scholarly journals MP006: Review of clinical presentation and trajectory of patients with a diagnosis of primary brain tumour in a pediatric tertiary centre

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S68-S68
Author(s):  
J. Abou-Diab ◽  
S. Gouin ◽  
I. Bouhout ◽  
A. Carret
Keyword(s):  
Brain Tumour ◽  
Brain Tumours ◽  
Clinical Presentation ◽  
Age Groups ◽  
Nausea And Vomiting ◽  
Primary Brain Tumour ◽  
Clinical Presentations ◽  
The Mean ◽  
Mean Time ◽  
Symptoms And Signs

Introduction: Recognition of life-threatening conditions, such as brain tumours, remains a challenge among pediatric patients. Few studies have described the implication of initial presentation, clinical evolution and healthcare system factors in diagnosis delay of brain tumours in children. We aimed to determine the clinical presentation patterns and health care trajectory of children with a diagnosis of primary brain tumour. Methods: A retrospective chart review in a pediatric university-affiliated hospital was conducted. Participants were all patients less than 18 years of age diagnosed with a brain tumour by neuroimaging between Jan 2003 and Dec 2014. Data were extracted from an institutional tumour registry and medical records. Results: From the registry, 288 patients were identified. The mean age at time of diagnosis was 7.44 ± 0.29 years. Most tumours were infra-tentorial (55%) and had astrocytic origin (29%). The majority (35%) had consulted only once prior to diagnosis, while 14% had consulted at least 4 times prior to diagnosis. The mean time between the onset of symptoms and diagnosis was 147 ± 19 days. The mean time between symptoms onset and first consultation was 84 ± 14 days. The most frequent symptoms and signs at onset and diagnosis were respectively: headache (44% vs 59%, p<0.01), nausea and vomiting (31% vs 58%, p<0.01) and abnormalities of gait (10% vs 32%, p<0.01). 129 patients (45%) were diagnosed in an Emergency Department (ED). Symptoms and signs that differed significantly for those diagnosed in an ED were: headache (71% vs 42%, p<0.01), nausea and vomiting (73 % vs 32%, p<0.01), lethargy (26% vs 9%, p<0.01), weight loss (15% vs 3%, p<0.01), irritability (9% vs 0%, p<0.01) and endocrine abnormality (2% vs 8%, p=0.02). Clinical presentations of infants up to one year of age (14%) differed from other age groups. They presented mostly with growth abnormality (46%), macrocephaly (40%), irritability (40%), development abnormalities (18%) and sun-setting eyes sign (10%). Conclusion: In this large comprehensive cohort, we have found that the diagnosis of primary brain tumours is most frequently made in the ED. Different clinical presentations have been identified and varied between different settings of diagnosis and different age groups.

scholarly journals Acute coronary syndrome: which age group tends to delay call for help?

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Ahmed Ayuna ◽  
Ayyaz Sultan
Keyword(s):  
Acute Coronary Syndrome ◽  
Time Delay ◽  
Local Population ◽  
Age Groups ◽  
Age Group ◽  
Teaching Programme ◽  
The Road ◽  
Coronary Syndrome ◽  
The Mean ◽  
Mean Time

Abstract Background Early diagnosis and treatment of ACS can reduce the risk of complications and death. Delay calling for help can increase morbidity and mortality. It is unclear which age group among patients with acute coronary syndrome tend to delay their call for help. Results Our observational retrospective study showed that men and women in their 50s and 40s respectively tend to delay their call for help from symptoms onset. For the former, the mean time delays (590 ± 71.1 min), whereas for the latter it was (1084 ± 120.1 min). Moreover, these groups tend to have a longer time delay between symptoms onset and arrival at the hospital. Among deaths, we observed that the death rate was proportional to the time delay, which is not unexpected. Next step, we plan to perform a qualitative study in the form of questionnaires to target the individuals with a high risk of CVD within these age groups. Conclusion Middle age group of both genders tend to delay their call for help when they experience symptoms of ACS; moreover, regardless of the age, the longer the delay, the higher the mortality rate. The results of this study gave us a better understanding of our local population and will pave the road for a well-structured teaching programme for them to minimise the time delay for calling for help.

Drug level monitoring in palliative patients

2021 ◽  
pp. bmjspcare-2020-002613
Author(s):  
Joanne Bartlett ◽  
Elizabeth Freshwater
Keyword(s):  
Brain Tumour ◽  
Palliative Medicine ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Primary Brain Tumour ◽  
Drug Level Monitoring ◽  
Symptoms And Signs ◽  
Level Monitoring ◽  
Palliative Patients

Palliative medicine is always patient centred and promotes the principle that no unnecessary investigations are performed. The case is reported of a patient with suspected carbamazepine toxicity presenting as progression of symptoms of primary brain tumour. A comparison is made of the symptoms and signs of toxicity versus tumour, and an aid for deciding when to perform therapeutic drug level monitoring for some common drugs.

scholarly journals Invasive Haemophilus influenzae disease in adults

2000 ◽  
Vol 124 (3) ◽  
pp. 441-447 ◽  
Author(s):  
J. SARANGI ◽  
K. CARTWRIGHT ◽  
J. STUART ◽  
S. BROOKES ◽  
R. MORRIS ◽  
...  
Keyword(s):  
Haemophilus Influenzae ◽  
Clinical Presentation ◽  
Age Groups ◽  
Case Fatality ◽  
Underlying Disease ◽  
Reference Laboratory ◽  
Age Group ◽  
Childhood Immunization ◽  
Clinical Presentations ◽  
Vaccines For Children

We reviewed retrospectively all invasive Haemophilus influenzae (Hi) infections in adults ascertained from reference laboratory records and notifications from five NHS regions over the 5 years from 1 October 1990, a period encompassing the introduction of routine Hib childhood immunization (October 1992). A total of 446 cases were identified, a rate of 0·73 infections per 105 adults per annum. Though numbers of Hib infections in adults fell after the introduction of Hib vaccines for children (P = 0·035), and there was no increase in infections caused by other capsulated Hi serotypes, total numbers of invasive Hi infections increased due to a large rise in infections caused by non-capsulated Hi (ncHi) strains (P = 0·0067). There was an unexpectedly low rate of infections in those aged 75 years or more (P < 0·0001). The commonest clinical presentations were pneumonia with bacteraemia (227/350, 65%) and bacteraemia alone (62/350, 18%) and the highest rates of disease were in the 65–74 years age group (P < 0·0001). Clinical presentation was not influenced by the capsulation status of the invading Hi strain. 103/350 cases (29%) died within 1 month, and 207/350 (59%) within 6 months of their Hi infection. Case fatality rates were high in all age groups. Pre-existing diseases were noted in 220/350 cases and were associated with a higher case fatality rate (82% vs. 21%, P < 0·0001). After the introduction of Hib immunization in children, invasive Hib infections in unimmunized adults also declined, but the overall rate of invasive Hi disease in adults increased, with most infections now caused by non-capsulated strains. Physicians and microbiologists should be aware of the changing epidemiology, the high associated mortality and high risk of underlying disease. Invasive haemophilus infections in adults should be investigated and treated aggressively.

scholarly journals A single blind controlled study comparing bipolar elecrocautery tonsillectomy to cold dissection method in pediatric age groups

2014 ◽  
Vol 11 (3) ◽  
pp. 270-272 ◽  
Author(s):  
ST Chettri ◽  
S Bhandary ◽  
A Nepal ◽  
RR Joshi ◽  
V Natesh ◽  
...  
Keyword(s):  
Age Groups ◽  
Controlled Study ◽  
Pediatric Age ◽  
The Mean ◽  
Patients Experience ◽  
Time Of Operation ◽  
Mean Time ◽  
Single Blind ◽  
Cold Dissection ◽  
Dissection Method

Background: Tonsillectomy is one of the most commonly performed operations in otolaryngology. There are many proven methods of tonsillectomy, including cold dissection and bipolar electrocautery. Objective: To compare bipolar elecrocautery tonsillectomy with cold dissection method in pediatric age groups. Methods: Single blind controlled study to compare bipolar technique against the conventional dissection/snare technique. Results: The average amount of bleeding on electrocautery side was 4.07ml and on the cold dissection side was 14.58 ml. The mean time of operation for electrocautery and cold dissection was 12.04 and 16.57 minutes respectively. On the second post operative day, 35% of the patients complained of pain on the cauterized side, 30% complained of more pain on the dissection side while 35 % experienced equal pain on both sides. Post-operative complication such as hemorrhage was not seen in both the techniques employed. Conclusion: In the present study, bipolar diathermy tonsillectomy had advantages in having less post-operative time and blood loss intraoperatively but patients experience slightly more pain than cold dissection. DOI: http://dx.doi.org/10.3126/hren.v11i3.9651 Health Renaissance 2013;11(3):270-272

scholarly journals Using surgical and oncology workload to plan brain tumour trial recruitment in England

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv11-iv12
Author(s):  
Kerlann Le Calvez ◽  
Peter Treasure ◽  
Matt Williams
Keyword(s):  
Clinical Trials ◽  
Brain Tumour ◽  
Brain Tumours ◽  
Adult Patients ◽  
Trial Recruitment ◽  
Trade Off ◽  
Primary Brain Tumour ◽  
Rational Planning ◽  
The Brain ◽  
Over Time

Abstract Introduction Access to clinical trials is a common request for patients with brain tumours. However, opening clinical trials requires additional work per centre opened. We have previously shown that surgical and oncology workload varies between centres, and fluctuates over time. There is a trade-off between offering access to clinical trials and increasing costs associated with opening trials in centres that treat few patients. Methods We used two separate datasets from England covering 3 years – one for neurosurgical workload and one for radiotherapy. We only included adult patients and calculated cumulative proportions of the malignant primary brain tumour population (C71) by number of centres. We investigated stability by checking how many patients would have to be added/ removed from a centre to change their rank. Results There were 7061 surgical and 5060 radiotherapy patients. To capture 25% of patients, we would need to open trials in 4 surgical/5 radiotherapy centres; for 50%, 9 surgical/ 13 radiotherapy centres; for 75%, 16 surgical/ 24 radiotherapy centres. Centre rank was fluid: adding 16 surgical/9 radiotherapy patients would change the rank of a centre. Discussion These are the first data to allow for rational planning of trials in brain tumour patients. We have shown that we can reach 75% of the brain tumour population by opening trials in ~50% of surgical and radiotherapy centres. Centre rank alters over year, so we should be cautious about being too prescriptive. Nonetheless, these data should allow some rational planning of trial centre inclusion.

scholarly journals Management of trans-vaginal extrusion of the distal ventriculoperitoneal shunt catheter: a systematic literature review from 1973 to 2021

2021 ◽  
Author(s):  
Rajendra K. Ghritlaharey
Keyword(s):  
Early Childhood ◽  
Literature Review ◽  
Ventriculoperitoneal Shunt ◽  
Clinical Presentation ◽  
Case Reports ◽  
Rare Complication ◽  
Age Groups ◽  
Chief Complaint ◽  
Vaginal Orifice ◽  
The Mean

Trans-vaginal extrusion of the distal ventriculoperitoneal shunt (VPS) catheter is a rare complication of VPS insertion done for the treatment of hydrocephalus. The primary purpose was to review the demographics. The secondary objectives were to review the clinical presentation, operative intervention executed, and outcome of the cases published on trans-vaginal extrusion of the distal VPS catheter. The literature and case reports were retrieved from 1973 to September 30, 2021. This literature review included (n=19) cases of the above-mentioned VPS complication. The mean age of 15 children at the time of diagnosis of the complication was 18.13 months and ranged from 2 to 72 months. For the entire case, the interval from the initial VPS insertion/VPS revision to the clinical diagnosis of complication ranged from 1 to 36 months, with a mean of 8.16 months. In three-fourth of the cases, it was detected within 6-months of the VPS implantation. Extrusion of the distal VPS catheter through the vagina was the chief complaint. Surgical procedures were performed in the following order of frequency (A) removal of the entire VPS catheter (n=14), and (B) removal of the distal/peritoneal VPS catheter (n=3). During the postoperative period, one of the children died. Extrusion of the distal VPS catheter through the vaginal orifice is a rare complication of VPS insertion. It occurred across all the age groups but was more common during early childhood. Three-fourth of them were treated by removal of the entire VPS catheter. For VPS revision, delayed re-VPS insertion was the preferred option.

scholarly journals Missed opportunities for diagnosing brain tumours in primary care: a qualitative study of patient experiences

2019 ◽  
Vol 69 (681) ◽  
pp. e224-e235 ◽  
Author(s):  
Fiona M Walter ◽  
Clarissa Penfold ◽  
Alexis Joannides ◽  
Smiji Saji ◽  
Margaret Johnson ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Brain Tumour ◽  
Brain Tumours ◽  
Help Seeking ◽  
Patient Experiences ◽  
Missed Opportunities ◽  
North West ◽  
Primary Brain Tumour ◽  
Symptom Appraisal ◽  
Poor Outcomes

BackgroundBrain tumours are uncommon, and have extremely poor outcomes. Patients and GPs may find it difficult to recognise early symptoms because they are often non-specific and more likely due to other conditions.AimTo explore patients’ experiences of symptom appraisal, help seeking, and routes to diagnosis.Design and settingQualitative study set in the East and North West of England.MethodIn-depth interviews with adult patients recently diagnosed with a primary brain tumour and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework.ResultsInterviews were carried out with 39 patients. Few participants (n = 7; 18%) presented as an emergency without having had a previous GP consultation; most had had one (n = 15; 38%), two (n = 9; 23%), or more (n = 8; 21%) GP consultations. Participants experienced multiple subtle ‘changes’ rather than ‘symptoms’, often noticed by others rather than the patient, which frequently led to loss of interest or less ability to engage with daily living activities. The most common changes were in cognition (speaking, writing, comprehension, memory, concentration, and multitasking), sleep, and other ‘head feelings’ such as dizziness. Not all patients experienced a seizure, and few seizures were experienced ‘out of the blue’. Quality of communication in GP consultations played a key role in patients’ subsequent symptom appraisal and the timing of their decision to re-consult.ConclusionMultiple subtle changes and frequent GP visits often precede brain tumour diagnosis, giving possible diagnostic opportunities for GPs. Refined community symptom awareness and GP guidance could enable more direct pathways to diagnosis, and potentially improve patient experiences and outcomes.

Evaluation of Sports-Related Concussion in Children (5–12) and Adolescents (13–18)

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S12.3-S13
Author(s):  
James Pate ◽  
Ian Cummins ◽  
Kasey Cooper ◽  
James Mooney ◽  
Marshall Chandler McLeod ◽  
...  
Keyword(s):  
Demographic Data ◽  
Skull Fracture ◽  
Age Groups ◽  
Child And Adolescent ◽  
Return To Play ◽  
Specific Outcome ◽  
The Mean ◽  
New Diagnosis ◽  
Mean Time

ObjectiveThe objective of this study was to examine the association between sport/non-sport concussions as well as age and time to recovery after concussion diagnosis in children and adolescents.BackgroundThere is an ongoing debate between policy makers and medical specialists on when is the appropriate time to allow children to begin playing contact sports. This dilemma is important because sports are incredibly prevalent in our child and adolescent population today. There is still significant debate if age at time of concussion diagnosis is associated with long term affects and time to recovery.Design/MethodsOf the 725 patients who received a diagnosis of concussion at Children's of Alabama (COA) from 2018 to 2019, 350 patients were included for retrospective cohort review based on documented recovery data defined as follow up appointment PRN (as needed) or begin return to play protocol. 221 patients were lost to follow up while 7 were excluded for concomitant skull fracture. Recovery time, patient demographic data, symptoms severity score, and injury characteristics were then analyzed for each patient.ResultsOverall, the mean time of recovery after new diagnosis of any concussion was 87.2 days. The mean time to documented recovery in sports-related concussion was 82.6 days compared to 98.5 days in non-sports related concussion. Of note, both the 5–12 and 13–18 age groups had the same mean time to recovery at 87 days.ConclusionsSports related concussion showed decreased mean time to recovery compared to non-sports related concussion. Also, age did not play a factor in time to recovery as there was no difference in the 2 age groups. This data, along with the NCAA-DOD Care Consortium showing repetitive head injury during early adolescence is unrelated to brain health as measured by specific outcome measures, has the potential to provide valuable information for future policy on child and adolescent sports.

scholarly journals Are patients with brain tumours being given timely DVLA advice?

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv2-iv3
Author(s):  
Shumail Mahmood ◽  
Yazan Hendi ◽  
Hasan Zeb ◽  
Yasir A Chowdhury ◽  
Ismail Ughratdar
Keyword(s):  
Brain Tumour ◽  
Secondary Care ◽  
Brain Tumours ◽  
Tertiary Care ◽  
Queen Elizabeth Hospital ◽  
The Public ◽  
Primary Brain Tumour ◽  
The Uk ◽  
New Diagnosis

Abstract Aims Over 11,000 patients are diagnosed with a primary brain tumour annually in the UK, with many more being diagnosed with a secondary brain tumour. UK law stipulates that all individuals with a brain tumour must inform the Driver and Vehicle Licensing Agency (DVLA) and may be required to surrender their driving license depending on their specific tumour and symptoms. Despite this guidance, we found that patients continue to arrive at the neuro-oncology clinic without the correct DVLA advice being given. This can potentially lead to patients with brain tumours continuing to drive on the public highway, which poses a severe hazard as the risk of seizures could endanger the public. This retrospective study looks to review what information was provided to patients with brain tumours upon initial diagnosis and determine the adequacy of this; ultimately aiming to improve the quality of information given to future neuro-oncology patients. Method A structured questionnaire was designed, asking patients who have been treated for a brain tumour at the Queen Elizabeth Hospital in Birmingham about any information they received about driving when they were first diagnosed. The questionnaire comprised of 11 questions designed to gather an understanding of what information was given to patients about driving. The study secured local audit approval. 75 patients identified from the weekly neuro-oncology MDT list were contacted. All patients included in this audit were required to stop driving and inform the DVLA about their condition as per the DVLA guidelines. Their responses were collated and analysed. Using this data, we determined if there were inadequacies in the information that was given to these patients about driving, and how this process may be improved in the future. Results 60 patients (80%) possessed driving licenses when first diagnosed and 17% of these (n=10) were not told to stop driving; 8 of whom were diagnosed in primary/secondary care. 39 patients (65%) were first diagnosed in primary/secondary care, however, only 21% of these (n=8) were told to stop driving by primary/secondary care consultants. The remaining 31 patients (81%) were only told to stop driving after referral to tertiary care, by consultant neurosurgeons at the Queen Elizabeth Hospital. Conversely, of the 12 patients first diagnosed at the Queen Elizabeth Hospital, 85% were told to stop driving at diagnosis, suggesting a notable difference in informing patients between primary/secondary care and tertiary care. Patients also commented on the quality of the information received, as 10 individuals (21%) mentioned needing more information about getting their license back, and 5 individuals (11%) mentioning being given conflicting or incorrect information from different members of the MDT. Conclusion The results show that in practice, there are inconsistencies about mandatory DVLA advice which should be clearly provided to patients with a new diagnosis of a brain tumour. Only 78% of patients were told to stop driving at diagnosis, suggesting that the remainder could be liable to continue driving despite their diagnosis. Furthermore, many patients diagnosed in primary/secondary care are not being told to stop driving until after referral to tertiary care which can take weeks, causing delays in them being given this information, which can pose risks to themselves and the public. These delays may be alleviated by giving patients a simplified resource when they are first diagnosed which clearly explains the driving rules. We therefore propose developing a one-page resource based on DVLA guidance and distributing this to patients and referring healthcare professionals at first diagnosis. A subsequent re-audit can evaluate if this intervention improves the current situation.

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