Risk of failure in pediatric ventriculoperitoneal shunts placed after abdominal surgery

OBJECTIVEExperience has led us to suspect an association between shunt malfunction and recent abdominal surgery, yet information about this potential relationship has not been explored in the literature. The authors compared shunt survival in patients who underwent abdominal surgery to shunt survival in our general pediatric shunt population to determine whether such a relationship exists.METHODSThe authors performed a retrospective review of all cases in which pediatric patients underwent ventriculoperitoneal shunt operations at their institution during a 7-year period. Survival time in shunt operations that followed abdominal surgery was compared with survival time of shunt operations in patients with no history of abdominal surgery. Univariate and multivariate analyses were used to identify factors associated with failure.RESULTSA total of 141 patients who underwent 468 shunt operations during the period of study were included; 107 of these 141 patients had no history of abdominal surgery and 34 had undergone a shunt operation after abdominal surgery. Shunt surgery performed more than 2 weeks after abdominal surgery was not associated with time to shunt failure (p = 0.86). Shunt surgery performed within 2 weeks after abdominal surgery was associated with time to failure (adjusted HR 3.6, 95% CI 1.3–9.6).CONCLUSIONSUndergoing shunt surgery shortly after abdominal surgery appears to be associated with shorter shunt survival. When possible, some patients may benefit from shunt placement utilizing alternative termini.

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Characteristics of Asthma Patients and Risk Factors of Uncontrolled Asthma in Children

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.10.10860 ◽

2020 ◽

Vol 103 (10) ◽

pp. 996-1003

Keyword(s):

Asthma Control ◽

Severe Asthma ◽

Pediatric Patients ◽

Treatment Compliance ◽

Asthma Severity ◽

Uncontrolled Asthma ◽

Factors Associated ◽

Acute Rhinosinusitis ◽

Baseline Severity ◽

History Of

Objective: To identify factors associated with baseline severity and control of asthma in pediatric patients. Materials and Methods: The medical records of 279 newly diagnosed patients with asthma aged younger than 15 years and that visited Taksin Hospital in Bangkok were reviewed. Demographic and clinical characteristics at first diagnosis and three months after treatment were collected. Medication and treatment compliance were recorded. Asthma control status was classified according to the Global Initiative for Asthma (GINA) guideline. Factors associated with baseline severity and levels of control were determined. Results: Among the 279 pediatric patients with asthma, 48 (17.6%) were severe asthma at time of diagnoses. Patient’s comorbidities, including acute rhinosinusitis, a family history of atopy, and a history of preterm birth, were significantly associated with severe asthma at baseline. Asthma severity can be assessed retrospectively from the level of treatment required to control symptom and exacerbation according to the GINA. At the 3-month visit, 105 (37.6%) patients had uncontrolled asthma. Factors associated with uncontrolled asthma included severe asthma at baseline (RR 4.86, 95% CI 2.96 to 7.99), a family history of atopy (RR 1.54, 95% CI 1.12 to 2.12), acute rhinosinusitis and snoring (RR 1.54, 95% CI 1.09 to 2.17), severe allergic rhinitis (RR 2.32, 95% CI 1.78 to 3.04), poor compliance (RR 4.66, 95% CI 3.36 to 6.45), and aggravated factors (RR 3.88, 95% CI 3.05 to 4.92). Environmental factors, such as owning pets and environmental tobacco smoke, were not associated with asthma control. Conclusion: Good treatment compliance for asthma and other comorbidities are important for well-controlled asthma. Keywords: Uncontrolled asthma, Pediatric asthma, Asthma severity, Treatment compliance, Asthma control

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Factors associated with long-term haemoptysis recurrence after transarterial embolisation for haemoptysis

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0490 ◽

2020 ◽

Vol 24 (6) ◽

pp. 606-611

Author(s):

Y. Li ◽

Z. Jia ◽

S. Li ◽

Y. Huang ◽

X. Yuan ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Multivariate Analyses ◽

Fresh Blood ◽

Factors Associated ◽

Transarterial Embolisation ◽

History Of ◽

The Mean

OBJECTIVE: To assess factors associated with long-term haemoptysis recurrence after transarterial embolisation (TAE) for haemoptysis due to bronchiectasis.METHODS: Patients with haemoptysis due to bronchiectasis who underwent TAE between May 2010 and May 2019 were included in this retrospective study. Long-term haemoptysis recurrence was defined as the expectoration of >10 mL/day of fresh blood (for at least 1 day) 1 month after TAE. Univariate and multivariate analyses were performed to identify risk factors for long-term haemoptysis recurrence after TAE.RESULTS: A total of 197 patients (108 women; mean age, 61.0 ± 12.2 years) were included in the study. TAE was performed successfully in all patients. Side effects occurred in 43 (21.8%) patients, and all patients recovered uneventfully. During 37.6 ± 11.6 months of follow-up, long-term haemoptysis recurrence occurred in 41 (20.8%) patients; the mean interval between the TAE and haemoptysis recurrence was 21.4 ± 16.3 months. Long-term haemoptysis recurrence after TAE was associated with a history of haemoptysis (OR 3.483, 95% CI 1.373–8.836; P = 0.009).CONCLUSIONS: Approximately one fifth patients with bronchiectasis had long-term haemoptysis recurrence after TAE. Risk factor for long-term haemoptysis recurrence after TAE was a history of haemoptysis.

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Emergency endoscopic third ventriculostomy for blocked shunts? Univariate and multivariate analysis of independent predictors for failure

Journal of Neurosurgery ◽

10.3171/2018.6.jns1865 ◽

2019 ◽

Vol 131 (4) ◽

pp. 1004-1010

Author(s):

David Y. C. Chan ◽

Anderson C. O. Tsang ◽

Wilson W. S. Ho ◽

Kevin K. F. Cheng ◽

Lai F. Li ◽

...

Keyword(s):

Success Rate ◽

Endoscopic Third Ventriculostomy ◽

Multivariate Analyses ◽

Cns Infection ◽

Third Ventriculostomy ◽

Emergency Procedure ◽

Factors Associated ◽

Significant Difference ◽

Threatening Condition ◽

History Of

OBJECTIVEHydrocephalus with a blocked ventriculoperitoneal (VP) shunt is a life-threatening condition. Emergency endoscopic third ventriculostomy (ETV) is a potential treatment option. The aim of the study was to identify independent risk factors associated with failure of ETV in treating patients with blocked shunts.METHODSThe authors retrospectively reviewed data from consecutive patients admitted for blocked shunt treated by ETV during the study period from 2000 to 2016. Univariate and multivariate analyses were performed to identify independent factors associated with failed ETV for blocked shunts, such as age, sex, history of CNS infection, number of previous shunt revisions, operations performed as an emergency or elective, number of specialists, and other factors.RESULTSIn total, 121 patients underwent ETV during the study period. Of these, 31 patients (25.6%) had ETV for treatment of a blocked shunt. In 25 (80.6%) of 31 ETV was performed as an emergency procedure. There was no significant difference in the success rate of ETV depending on whether it was performed as an emergency procedure (64% [16/25]) or an elective procedure (66.7% [4/6]; OR 0.062, 95% CI 0.001–2.708; p = 0.149). Univariate and multivariate analyses identified that history of a CNS infection was an independent risk factor for failure of ETV in treating patients with a blocked shunt (OR 0.030, 95% CI 0.001–0.888; p = 0.043).CONCLUSIONSEmergency ETV had a comparable success rate as elective ETV. A history of CNS infection is an independent predictor of ETV failure in treating patients with blocked shunts.

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Shunt Infection in Adults: A Retrospective Study of 1324 Cases

10.21203/rs.3.rs-576468/v1 ◽

2021 ◽

Author(s):

Bing Qin ◽

Liansheng Gao ◽

Chun Wang ◽

Chenghan Wu ◽

lin wang

Keyword(s):

Risk Factors ◽

Spine Surgery ◽

Major Complication ◽

Shunt Infection ◽

Shunt Operation ◽

Shunt Surgery ◽

Shunt Placement ◽

Intracranial Infection ◽

Shunt Procedure ◽

History Of

Abstract Background: Shunt infection (SI) is a serious major complication in the management of hydrocephalus after cerebral fluid shunts. Here we study retrospectively hydrocephalus shunting to evaluate the incidence of SI, including the risk factors and types of infection.Meterial and Methods: 1556 patients (age≥18years) who had undergone shunt surgery from January 2013 to December 2019 at our center were included(6-78 months follow-up period). 1324 cases of them were confirmed as effective cases. Infection rate and risk factors were investigated.Results: We found 79 (6.0%) cases (58 men and 21 women) with SI, of which 72 were ventriculo-peritoneal (VP) shunt and 7 were lumbo-peritoneal (LP) shunt. Risk factors include male gender (p=0.04), patients with a history of intracranial infection (p<0.001) and patients suffered an infection when shunt surgery performed (p=0.008). Surgery type (p=0.80), Glasgow Coma Score (GCS) before shunt procedure (p=0.57) and history of hypertension (p=0.16), diabetes (p=0.44) or cerebral infarction (p=0.29) were not risk factors of SI. Brain or spine surgery performed within 2 years prior to shunt procedure increased rate of SI (p=0.015, SI rate: 7.4%), but not when performed after shunt procedure (p=0.42). Idiopathic hydrocephalus and hydrocephalus caused by trauma, hemorrhage, tumor and other factors showed no significant correlation with SI. Of all SI, 48 (60.8%) and 62 (78.5%) cases were present within 1 and 2 months after shunt surgery, respectively. Only 2.5% (2/79) of SI were found after 1 year since shunt placement. Pathogens were found in 46 cases, and Gram positive cocci were accounted for 50.0% (23/46). Conclusions: Our study suggests that male, history of intracranial infection, patients’ infection status when shunt surgery performed and history of brain or spine surgery performed within 2 years are risk factors of SI. Infections are more likely to present within the first 2 months after shunt placement, only 2.5% shunt infections were found after more than 1 year form shunt operation.

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Extubation of patients undergoing extracorporeal life support. A retrospective study

Perfusion ◽

10.1177/0267659118791072 ◽

2018 ◽

Vol 34 (1) ◽

pp. 50-57 ◽

Cited By ~ 10

Author(s):

Omar Ellouze ◽

Julie Lamirel ◽

Justine Perrot ◽

Anis Missaoui ◽

Theresa Daily ◽

...

Keyword(s):

Retrospective Study ◽

Pediatric Patients ◽

Life Support ◽

Multivariate Analyses ◽

Extracorporeal Life Support ◽

Survival Rates ◽

Ventricular Failure ◽

Factors Associated ◽

Significant Difference ◽

Post Cardiopulmonary Bypass

Introduction: The use of extracorporeal life support (ECLS) is increasing worldwide, in particular for the management of refractory cardiac arrest, cardiogenic shock and post cardiopulmonary bypass ventricular failure. Extubation of patients under extracorporeal membrane oxygenation (ECMO) for respiratory failure is a growing practice for adult and pediatric patients, especially for lung transplantation candidates. Because of potential complications and, specifically, accidental arterial decannulation, extubation of patients under ECLS is not standard practice. Our goal was to evaluate the interest in patient extubation under ECLS. Materials and methods: We performed a monocentric, retrospective study of all ECLS cases between January 2014 and January 2016. We excluded patients who died within the first 48 hours of ECLS. Results: We analyzed 57 of the initial 109 patients included in the study. The initial SOFA score was higher in the non-extubated group under ECLS, without significant difference (8.6 ± 2.8 vs 7.2 ± 2.1, p=0.065). Patients who were not extubated had a higher rate of acquired ventilator pneumonia (61.9% vs 26.7%, p=0.03). Moreover, patients who were extubated under ECLS had better 30-day survival rates (73.3% vs 40.5%, p=0.04). In multivariate analyses, the independent factors associated with mortality were age, duration of ECLS and the lack of extubation under ECLS. Conclusion: Extubation of patients under ECLS is safe and feasible. Furthermore, in extubated patients, we observed fewer cases of ventilator-associated pneumonia and better 30-day survival rates.

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Ventriculo-Peritoneal Shunt Complications at Emergency Teaching Hospital in Duhok City

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i2430749 ◽

2020 ◽

pp. 32-42

Author(s):

Nabeel Ali Hussein ◽

Walid W. Al- Rawi ◽

Arjan M. Rasheed

Keyword(s):

Risk Factors ◽

Teaching Hospital ◽

Pediatric Patients ◽

Oral Intake ◽

Shunt Surgery ◽

Vp Shunt ◽

X Ray ◽

Shunt Complications ◽

Csf Analysis ◽

Shunt Survival

Background: Ventriculoperitoneal (VP) shunt surgery is the predominant mode of therapy for patients with hydrocephalus. However, it has potential complications that may require multiple surgical procedures during a patient’s lifetime. The aim of the article was to review the experience in a 2-year teaching hospital and to evaluate the risk factors for PV shunt failure after initial shunt surgery and after subsequent reviews. Methods: The study was carried out at The Emergency Teaching Hospital in Duhok City in Iraq. All complications of VP shunted patients admitted to the hospital from January 2013 to January 2015, were included in the study. Forty six patients (out of 170 VP shunt operations), with all shunt related complications, qualified for this study. Identification of patients with complications of VP shunt is done by obtaining proper history, examination, and identification of ventricular enlargement with periventricular edema on imaging (brain computed tomography (CT) or magnetic resonance study (MRI); also, identification of any evidence of device migration by direct vision, chest and abdominal X-ray and evidence of infection on CSF analysis. Results: The incidence of the complications was (27.1%). There were 24 (52.2%) males and 22 (47.8%) females. Males were affected more than females with a ratio 1.1:1. Their age ranged from 2 months to 67 years, with mean age 8.6 years. The most common cause for the initial VP shunt implantation was congenital hydrocephalus and was noticed in 34 (73.9%) patients. Mean duration to develop VP shunt complication was 26.6 months. The most common presenting symptom in pediatric patients was decreased oral intake in 37 (80.4%) patients; however, in adult patients, it was headache, 4 (80%) patients. The most common complication was obstruction, 25 (54.3%) patients, followed by infection in 9 (19.6%) patients. The most common treatment option given to the patients who suffered from VP shunt complications was whole system change for a new one, in 15 (32.6%) patients. Conclusions: The findings of the study indicate that age of the patient at time of shunt placement, etiology of hydrocephalus, and previous treatments before shunt surgery were independently significantly associated with the shunt survival. Prospective controlled studies are required to address the observed associations between the risk factors and incidence of shunt revisions in these patients.

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Prevalence, Genotypic Distribution and the associated Risk Factors of Hepatitis C Infection in Pakistan Pediatric Patients

Journal of Pure and Applied Microbiology ◽

10.22207/jpam.16.1.01 ◽

2022 ◽

Author(s):

Muhammad Numan ◽

Mateen Jabbar ◽

Aizza Zafar ◽

Humera Javed ◽

Sonia Younas ◽

...

Keyword(s):

Risk Factors ◽

Hepatitis C ◽

Blood Transfusion ◽

Surgical Procedures ◽

Pediatric Patients ◽

Hcv Rna ◽

Factors Associated ◽

Hcv Transmission ◽

History Of ◽

Genotype 3A

Hepatitis C virus (HCV) is an important contributor to chronic morbidity and mortality in developing countries. The study’s objective was to determine the genotype distribution and risk factors associated with the transmission of HCV infections in pediatric patients. Rapid screening and confirmation by the enzyme-linked immunosorbent assay (ELISA) were used to analyze 585 pediatric blood specimens hospitalized and visited the outpatient department of the largest tertiary care hospital in Pakistan. Detection and genotyping of HCV RNA were performed using a real-time polymerase chain reaction (RT-PCR). Demographic data and a history of risk factors were gathered through a survey questionnaire. HCV RNA was detected in 323 (72.4%) cases which showed viral load ranging from Log10 IU/mL < 3 to > 6 IU/mL. HCV genotype 3a was detected in 256 (79.3%) cases while type 3b and 1a was observed in 36 (11.1%) and 31 (9.6%) patients, respectively. HCV positivity was significantly associated with the cases from rural areas [p = 0.005; odds ratio (OR) 1.65; 95% CI 1.16-2.23] and also significantly associated with low-income group [p < 0.001; OR 5.75; 95% CI 3.90-8.40]. The primary risk factors associated with HCV transmission in children were family history (p = 0.002), blood transfusion (p = 0.03), surgical procedures (p = 0.02), and history of injections (p = 0.05). HCV genotype 3a is the most common genotype in children. The main risk factors for HCV transmission in children are blood transfusion, surgical procedures, and injection practices by informal health care providers.

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