidectomy versus TL alone for 0 to 1 month (odds ratio [OR]: 2.88 [1.95‐4.26]) 1 to 6 months (OR: 5.08 [2.29‐11.3]), and 6 to 12 months (OR: 2.63 [1.003‐6.88]) postoperatively, with adjustment for age at laryngectomy, race, ethnicity, and gender. Results were similar among those who received calcium supplementation. The rate of low PTH levels differed in these groups for 0 to 1 month (OR: 5.13 [3.10‐8.51]), 1 to 6 months (OR: 3.47 [1.46‐8.22]), and 6 to 12 months (OR: 3.63 [1.40‐9.38]) following surgery. Rates of postoperative calcium supplementation were increased for patients receiving total thyroidectomy versus TL for 1 to 6 months (OR: 2.44 [1.62‐3.68]), and 6 to 12 months following surgery (OR: 1.79 [1.18‐2.72]). Conclusion: Patients undergoing TL with total thyroidectomy have a higher risk of postoperative hypocalcemia compared to patients receiving TL alone. Risk of parathyroid injury in these patients may warrant further emphasis on PTH measurement after surgery and a multidisciplinary approach to management. [ABSTRACT FROM AUTHOR]

This article discusses the postoperative complications that can occur after surgery for trigeminal neuralgia (TN). The study analyzed data from over 100 million patients in the TriNetX healthcare database to compare outcomes between different surgical treatments for TN, including microvascular decompression (MVD), rhizotomy, and radiosurgery (GKRS). The results showed that MVD had higher rates of complications such as hearing loss, vertigo/dizziness, facial numbness, CSF leaks, stroke, and emergency department visits compared to GKRS. Rhizotomy also had higher rates of complications compared to GKRS. The findings suggest that the choice of surgical treatment for TN should take into account the potential for postoperative complications. [Extracted from the article]

Head and neck cancers (HNC) are a biologically diverse set of cancers that are responsible for over 660,000 new diagnoses each year. Current therapies for HNC require a comprehensive, multimodal approach encompassing resection, radiation therapy, and systemic therapy. With an increased understanding of the mechanisms behind HNC, there has been growing interest in more accurate prognostic indicators of disease, effective post-treatment surveillance, and individualized treatments. This chapter will highlight the commonly used and studied biomarkers in head and neck squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, examines the use of fibrin sealants in reducing postoperative complications in skull base surgery. The study conducted a systematic review and meta-analysis of published studies that assessed patients who had undergone skull base surgery with the use of fibrin sealants. The results showed that patients who received fibrin sealants had a lower incidence of postoperative cerebrospinal fluid (CSF) leak and drain placement compared to those who did not receive fibrin sealants. However, there was no significant difference in the incidence of revision surgery or infection between the two groups. Overall, the findings suggest that fibrin sealants may be effective in reducing CSF leaks and related complications in skull base surgery. [Extracted from the article]

Hypocalcemia following thyroidectomy is a common and potentially life‐threatening complication. It is caused by intraoperative injury to the parathyroid glands or their blood supply. Although several studies have shown that patients with a prior history of bariatric surgery may be at an increased risk for hypocalcemia after thyroidectomy, no clear recommendations exist for preventing and managing this condition in this population. This paper highlights the significance of understanding this risk and of obtaining a history of prior bariatric surgery before thyroidectomy. We propose concise recommendations for preventing and managing hypocalcemia following thyroidectomy in patients with a history of bariatric surgery. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is associated with multiple chronic comorbidities with treatments including continuous positive airway pressure (CPAP), upper airway surgery (UAS), and hypoglossal nerve stimulation (HNS). Given the complexity of the condition and multiple treatment options, there is an ongoing debate to determine the best management. O'Connor-Reina et al. recently published a paper titled "Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study." In their study, the authors stated that OSA patients who received surgery had a 50% less chance of developing diabetes compared to patients who only received CPAP treatment. However, we would like to point out some limitations that warrant attention and caution interpretation of the findings by physicians and patients. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has altered innumerable lives. Although recent mass vaccinations offer a glimmer of hope, the rising death toll and new variants continue to dominate the current scenario. As we begin to understand more about SARS-CoV-2 infections, the territory of reinfections with COVID-19 remains unexplored. In this review, we will discuss several aspects of reinfection: (a) How is COVID-19 reinfection characterized? (b) Does prior literature differentiate between reinfection and reactivation? (c) What SARS-CoV-2 strains do the vaccines target and can they protect against new strains? Larger and longer timeline studies are needed to understand reinfection risks. With the ongoing distribution of the SARS-CoV-2 vaccines to provide protection, the understanding of the possibility for SARS-CoV-2 reinfection remains critical. Abbreviations CDC: Centers for Disease ControlSARS-CoV-2: Severe acute respiratory syndrome coronavirus 2COVID-19: Coronavirus disease 2019RT-PCR: Reverse Transcription Polymerase Chain ReactionPASC: Post-Acute Sequelae of SARS-CoV-2 infection [ABSTRACT FROM AUTHOR]

Objective: To assess adherence to the 2019 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) guidelines for the diagnosis and management of sudden hearing loss (SHL) and sudden sensorineural hearing loss (SSNHL)., Study Design: Retrospective cohort., Setting: TriNetX, a de-identified healthcare database., Methods: Evaluation focused on the percentage of patients undergoing proper guideline-adherent workup and treatment for SHL. Key measures include audiogram testing within 2 weeks for distinguishing SSNHL from CHL. For SSNHL patients, MRI or auditory brainstem response (ABR) testing should be obtained, and steroids and/or hyperbaric oxygen may be offered within 2 weeks., Results: There were 24,203 SHL patients, 59.1% (n = 14,309) of whom underwent recommended audiogram testing, with 35.8% (n = 8,674) completing it within 2 weeks. Overall, 3,107 were diagnosed with unilateral SSNHL, 104 with unilateral conductive hearing loss (CHL), 121 with mixed hearing loss, and 10,977 were lost to follow-up. Among 3,107 SSNHL cases, just 25.5% (n = 791) obtained MRI/ABR within 1 month, and vestibular schwannoma was diagnosed in 3.5% (n = 28). Additionally, steroids were prescribed to 54.5% (n = 1,692), and <0.3% (n ≤ 10) received hyperbaric oxygen. In accordance with strong recommendations against or insufficient evidence to support the following diagnostics and treatments, 2.0% (n = 63) underwent a CT scan, less than 0.3% (n ≤ 10) were prescribed vasodilators or thrombolytics, and 3.5% (n = 108) were on antivirals., Conclusion: There is a significant opportunity for improvement in evaluating patients with SHL, specifically SSNHL. Proper adherence to guidelines may improve screening, detection, and management of neurotologic pathologies, including vestibular schwannoma., (© 2024 The Author(s). Otolaryngology‐Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology‐Head and Neck Surgery Foundation.)

Objectives: To assess postoperative outcomes in immunosuppressed patients with facial fractures. Methods: TriNetX, a large de-identified health research database, was utilized to compare outcomes within 30 days of treatment between immunosuppressed and immunocompetent patients with facial fractures. Subgroup analysis was conducted based on use of immunosuppressive therapy, human immunodeficiency virus (HIV) status, diabetes, and chronic kidney disease (CKD). Results: Nine thousand four hundred seventy-five patients were identified. On subgroup analysis, 555 patients were on immunosuppressants, 429 patients had HIV, 619 patients had CKD, 1322 patients with liver disease, and 3133 had diabetes. Immunosuppressed patients more frequently experienced postoperative infections [odds ratio (OR) 1.37 (1.9-1.54), P < .001], thromboembolic events [OR 1.71 (1.33-2.20), P < .001], hemorrhage [OR 1.46 (1.10-1.92), P = .0087], hospital readmission [OR 1.36 (1.28-1.44), P < .001], subsequent emergency department encounters [OR 1.08 (1.01-1.15), P = .0249], and wound disruptions [OR 1.52 (1.17-1.97), P = .0017]. Analyses comparing outcomes by immunosuppression type found increased rates of infection [OR 1.59 (1.25-2.01), P < .001], thromboembolic events [OR 1.56 (1.07-2.26), P = .0196], wound disruption [OR 1.57 (1.03-2.39), P = .0357], and hospital readmission [OR 1.28 (1.16-1.42), P < .001] in diabetic patients. Patients with CKD [OR 1.7 (1-2.90), P = .0478] had higher rates of infection [OR 2.02 (1.18-3.46), P = .0092] and readmission [OR 1.43 (1.14-1.79), P = .0017]. Patients with liver disease had higher rates of infection [OR 1.54 (1.07-2.23), P = .0210], thromboembolic events [OR 2.84 (1.37-5.87), P = .0033], and readmission [OR 2.14 (1.83-2.51), P < .001]. No significant differences were seen between groups for HIV patients. Conclusions: Immunosuppressed patients with facial trauma have a higher prevalence of postoperative complications compared to immunocompetent patients. Diabetics had a higher prevalence of most complications while patients with CKD and liver disease had higher rates of infections. Surgeons may consider measures to decrease postoperative risk in these patients and to provide preoperative patient counseling., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Thyroid carcinoma with cutaneous metastases is a rare clinical finding. Cutaneous metastases from thyroid carcinoma have been associated with a poor prognosis, but these data are limited to case reports. The exact mechanism of cutaneous metastases from thyroid carcinoma is not clear. Our study aims to report the demographic, clinical, and histologic findings of patients with cutaneous metastases from thyroid carcinoma. Methods: A review was conducted using the Medline/PubMed, Cochrane, and Scopus databases to review literature from inception to May 2023. Data extracted included patient age at diagnosis of cutaneous metastases, patient sex, thyroid carcinoma histotype, location of metastases, the time interval between diagnoses of thyroid carcinoma and cutaneous metastases, and overall survival (OS) from the time of cutaneous metastases. Results: One hundred thirty-six patients were identified and 75 were female. The most common types of thyroid carcinoma with cutaneous metastases were papillary (47.79%), followed by follicular (30.15%), and medullary (11.03%). In addition, 11 cases of anaplastic carcinoma, 2 cases of oncocytic carcinoma, and 2 cases of poorly differentiated thyroid carcinoma were reported. The average age at diagnosis of cutaneous metastases was 63.13 years, and the average time interval between the diagnoses of primary thyroid carcinoma and cutaneous metastases was 48.27 months. The most common location of metastases was the scalp (n = 48). Other common locations included the neck, chest, and face. The OS after diagnosis of metastases was only available in 34 patients with an average of 13.07 months. Of these 34 cases, 10 were medullary, 10 were papillary, 9 were anaplastic, and 5 had follicular carcinoma. Conclusions: This study represents an up-to-date review of the cases of thyroid carcinoma with cutaneous metastases. While cutaneous metastasis remains a rare finding, one needs a high index of suspicion, and their presence portends a poor prognosis., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Social media is becoming increasingly ubiquitous in the professional realm. The coronavirus disease 2019 (COVID-19) pandemic accelerated the shift towards utilizing social media to network and disseminate information, especially via Twitter. Neurosurgery programs have also leveraged Twitter to inform and attract applicants., Objective: The purpose of this study is to identify factors influencing the adoption of Twitter by matched neurosurgery applicants before and during the COVID-19 pandemic., Methods: A list of matched U.S. neurosurgery residents from just before the start of the pandemic (2019-2020) to after the peak of the pandemic (2021-2022), was collated. Twitter was searched to evaluate the presence of a professional account at the time of Electronic Residency Application Service (ERAS) submission. The following demographic variables were collected: gender, medical school, and matched residency institution., Results: Over four application cycles (2019-2022), 897 matched residents were evaluated in the study. Overall, 31.1% had a Twitter account during the time of their residency application. In particular, international medical school graduates were more likely to have a Twitter platform compared to U.S. applicants (50.0% vs. 29.7%; p=. 001). The percentage of matched neurosurgery applicants with a Twitter profile significantly increased during the pandemic (21.0% vs. 41.1%; p<. 001) with a two-fold increase from 20.0% to 39.7% ( p< .001) in U.S. applicants., Conclusion: Over the past four years, an increasing number of matched neurosurgery applicants have adopted a Twitter presence during application. Driven by the increasing use of social media and accelerated by the COVID-19 pandemic, Twitter has become an important tool leveraged by during the application process., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sciscent et al.)

Objective: Although medical advances have allowed most patients with spina bifida (SB) to survive into adulthood, these patients may have physical impairments, urological complications, infections, and neurocognitive deficits. These factors can cause psychological distress and impact the transition from pediatric to adult care. There remains limited research on mental health disorders (MHDs) and substance use disorders (SUDs) in SB patients during this vulnerable transition period. This study aimed to investigate the 10-year incidence of MHDs and SUDs in 18- to 25-year-old patients with SB., Methods: TriNetX, a federated de-identified database, was retrospectively queried to identify 18- to 25-year-old patients with SB. The presence of MHDs and SUDs based on ICD-10 codes in SB patients (cohort 1) was analyzed and compared with those of patients without SB (cohort 2). Subgroup analysis was performed on SB patients with hydrocephalus and neurogenic bladder (NB). SB patients were further compared to patients with a spinal cord injury (SCI)., Results: After propensity score matching, the authors identified 1494 patients in each cohort. SB patients were more likely to have depression (OR 1.949, 95% CI 1.64-2.317), anxiety (OR 1.603, 95% CI 1.359-1.891), somatoform disorders (OR 2.102, 95% CI 1.052-4.199), and suicidal ideations or attempts and self-harm (OR 1.424, 95% CI 1.014-1.999). The prevalence of attention-deficit/hyperactivity disorder (ADHD) and eating disorders were comparable between cohorts. SB patients also had increased rates of nicotine dependence (OR 1.546, 95% CI 1.22-1.959) but not of alcohol or opioid disorders. In SB patients, the presence of hydrocephalus and NB was not associated with significantly increased rates of any measured MHDs or SUDs. When compared with SCI patients, SB patients were more likely to have anxiety (OR 1.377, 95% CI 1.028-1.845) and ADHD (OR 1.875, 95% CI 1.084-3.242). However, SB patients had lower rates of nicotine dependence (OR 0.682, 95% CI 0.482-0.963) and opioid-related disorders (OR 0.434, 95% CI 0.223-0.845). SB and SCI patients shared similar rates of depression, suicidal ideations or attempts and self-harm, and alcohol-related disorders., Conclusions: Young adults with SB have higher prevalence rates of MHDs and SUDs compared with the general population. Therefore, incorporation of mental health and substance use management is critical to facilitate transition to adulthood.

Background Ten percent of women of childbearing age have histologically confirmed meningioma. To date, little is known regarding pregnancy-related outcomes for women with meningioma. Methods We used a de-identified database network (TriNetX's Research Network, https://trinetx.com/) to gather information on pregnant patients with meningioma (cohort 1) versus pregnant patients without meningioma (cohort 2). The primary outcome of interest included the impact of meningioma on mortality at one year. Secondary endpoints included ectopic or molar pregnancy, cesarean section, abortion, preterm labor, depression, pre-eclampsia/eclampsia, and craniotomy. Odds ratios (OR) with 95% confidence intervals (CI) were used to measure levels of association between each cohort and the outcomes of interest. Results A total of 1,739 patients were identified in each cohort following propensity-score matching. Mortality was seen in 23 patients (1.32%) in cohort 1 versus 26 patients (1.41%) in cohort 2 (OR 0.88, 95% CI {0.50, 1.55}, p=0.66). Ectopic/ molar pregnancy was seen in 31 (1.78%) versus 42 (2.42%) patients in cohorts 1 and 2, respectively (OR 0.73, 95% CI {0.046,1.17}, p=0.19). Cesarean section was seen in 126 (7.25%) versus 164 (9.43%) patients, respectively (OR 0.75, 95% CI {0.59,0.97}, p=0.020). Abortion was seen in 128 (7.36%) versus 183 (10.52%) patients, respectively (OR 0.68, 95% CI {0.53,0.86}, p=0.0011). Preterm labor was seen in 75 (4.31%) versus 119 (6.84%) patients, respectively (OR 0.61, 95% CI {0.46,0.83}, p=0.0012). Depression was seen in 258 (14.84%) versus 270 (15.53%) patients, respectively (OR 0.95, 95% CI {0.79,1.14}, p=0.57). Pre-eclampsia/eclampsia was seen in 3.11% versus 5.52% patients, respectively (OR 0.55, 95% CI {0.39,0.77}, p=0.0005). Craniotomy was seen in 74 (4.26%) versus 0 (0%) patients in cohort 1 and cohort 2, respectively. Conclusion Patients with meningioma were not at higher risk for pregnancy complications, including ectopic/molar pregnancy, cesarean section, abortion, preterm labor, pre-eclampsia/eclampsia, and mortality, compared to their non-meningioma counterparts. Still, coordinated care by neurosurgical and obstetrical providers may benefit women with meningiomas who are planning for pregnancy or are currently pregnant., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Hallan et al.)

Introduction: Intracerebral hemorrhage (ICH) is a devastating complication of immune thrombocytopenic purpura (ITP). Using a large database, we sought to determine its incidence and mortality., Methods: We used a de-identified database (TriNetX) to gather information on patients with ITP with subsequent ICH (cohort 1), propensity score-matched with patients with ITP and no ICH (cohort 2). Primary endpoint was mortality, with secondary endpoints of percutaneous endoscopic gastrostomy (PEG) placement, craniotomy, palliative care encounters, intensive care unit (ICU) management, seizure, falls, pulmonary embolism (PE), myocardial infarction (MI), deep venous thrombosis (DVT), ischemic stroke (IS), and other venous embolism and thrombosis (VTE)., Results: Incidence of ICH in patients with ITP was 1.540% in all ages, and 0.774% in those under age 18. After matching, 942 patients from each cohort were identified. Mean age was 58.3 years versus 61.2 years in cohort 1 and 2, respectively. Mortality rate was 34.076% vs. 20.17% (p <0.0001, OR 2.046 with 95% CI 1.661,2.520) at five years. Thirty-day survival was 83.46% vs. 95.17% (p<0.0001), and 365-day survival 68.59% vs. 85.33% (p<0.0001). PEG placement was seen in 21 (2.229%) patients in cohort 1, and less than 10 patients (<1.062%) in cohort 2 (p<0.0464). 2.442% vs. 0% underwent craniotomy (p<0.0001), palliative care was involved in 15.711% vs. 7.962% (p<0.0001), ICU care was seen in 27.389% vs. 11.783% (p<0.0001), with a mean ICU stay of 8.075 vs. 5.812 days (p=0.0537). 6.582% vs. 3.715% had PE (p=0.0049), 7.643% vs. 7.113% experienced MI (p=0.6595), 9.236% vs. 4.883% had DVTs (p=0.0002), 23.673% vs. 5.732% had seizures (p<0.0001), 9.023% vs. 6.582% suffered falls (p=0.0482), 7.537% vs. 3.503% suffered IS (p<0.0001), and 15.074% vs. 8.174% experienced other VTE (p<0.0001)., Conclusion: ICH occurs in approximately 1.54% of ITP patients, and is associated with a 34% mortality rate, increased PEG tube placement rates, palliative care involvement, ICU care, craniotomy, PE, IS, DVT, seizures, and falls., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Hallan et al.)

A homologous series of electronically tuned 2,2 ' ,2 '' -nitrilotris( N -arylacetamide) pre-ligands ( H 3 L R ) were prepared (R = NO 2 , CN, CF 3 , F, Cl, Br, Et, Me, H, OMe, NMe 2 ) and some of their corresponding Fe and Zn species synthesized. The iron complexes react rapidly with O 2 , the final products of which are diferric mu-oxo bridged species. The crystal structure of the oxidized product obtained from DMA solutions contain a structural motif found in some diiron proteins. The mechanism of iron mediated O 2 reduction was explored to the extent that allowed us to construct an empirically consistent rate law. A Hammett plot was constructed that enabled insightful information into the rate-determining step and hence allows for a differentiation between two kinetically equivalent O 2 reduction mechanisms.