SARS-CoV-2 Seroprevalence Among Health Care Workers in Major Private and Public Hospitals With COVID-19 Patient's Referral in Tehran, Iran

Estimating the prevalence of SARS-CoV-2 antibody seropositivity among health care workers (HCWs) is crucial. In this study, the seroprevalence of anti-SARS-CoV-2 antibodies among HCWs of five hospitals of Tehran, Iran with high COVID-19 patient's referrals from April to June, 2020, was assessed. In this cross-sectional study, HCWs from three public and two private hospitals, selected randomly as a pilot, were included. Participants were asked questions on their demographic characteristics, medical history, hospital role, and usage of personal protective equipment (PPE). Iran FDA-approved SARS-CoV-2 ELISA kits were used to detect IgG and IgM antibodies in blood samples. The seroprevalence was estimated on the basis of ELISA test results and adjusted for test performance. Among the 2,065 participants, 1,825 (88.4%) and 240 (11.6%) HCWs were recruited from public and private hospitals, respectively. A total of 340 HCWs were tested positive for SARS-CoV-2-specific IgG or IgM antibodies, and 17.9% of seropositive individuals were asymptomatic. The overall test performance-adjusted seroprevalence estimate among HCWs was 22.6 (95% CI: 20.2–25.1), and PPE usage was significantly higher among HCWs of public vs. private hospitals (66.5 vs. 20.0%). This study found that seroprevalence of SARS-CoV-2 among HCWs was higher in private hospitals (37.0%; 95% CI: 28.6–46.2) than public hospitals (20.7%; 95% CI: 18.2–23.3), and also highest among assistant nurses and nurses, and lowest among janitor or superintendent categories. The PPE usage was especially suboptimal among HCWs in private hospitals. Continued effort in access to adequate PPE and regular screening of hospital staff for detecting asymptomatic personnel, especially during the upcoming wave of infection, are warranted.

Magnetic resonance imaging and intraoperative neurosonography in syringomyelia

Treatment of syringomyelia remains a difficult and controversial problem. However, the recent advent of magnetic resonance imaging (MRI) and intraoperative ultrasound allows a more precise approach to the diagnosis and management of this disorder. Experience with 27 cases of syringomyelia has shown that MRI is superior to all other forms of diagnostic imaging for the exact anatomical delineation of syrinxes and other spinal cavities. One-third of the syrinxes demonstrated by MRI were either not adequately visualized or missed by myelography and/or computed tomographic scanning. Intraoperative ultrasound has been used to allow more precise operative approaches to the syrinx as well as to guide the exact placement of shunt tubes into syrinx cavities. A method has also been developed to allow intraoperative ultrasound of the spinal cord with patients in the sitting position.

Fetal neurosurgery

Advances in antenatal diagnostic techniques coupled with innovative neurosurgical techniques have led to the consideration of treatment of major congenital neurological anomalies in utero. The rationale for such fetal neurosurgical intervention rests in the possibility of halting the progressive neurological deterioration and ameliorating the sequelae associated with severe congenital hydrocephalus and neural tube defects. Although the concept of in utero treatment of neurological anomalies remains more theoretical and experimental than clinically practical, preliminary evidence from both the laboratory and the clinic has begun to emerge to support continued efforts in this field. This review focuses on the role of neurosurgeons in surgery in utero. Emphasis is placed on advances in antenatal diagnosis, current research in surgery in utero, and potential clinical applications of fetal neurosurgery.

Penetrating spinal injury by a glass fragment: case report and review

Stab wounds of the spinal canal are rare. Usually they produce obvious neurological deficits, but occasionally patients present with cerebrospinal fluid leak or related symptoms. We report a case of penetration of the lumbar dural sac with a glass fragment. Postural headache and mild back pain were the only presenting complaints. The radiological findings, surgical indications, and management are discussed, and a review of the literature is presented.

Retromastoid approach for biopsy of brain stem tumors

Brain stem tumors constitute about 10 to 20% of all pediatric brain tumors. The clinical manifestations are protean and may be produced by malignant as well as benign lesions. Although the computed tomographic (CT) scan has contributed considerably in the diagnosis of these lesions, it is not possible to differentiate these tumors from viral encephalitis of the brain stem, vascular malformations, and other benign lesions. Over the years, biopsy of brain stem lesions has been considered a low yield and high risk procedure. In one of the recent series, the incidence of nondiagnostic biopsy approached 20% and major deterioration of cranial nerve function also occurred in 20% of the cases. Traditionally, suboccipital craniectomy and biopsy of the floor of the 4th ventricle has been used. This is usually associated with aggravation of cranial nerve deficits. Review of pathological specimens indicates that brain stem gliomas most often involve the pons, with predominantly unilateral involvement, and frequently fill in part of the cerebellopontine angle. On this basis, we have recently used a retromastoid approach on five patients with brain stem tumors to obtain biopsies from the ventrolateral pons and the cerebellopontine angle. A diagnosis was made in each case without complication. Minimal morbidity might be anticipated from this approach, as all cranial nerve nuclei are far away from the biopsy site. The biopsy of brain stem lesions is extremely important because aggressive therapeutic decisions may be made only after a histological diagnosis has been made. In one of our cases, a diagnosis of medulloblastoma was made in a patient with a clinical and CT scan diagnosis of brain stem glioma; this diagnosis changed the treatment plan. The retromastoid approach for the biopsy of brain stem tumors is a safe procedure with minimal morbidity and a high diagnostic yield.