scholarly journals Tubercular meningitis with hydrocephalus with HIV co-infection: role of cerebrospinal fluid diversion procedures

2015 ◽  
Vol 122 (5) ◽  
pp. 1087-1095 ◽  
Author(s):  
Raman Mohan Sharma ◽  
Nupur Pruthi ◽  
Arivazhagan Arimappamagan ◽  
Sampath Somanna ◽  
Bhagavathula Indira Devi ◽  
...  
Keyword(s):  
Hiv Positive ◽  
Short Term ◽  
Tubercular Meningitis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Shunt Placement ◽  
Poor Outcome ◽  
Hiv Negative

OBJECT Hydrocephalus is one of the commonest complications of tubercular meningitis (TBM), and its incidence is increasing with the HIV epidemic. Literature evaluating the role of ventriculoperitoneal shunts in HIV-positive patients with TBM and their long-term prognosis is scarce. METHODS Between June 2002 and October 2012, 30 HIV-positive patients with TBM and hydrocephalus underwent ventriculoperitoneal shunt placement. Thirty age-, sex-, and grade-matched HIV-negative patients with TBM and hydrocephalus were randomly selected as the control group. Outcome was analyzed at discharge (short-term outcome) and at follow-up (long-term outcome). Univariate and multivariate analyses were performed to look for predictors of outcome; p < 0.05 was considered significant. RESULTS There were no differences in the clinical, radiological, or biochemical parameters between the 2 groups. Short-term outcome was better in the HIV-negative group (76.7% improvement) than in the HIV-positive group (70%). However, the long-term outcome in HIV-positive patients was very poor (66.7% mortality and 76.2% poor outcome) compared with HIV-negative patients (30.8% mortality and 34.6% poor outcome). Seropositivity for HIV is an independent predictor of poor outcome both in univariate and multivariate analyses (p = 0.038). However, in contrast to previous reports, of 5 patients with TBM in good Palur grades among the HIV-positive patients, 4 (80%) had good outcome following shunt placement. CONCLUSIONS The authors recommend that shunt treatment should not be performed in HIV-positive patients in poor Palur grade with hydrocephalus. A trial of external ventricular drainage should be undertaken in such patients, and shunt treatment should be performed only if there is any improvement. However, HIV-positive patients in good Palur grades should undergo VP shunt placement, as these patients have better outcomes than previously reported.

Outcome of ventriculoperitoneal shunt placement in Grade IV tubercular meningitis with hydrocephalus: a retrospective analysis in 95 patients

2009 ◽  
Vol 4 (2) ◽  
pp. 176-183 ◽  
Author(s):  
Umesh Srikantha ◽  
Jagadeesh V. Morab ◽  
Savitr Sastry ◽  
Rojin Abraham ◽  
Anandh Balasubramaniam ◽  
...  
Keyword(s):  
Long Term Outcomes ◽  
Short Term ◽  
Tubercular Meningitis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Short Term Outcome ◽  
Short And Long Term

Object Hydrocephalus is the most common complication of tubercular meningitis (TBM). Relieving hydrocephalus by ventriculoperitoneal (VP) shunt placement has been considered beneficial in patients in Palur Grade II or III. The role of VP shunt placement in those of Grade IV is controversial and the general tendency is to avoid its use. Some authors have suggested that patients in Grade IV should receive a shunt only if their condition improves with a trial placement of an external ventricular drain (EVD). In the present study, the authors assessed the outcome of VP shunt placement in patients in Grade IV TBM with hydrocephalus to examine the factors predicting outcome and to determine whether a trial with an EVD is absolutely necessary prior to shunt placement. Methods Ninety-five consecutive cases of TBM with hydrocephalus in which the patients underwent VP shunt placement were retrospectively analyzed, and direct VP shunts were placed whenever possible. An EVD was placed first only in the presence of deranged blood parameters. Outcomes were assessed both in the short and long term. Results The mean patient age was 17.5 years (range 1–55 years). Fifty-two patients underwent direct VP shunt placement, and the remaining 43 received EVDs first. Overall, 33 and 45% of patients had favorable short- and long-term outcomes, respectively. Age older than 3 years and duration of altered sensorium ≤ 3 days were predictive of a favorable short-term outcome. Glasgow Coma Scale score at presentation was predictive of long-term outcome. Of the patients who did not improve with placement of an EVD prior to VP shunt insertion, 24 and 18% had favorable short- and long-term outcomes, respectively; this was not significantly different from the outcome in the patients who underwent direct VP shunt placement. Conclusions Direct VP shunt placement is an effective option in patients with Grade IV TBM with hydrocephalus. Age and duration of altered sensorium are predictive of short-term outcome, while Glasgow Coma Scale score at presentation predicts long-term outcome. Ventriculoperitoneal shunts should be considered even in patients who do not improve with an EVD.

Abstract TP301: Gender Differences in Short- and Long-Term Outcome of Patients With Suspected Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Naveed Akhtar ◽  
Saadat Kamran ◽  
Rajvir Singh ◽  
Zain Bhutta ◽  
Debby Morgan ◽  
...  
Keyword(s):  
Gender Differences ◽  
Regression Analysis ◽  
Acute Stroke ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Poor Outcome ◽  
Significant Difference

Background: There are gender differences in the short-term prognosis following acute stroke suggesting that outcome is less favorable in women. Factors contributing to this poor outcome include preexisting morbidity, stroke severity and higher age. Most previous studies have looked at short-term prognosis. PURPOSE: We investigated whether gender differences have a differential impact on incidence of short-term outcome and long-term major adverse cardiovascular events (MACE) including stroke, myocardial infarction, unstable angina, coronary revascularization procedure, and death in patients with suspected acute stroke. Methods: The study used a prospective cohort of Qatari patients with suspected acute stroke between January 2014 and February 2019. We calculated the modified Rankin score (mRS) at discharge and 90-days (short-term) and MACE (long-term) outcomes in both genders. To determine the independent predictor for MACE, the Cox proportional hazards regression analysis was used and summarized as hazard ratio and 95% confidential interval. Results: A total of 1372 patients identified. At 90-days, women found to have significantly poorer outcome (34.0% vs 23.4%, p<0.001) mortality (8.5% vs 5.2%, p<0.03) overall. MACE was present in 30.5% (418/1372) during follow-up (57.2% males and 54.3% females, p=0.32). Median follow-up was 44.6 months for females and 47.2 months for males. Mean age in MACE group was significantly higher (65.5±15.3 vs 60.1±15.9, p< 0.001). Hypertension, diabetes, prior history of stroke, coronary artery disease, and atrial fibrillation on admission was more significant in MACE group, while obesity (BMI ≥ 30 kg/m2) was more common in non-MACE group. Patients with MACE had higher NIHSS on admission (6.1±7.4 vs 3.5±5.3, p<0.001), HbA1c (7.7±2.3 vs 7.4±2.3, p=0.02) and poorer prognosis (44.5% vs 18.6%, p<0.001) and higher mortality at 90-days. Once corrected, the hazard regression analysis showed that no difference in MACE between the two genders. Conclusion: Our results show that despite higher mortality and poor outcome at 90-days, the long-term outcome in women did not show any significant difference from men in this cohort. This may be related to older age and presence of cardiovascular risk factors.

scholarly journals Maternal Vaginal Ureaplasma spp. Colonization in Early Pregnancy Is Associated with Adverse Short- and Long-Term Outcome of Very Preterm Infants

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 276
Author(s):  
Judith Rittenschober-Böhm ◽  
Tanja Habermüller ◽  
Thomas Waldhoer ◽  
Renate Fuiko ◽  
Stefan M. Schulz ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Early Pregnancy ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Vaginal Colonization ◽  
Short And Long Term

Vaginal colonization with Ureaplasma (U.) spp. has been shown to be associated with adverse pregnancy outcome; however, data on neonatal outcome are scarce. The aim of the study was to investigate whether maternal vaginal colonization with U. spp. in early pregnancy represents a risk factor for adverse short- or long-term outcome of preterm infants. Previously, 4330 pregnant women were enrolled in an observational multicenter study, analyzing the association between vaginal U. spp. colonization and spontaneous preterm birth. U. spp. colonization was diagnosed via PCR analysis from vaginal swabs. For this study, data on short-term outcome were collected from medical records and long-term outcome was examined via Bayley Scales of Infant Development at 24 months adjusted age. Two-hundred-and-thirty-eight children were born <33 weeks gestational age. After exclusion due to asphyxia, malformations, and lost-to-follow-up, data on short-term and long-term outcome were available from 222 and 92 infants, respectively. Results show a significant association between vaginal U. spp. colonization and severe intraventricular hemorrhage (10.4% vs. 2.6%, p = 0.03), retinopathy of prematurity (21.7% vs. 10.3%, p = 0.03), and adverse psychomotor outcome (24.3% vs. 1.8%, OR 13.154, 95%CI 1.6,110.2, p = 0.005). The data suggest an association between vaginal U. spp. colonization in early pregnancy and adverse short- and long-term outcome of very preterm infants.

scholarly journals Comparative short-term and long-term outcomes between internal and external intestinal plication in the management of small bowel obstruction

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Song Liu ◽  
Qiongyuan Hu ◽  
Lihua Shao ◽  
Xiaofeng Lu ◽  
Xiaofei Shen ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Gut Dysfunction ◽  
Gut Function

Abstract Background Small bowel obstruction (SBO) is common and usually requires surgical intervention. Intestinal plication is a traditional but critical strategy for SBO in certain scenarios. This study is to compare the short-term and long-term outcome between internal and external plications in the management of SBO. Methods All patients receiving intestinal plication in our hospital were retrospectively collected. Short-term outcome including postoperative complications, reoperation, postoperative ICU stay, starting day of liquid diet and postoperative hospitalization, as well as long-term outcome including recurrence of obstruction, readmission, reoperation and death were compared between groups. Gut function at annual follow-up visits was evaluated as well. Results Nine internal and 11 external candidates were recruited into each group. The major causes of plication were adhesive obstruction, abdominal cocoon, volvulus and intussusception. Lower incidence of postoperative complication (p = 0.043) and shorter postoperative hospitalization (p = 0.049) was observed in internal group. One patient receiving external plication died from anastomosis leakage. During the 5-year follow-up period, the readmission rate was low in both groups (22.2 % vs. 9.1 %), and none of patients required reoperation or deceased. None of patients exhibited gut dysfunction, and all patients restored normal gut function after 4 years. Patients in external group demonstrated accelerated recovery of gut function after surgery. Conclusions This study compares short-term and long-term outcome of patients receiving internal or external intestinal plication. We suggest a conservative attitude toward external plication strategy. Surgical indication for intestinal plication is critical and awaits future investigations.

Long-term outcome of children undergoing surgery for suspected perilymph fistula

2008 ◽  
Vol 123 (3) ◽  
pp. 298-302 ◽  
Author(s):  
R J Sim ◽  
A H Jardine ◽  
E J Beckenham
Keyword(s):  
Hearing Loss ◽  
Case Series ◽  
Outcome Data ◽  
Rank Test ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Signed Rank ◽  
Signed Rank Test

AbstractA number of authors have suggested that surgery for suspected perilymph fistula is effective in preventing deterioration of hearing and in improving hearing in some cases in the short term. We present long-term hearing outcome data from 35 children who underwent exploration for presumed perilymph fistula at The Children's Hospital, Sydney, Australia, between 1985 and 1992.Methods:The pre-operative audiological data (mean of 500, 1000, 2000 and 4000 Hz results) were compared with the most recently available data (range two to 15 years) and the six-month post-operative data.Results:The short-term results showed no significant change in hearing at six months, with a subsequent, statistically significant progression of hearing loss in both operated and non-operated ears (Wilcoxon signed rank test: operated ear, p < 0.017; non-operated ear, p < 0.009).Conclusion:In this case series, exploratory surgery for correction of suspected perilymph fistula did not prevent progression of long-term hearing loss.

scholarly journals Mycophenolate mofetil for Crohn's disease: short-term efficacy and long-term outcome

2004 ◽  
Vol 19 (4) ◽  
pp. 427-434 ◽  
Author(s):  
H. H. Wenzl ◽  
T. A. Hinterleitner ◽  
B. W. Aichbichler ◽  
P. Fickert ◽  
W. Petritsch
Keyword(s):  
Crohn’S Disease ◽  
Mycophenolate Mofetil ◽  
Crohn's Disease ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Term Efficacy

Non-constrained implant arthroplasty for the distal radioulnar joint

2017 ◽  
Vol 42 (4) ◽  
pp. 415-421 ◽  
Author(s):  
B. D. Adams ◽  
J. L. Gaffey
Keyword(s):  
Surgical Techniques ◽  
Distal Radioulnar Joint ◽  
Implant Loosening ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Strenuous Activity

A variety of surgical techniques are used to treat the arthritic distal radioulnar joint, which is influenced by aetiology and previous procedures. Four types of ulnar head arthroplasty exist: total ulnar head, partial ulnar head, unlinked total distal radioulnar joint, and linked distal radioulnar joint. Although long-term outcome studies are sparse, short-term clinical and biomechanical studies have shown encouraging results, leading to expanded indications. Based on our experience and a literature review, patients are advised that pain is improved but minor pain is common after strenuous activity. Ulnar neck resorption is common, however, implant loosening is rare. Sigmoid notch erosion is concerning, but appears to stabilize and not affect outcome. A partial ulnar head replacement that retains bony architecture and soft tissue restraints may have benefit over a total ulnar head in appropriate patients. If appropriate selection criteria are met, ulnar head replacement typically produces reliable results, with low revision.

Sign in / Sign up

Export Citation Format

Share Document