Unexpected Decrease in Shunt Surgeries Performed during the Shelter-in-Place Period of the COVID-19 Pandemic

Abstract BACKGROUND It is expected that the incidence of cerebrospinal fluid (CSF) shunt malfunctions would remain unchanged during the shelter-in-place period related to the COVID-19 pandemic. OBJECTIVE To examine the number of shunt surgeries performed in a single institution during this time interval in comparison to equivalent periods in past years. METHODS The numbers of elective and emergent/urgent shunt surgeries performed at a single institution were queried for a 28-d period starting on the third Monday of March, between years 2015 and 2020. These were further stratified by how they presented as well as the type of surgery performed. RESULTS During the 28-d period of interest, in the years between 2015 and 2020, there was a steady increase in the number of shunt surgeries performed, with a maximum of 64 shunt surgeries performed in 2019. Of these, approximately 50% presented in urgent fashion in any given year. In the 4-wk period starting March 16, 2020, a total of 32 shunt surgeries were performed, with 15 of those cases presenting from the outpatient setting in emergent/urgent fashion. For the surgeries performed, there was a statistically significant decrease in the number of revision shunt surgeries performed. CONCLUSION During the 2020 COVID-19 pandemic, there was an unexpected decrease in the number of shunt surgeries performed, and particularly in the number of revision surgeries performed. This suggests that an environmental factor related to the pandemic is altering the presentation rate of shunt malfunctions.

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Tectono-Sedimentary Evolution of the Cenozoic Basins in the Eastern External Betic Zone (SE Spain)

Geosciences ◽

10.3390/geosciences10100394 ◽

2020 ◽

Vol 10 (10) ◽

pp. 394

Author(s):

Manuel Martín-Martín ◽

Francesco Guerrera ◽

Mario Tramontana

Keyword(s):

Strike Slip ◽

Alluvial Fan ◽

Tectonic Activity ◽

Time Interval ◽

Se Spain ◽

The Third ◽

Sedimentary Evolution ◽

Marine Sedimentation ◽

Geodynamic Processes ◽

Early Paleocene

Four main unconformities (1–4) were recognized in the sedimentary record of the Cenozoic basins of the eastern External Betic Zone (SE, Spain). They are located at different stratigraphic levels, as follows: (1) Cretaceous-Paleogene boundary, even if this unconformity was also recorded at the early Paleocene (Murcia sector) and early Eocene (Alicante sector), (2) Eocene-Oligocene boundary, quite synchronous, in the whole considered area, (3) early Burdigalian, quite synchronous (recognized in the Murcia sector) and (4) Middle Tortonian (recognized in Murcia and Alicante sectors). These unconformities correspond to stratigraphic gaps of different temporal extensions and with different controls (tectonic or eustatic), which allowed recognizing minor sedimentary cycles in the Paleocene–Miocene time span. The Cenozoic marine sedimentation started over the oldest unconformity (i.e., the principal one), above the Mesozoic marine deposits. Paleocene-Eocene sedimentation shows numerous tectofacies (such as: turbidites, slumps, olistostromes, mega-olistostromes and pillow-beds) interpreted as related to an early, blind and deep-seated tectonic activity, acting in the more internal subdomains of the External Betic Zone as a result of the geodynamic processes related to the evolution of the westernmost branch of the Tethys. The second unconformity resulted from an Oligocene to Aquitanian sedimentary evolution in the Murcia Sector from marine realms to continental environments. This last time interval is characterized as the previous one by a gentle tectonic activity. On the other hand, the Miocene sedimentation was totally controlled by the development of superficial thrusts and/or strike-slip faults zones, both related to the regional geodynamic evolutionary framework linked to the Mediterranean opening. These strike-slip faults zones created subsidence areas (pull-apart basin-type) and affected the sedimentation lying above the third unconformity. By contrast, the subsidence areas were bounded by structural highs affected by thrusts and folds. After the third unconformity, the Burdigalian-Serravallian sedimentation occurred mainly in shallow- to deep-water marine environments (Tap Fm). During the Late Miocene, after the fourth unconformity, the activation of the strike-slip faults zones caused a shallow marine environment sedimentation in the Murcia sector and a continental (lacustrine and fluvial) deposition in the Alicante sector represented the latter, resulting in alluvial fan deposits. Furthermore, the location of these fans changed over time according to the activation of faults responsible for the tectonic rising of Triassic salt deposits, which fed the fan themselves.

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Cerebrospinal fluid biomarkers of neuroinflammation in children with hydrocephalus and shunt malfunction

Fluids and Barriers of the CNS ◽

10.1186/s12987-021-00237-4 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Carolyn A. Harris ◽

Diego M. Morales ◽

Rooshan Arshad ◽

James P. McAllister ◽

David D. Limbrick

Keyword(s):

Cerebrospinal Fluid ◽

Inflammatory Cytokines ◽

Protein Concentration ◽

Shunt Revision ◽

Csf Shunt ◽

Shunt Failure ◽

Revision Operation ◽

Protein Levels ◽

Anti Inflammatory ◽

Pro Inflammatory Cytokines

Abstract Background Approximately 30% of cerebrospinal fluid (CSF) shunt systems for hydrocephalus fail within the first year and 98% of all patients will have shunt failure in their lifetime. Obstruction remains the most common reason for shunt failure. Previous evidence suggests elevated pro-inflammatory cytokines in CSF are associated with worsening clinical outcomes in neuroinflammatory diseases. The aim of this study was to determine whether cytokines and matrix metalloproteinases (MMPs) contribute towards shunt failure in hydrocephalus. Methods Using multiplex ELISA, this study examined shunt failure through the CSF protein concentration profiles of select pro-inflammatory and anti-inflammatory cytokines, as well as select MMPs. Interdependencies such as the past number of previous revisions, length of time implanted, patient age, and obstruction or non-obstruction revision were examined. The pro-inflammatory cytokines were IL-1β, IL-2, IL-5, IL-6, IL-8, IL-12, IL-17, TNF-α, GM-CSF, IFN-γ. The anti-inflammatory cytokines were IL-4 and IL-10, and the MMPs were MMP-2, MMP-3, MMP-7, MMP-9. Protein concentration is reported as pg/mL for each analyte. Results Patient CSF was obtained at the time of shunt revision operation; all pediatric (< 18), totaling n = 38. IL-10, IL-6, IL-8 and MMP-7 demonstrated significantly increased concentrations in patient CSF for the non-obstructed subgroup. Etiological examination revealed IL-6 was increased in both obstructed and non-obstructed cases for PHH and congenital hydrocephalic patients, while IL-8 was higher only in PHH patients. In terms of number of past revisions, IL-10, IL-6, IL-8, MMP-7 and MMP-9 progressively increased from zero to two past revisions and then remained low for subsequent revisions. This presentation was notably absent in the obstruction subgroup. Shunts implanted for three months or less showed significantly increased concentrations of IL-6, IL-8, and MMP-7 in the obstruction subgroup. Lastly, only patients aged six months or less presented with significantly increased concentration of IL-8 and MMP-7. Conclusion Non-obstructive cases are reported here to accompany significantly higher CSF cytokine and MMP protein levels compared to obstructive cases for IL-10, IL-6, IL-8, MMP-7 and MMP-9. A closer examination of the definition of obstruction and the role neuroinflammation plays in creating shunt obstruction in hydrocephalic patients is suggested.

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Cerebrospinal fluid rhinorrhea and acquired anterior basal encephalocoele in a patient with colloid cyst of the third ventricle

Neurology India ◽

10.4103/0028-3886.60431 ◽

2010 ◽

Vol 58 (1) ◽

pp. 156 ◽

Cited By ~ 2

Author(s):

Chandrasekharan Kesavadas ◽

TirurRaman Kapilamoorthy ◽

Gireesh Menon ◽

KythasandraShivakumar Deepak

Keyword(s):

Cerebrospinal Fluid ◽

Third Ventricle ◽

Colloid Cyst ◽

Cerebrospinal Fluid Rhinorrhea ◽

The Third

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Problems Of Metabolic Syndrome

The American Journal of Medical Sciences and Pharmaceutical Research ◽

10.37547/tajmspr/volume03issue06-08 ◽

2021 ◽

Vol 03 (06) ◽

pp. 52-55

Author(s):

Maksuda Ahmedjanovna Karimova ◽

◽

Dilnoza Kakhramanovna Kurbanbaeva ◽

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Metabolic Syndrome ◽

Lifestyle Modification ◽

Syndrome X ◽

Steady Increase ◽

The Third ◽

Calorie Content ◽

Single Term ◽

Life Threatening

At the beginning of the third millennium, for mankind, which overcame the epidemic of life-threatening infections during its centuries-old history, the problem of cardiovascular diseases (CVD) came to the fore in relevance among all causes of morbidity and mortality. A significant role in this was played by lifestyle modification associated with limiting physical activity, increasing the calorie content of food, and a steady increase in emotional stress. All of this potentiates the main risk factors for CVD, which are a “negative asset of progress,” namely increased blood pressure (BP), dyslipidemia, diabetes mellitus (DM) and obesity. Since 1988, after G. Reaven's Banting lecture, it is customary to designate the interconnected combination of these pathologies by the single term "metabolic syndrome X".

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Lumbar Puncture in Pediatric Bacterial Meningitis: Defining the Time Interval for Recovery of Cerebrospinal Fluid Pathogens After Parenteral Antibiotic Pretreatment

PEDIATRICS ◽

10.1542/peds.108.5.1169 ◽

2001 ◽

Vol 108 (5) ◽

pp. 1169-1174 ◽

Cited By ~ 2

Author(s):

John T. Kanegaye ◽

Peyman Soliemanzadeh ◽

John S. Bradley

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Laboratory Data ◽

Final Diagnosis ◽

Prolonged Treatment ◽

Time Interval ◽

Antibiotic Administration ◽

Parenteral Antibiotic ◽

Culture Material ◽

Before And After

Objective. Despite the lack of evidence defining a time interval during which cerebrospinal fluid (CSF) culture yield will not be affected by previous antibiotic therapy, recent publications cite a “minimum window” of 2 to 3 hours for recovery of bacterial pathogens after parenteral antibiotic administration. We conducted a retrospective review of children with bacterial meningitis to describe the rate at which parenteral antibiotic pretreatment sterilizes CSF cultures. Methods. The medical records of pediatric patients who were discharged from a tertiary children's hospital during a 5-year period with the final diagnosis of bacterial meningitis or suspected bacterial meningitis were reviewed. The decay in yield of CSF cultures over time was evaluated in patients with lumbar punctures (LP) delayed until after initiation of parenteral antibiotics and in patients with serial LPs before and after initiation of parenteral antibiotics. Results. The pathogens that infected the 128 study patients were Streptococcus pneumoniae (49),Neisseria meningitidis (37), group BStreptococcus (21), Haemophilus influenzae (8), other organisms (11), and undetermined (3). Thirty-nine patients (30%) had first LPs after initiation of parenteral antibiotics, and 55 (43%) had serial LPs before and after initiation of parenteral antibiotics. After ≥50 mg/kg of a third-generation cephalosporin, 3 of 9 LPs in meningococcal meningitis were sterile within 1 hour, occurring as early as 15 minutes, and all were sterile by 2 hours. With pneumococcal disease, the first negative CSF culture occurred at 4.3 hours, with 5 of 7 cultures negative from 4 to 10 hours after initiation of parenteral antibiotics. Reduced susceptibility to β-lactam antibiotics occurred in 11 of 46 pneumococcal isolates. Group B streptococcal cultures were positive through the first 8 hours after parenteral antibiotics. Blood cultures were positive in 74% of cases without pretreatment and in 57% to 68% of cases with negative CSF cultures. Conclusions. The temptation to initiate antimicrobial therapy may override the principle of obtaining adequate pretreatment culture material. The present study demonstrates that CSF sterilization may occur more rapidly after initiation of parenteral antibiotics than previously suggested, with complete sterilization of meningococcus within 2 hours and the beginning of sterilization of pneumococcus by 4 hours into therapy. Lack of adequate culture material may result in inability to tailor therapy to antimicrobial susceptibility or in unnecessarily prolonged treatment if the clinical presentation and laboratory data cannot exclude the possibility of bacterial meningitis.

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The third millennium dementia epidemic

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2018.v37.1-2 ◽

2018 ◽

Vol 37 (1) ◽

pp. 1

Author(s):

Richard Tjan

Keyword(s):

Older Persons ◽

Steady Increase ◽

Middle Income ◽

Middle Income Countries ◽

The Third ◽

People With Dementia ◽

Third Millennium ◽

The Future ◽

Low And Middle Income

The global dementia epidemic now and in the future is mainly caused by the steady increase in the population of older persons, where around 2 billion people will be 60 years of age and older by 2050.<sup>(1,2)</sup> As a consequence, in that year there will be 135 million people with dementia, particularly in low- and middle-income countries where 60% of the more than 47 million cases (2015 estimate) are living now.<sup>(2)</sup>

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Listeria monocytogenes meningitis in an immunocompetent 18-year old patient as a possible diagnostic and therapeutical problem

Vojnosanitetski pregled ◽

10.2298/vsp1310976v ◽

2013 ◽

Vol 70 (10) ◽

pp. 976-978

Author(s):

Miodrag Vrbic ◽

Marina Dinic ◽

Maja Jovanovic ◽

Aleksandar Rankovic ◽

Lidija Popovic-Dragonjic ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Case Report ◽

Listeria Monocytogenes ◽

Bacterial Meningitis ◽

Initial Treatment ◽

Clinical Effect ◽

Complete Recovery ◽

Cell Mediated Immunity ◽

The Third ◽

Appropriate Treatment

Introduction. Listeria monocytogenes is the third most frequent cause of bacterial meningitis in adults. It commonly affects persons with defective cell-mediated immunity or advanced age, and only a few patients with no underlying predisposition have been reported. Case report. We presented an previously healthy, 18-year-old man with typical clinical features of meningitis. On the account of earlier treatment with ceftriaxone and cerebrospinal fluid finding, an assumption of partially treated bacterial meningitis was made. The initial treatment with vancomycin and ceftriaxone, substituted on day 4 with meropenem, did not produce any clinical effect. On day 6 Listeria monocytogenes was isolated and, even as late as that, the administration of ampicillin was followed by complete recovery of the patient. Conclusion. In younger, immunocompetent individuals, in spite of the existent diagnostic and therapeutic problems, the subacute course of Listeria monocytogenes meningitis provides enough time for appropriate treatment and favorable disease outcome.

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Patient and Treatment Characteristics by Infecting Organism in Cerebrospinal Fluid Shunt Infection

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy035 ◽

2018 ◽

Vol 8 (3) ◽

pp. 235-243 ◽

Cited By ~ 1

Author(s):

Tamara D Simon ◽

Matthew P Kronman ◽

Kathryn B Whitlock ◽

Samuel R Browd ◽

Richard Holubkov ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Shunt Infection ◽

Research Network ◽

Csf Shunt ◽

Coagulase Negative Staphylococcus ◽

Gram Negative ◽

Treatment Characteristics ◽

Infection Treatment ◽

Csf Shunt Infection ◽

Univariate Analyses

Abstract Background Previous studies of cerebrospinal fluid (CSF) shunt infection treatment have been limited in size and unable to compare patient and treatment characteristics by infecting organism. Our objective was to describe variation in patient and treatment characteristics for children with first CSF shunt infection, stratified by infecting organism subgroups outlined in the 2017 Infectious Disease Society of America’s (IDSA) guidelines. Methods We studied a prospective cohort of children <18 years of age undergoing treatment for first CSF shunt infection at one of 7 Hydrocephalus Clinical Research Network hospitals from April 2008 to December 2012. Differences between infecting organism subgroups were described using univariate analyses and Fisher’s exact tests. Results There were 145 children whose infections were diagnosed by CSF culture and addressed by IDSA guidelines, including 47 with Staphylococcus aureus, 52 with coagulase-negative Staphylococcus, 37 with Gram-negative bacilli, and 9 with Propionibacterium acnes. No differences in many patient and treatment characteristics were seen between infecting organism subgroups, including age at initial shunt, gender, race, insurance, indication for shunt, gastrostomy, tracheostomy, ultrasound, and/or endoscope use at all surgeries before infection, or numbers of revisions before infection. A larger proportion of infections were caused by Gram-negative bacilli when antibiotic-impregnated catheters were used at initial shunt placement (12 of 23, 52%) and/or subsequent revisions (11 of 23, 48%) compared with all other infections (9 of 68 [13%] and 13 of 68 [19%], respectively). No differences in reinfection were observed between infecting organism subgroups. Conclusions The organism profile encountered at infection differs when antibiotic-impregnated catheters are used, with a higher proportion of Gram-negative bacilli. This warrants further investigation given increasing adoption of antibiotic-impregnated catheters.

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ALTERATIONS IN THE GLUCOSE TRANSPORT MECHANISM IN PATIENTS WITH COMPLICATIONS OF BACTERIAL MENINGITIS

PEDIATRICS ◽

10.1542/peds.34.4.491 ◽

1964 ◽

Vol 34 (4) ◽

pp. 491-502

Author(s):

R. D. Brooke Williams

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Glucose Transport ◽

Intravenous Injection ◽

Transport Mechanism ◽

Spinal Fluid ◽

Normal Pattern ◽

The Third ◽

Glucose Diffusion

Glucose diffusion tests were made on 8 children with bacterial meningitis, in 7 [SEE TABLE IV AND FIG 8. IN SOURCE PDF] of whom the organism had been identified. The results of the tests were correlated with the outcome of the illness. Of 3 patients who recovered without sequelae the glucose diffusion patterns were normal in 2 cases, while the third case had somewhat low curves. In 4 cases of proven bacterial meningitis with complication all the tests were abnormal. Three of these were cases of proven hydrocephalus and there was a reversal of the normal pattern of diffusion for the entry of glucose into the cisternal and lumbar regions. An actual lowering of the cisternal glucose following the intravenous injection of glucose was observed in two cases with initial very low spinal fluid sugars. The hypothesis is proposed that alterations in the blood cerebrospinal fluid barrier perhaps due to increased metabolism of arachnoid lining cells or edema in [SEE FIG 9 IN SOURCE PDF] addition to the action of bacteria and leukocytes contribute to the persistent hypoglycorrhachia seen in complicated cases of bacterial meningitis.

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Operative Related Infection Rates for Ventriculoperitoneal Shunt Procedures in a Children's Hospital

Infection Control ◽

10.1017/s0195941700067102 ◽

1987 ◽

Vol 8 (2) ◽

pp. 67-70 ◽

Cited By ~ 21

Author(s):

Janara J. Younger ◽

James C.H. Simmons ◽

Fred F. Barrett

Keyword(s):

Cerebrospinal Fluid ◽

Ventriculoperitoneal Shunt ◽

Shunt Infection ◽

Infection Risk ◽

Csf Shunt ◽

Infection Rates ◽

Surgical Infection ◽

Shunt Procedure ◽

Csf Shunt Infection

AbstractWe determined the operative related cerebrospinal fluid (CSF) shunt infection rates for our institution over a 3-year period (1982 to 1984) using strictly defined numerator and denominator data. The minimum post-operative follow-up period was 12 months. The average surgical infection risk for a CSF shunt procedure at our institution during the study period was 13.3%. Annual infection rates were relatively constant (13.8%, 13.2% and 12.9%), however both quarterly (5.7% to 23.3%) and surgeon-specific (5.7% to 22.8%) rates varied widely. Infection rates calculated by using “traditional” numerator and denominator data were considerably lower (6.5% to 9.2%).Operative related CSF shunt infection rates should be determined by utilizing strictly defined numerator and denominator values in order to allow valid comparisons of published rates.

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