scholarly journals Improving Infant Hydrocephalus Outcomes in Uganda: A Longitudinal Prospective Study Protocol for Predicting Developmental Outcomes and Identifying Patients at Risk for Early Treatment Failure after ETV/CPC

Metabolites ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 78
Author(s):  
Taylor A. Vadset ◽  
Ajay Rajaram ◽  
Chuan-Heng Hsiao ◽  
Miriah Kemigisha Katungi ◽  
Joshua Magombe ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Near Infrared ◽  
Third Ventriculostomy ◽  
Clinical Workflow ◽  
Neurodevelopmental Outcomes ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Operative Care ◽  
Patients At Risk ◽  
Ventricle Volume

Infant hydrocephalus poses a severe global health burden; 80% of cases occur in the developing world where patients have limited access to neurosurgical care. Surgical treatment combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC), first practiced at CURE Children’s Hospital of Uganda (CCHU), is as effective as standard ventriculoperitoneal shunt (VPS) placement while requiring fewer resources and less post-operative care. Although treatment focuses on controlling ventricle size, this has little association with treatment failure or long-term outcome. This study aims to monitor the progression of hydrocephalus and treatment response, and investigate the association between cerebral physiology, brain growth, and neurodevelopmental outcomes following surgery. We will enroll 300 infants admitted to CCHU for treatment. All patients will receive pre/post-operative measurements of cerebral tissue oxygenation (SO2), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2) using frequency-domain near-infrared combined with diffuse correlation spectroscopies (FDNIRS-DCS). Infants will also receive brain imaging, to monitor tissue/ventricle volume, and neurodevelopmental assessments until two years of age. This study will provide a foundation for implementing cerebral physiological monitoring to establish evidence-based guidelines for hydrocephalus treatment. This paper outlines the protocol, clinical workflow, data management, and analysis plan of this international, multi-center trial.

Effects of Neonatal Thoracoscopic Surgery on Tissue Oxygenation: A Pilot Study on (Neuro-) Monitoring and Outcomes

2017 ◽  
Vol 29 (02) ◽  
pp. 166-172 ◽  
Author(s):  
John Vlot ◽  
Joost van Rosmalen ◽  
René Wijnen ◽  
Frank Weber ◽  
Sophie Costerus
Keyword(s):  
Pilot Study ◽  
Near Infrared ◽  
Thoracoscopic Surgery ◽  
Neurodevelopmental Outcome ◽  
Neurodevelopmental Outcomes ◽  
Term Outcome ◽  
Specific Patient ◽  
Long Term Outcome ◽  
Arterial Blood ◽  
Thoracoscopic Repair

Introduction Multiple reports have questioned the feasibility of neonatal thoracoscopic repair of congenital diaphragmatic hernia (CDH) and esophageal atresia (EA). The aim of this study is to examine the effects of CO2 pneumothorax on cerebral and renal rSO2 and to assess the potential predictive value of these data on neurodevelopmental outcome after neonatal thoracoscopic surgery for CDH or EA. Materials and Methods A prospective observational pilot study. Cerebral and renal regional tissue oxyhemoglobine saturation (rSO2) rSO2 were assessed using near-infrared spectroscopy (NIRS) during thoracoscopic surgery in neonates with CDH and with EA, in addition to routine anesthesia monitoring. Cerebral and renal rSO2, linked to repeated arterial blood gas analyses, heart rate, blood pressure, and to structured longitudinal neurodevelopmental follow-up. Results Baseline estimated marginal means of cerebral rSO2 values (CDH: 82%, EA: 91%) did not change significantly during pneumothorax (CDH: 81%, EA 79% [n.s. versus baseline]) despite severe acidosis (lowest pH, CDH: 6.99, EA: 7.1). Neurodevelopmental outcomes at 24 months were normal in all 7 patients who were available for evaluation. Conclusion Neonatal thoracoscopic repair of CDH and EA using CO2-pneumothorax leads to severe acidosis. Cerebral rSO2 remained within clinical acceptable limits during intraoperative periods of acidosis. Neurodevelopmental outcome was favorable within the first 24 months. The potential of NIRS to further improve perioperative care and long-term outcome in this specific patient group deserves further investigation.

Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus: validation of a success score that predicts long-term outcome

2011 ◽  
Vol 8 (5) ◽  
pp. 489-493 ◽  
Author(s):  
Andrew J. Durnford ◽  
Fenella J. Kirkham ◽  
Nijaguna Mathad ◽  
Owen C. E. Sparrow
Keyword(s):  
Clinical Decision Making ◽  
Endoscopic Third Ventriculostomy ◽  
Risk Groups ◽  
Individual Characteristics ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
High Chance

Object The goal of this study was to externally validate the proposed Endoscopic Third Ventriculostomy Success Score (ETVSS), which predicts successful treatment for hydrocephalus on the basis of a child's individual characteristics. Methods The authors retrospectively identified 181 cases of consecutive endoscopic third ventriculostomy (ETV) performed in children at a single neurosurgery center in the United Kingdom. They compared actual success at both 6 and 36 months, with mean predicted probabilities for low, moderate, and high chance of success strata based on the ETVSS. Long-term success was calculated using Kaplan-Meier methods and comparisons were made by means of unpaired t-tests. Results Overall, 166 primary ETVs were performed; ETV success was 72.9% at 6 and 64.5% at 36 months. At long-term follow-up, the mean predicted probability of success was significantly higher in those with a successful ETV (99 patients) than in those with a failed ETV (67 patients) (p = 0.001). The ETVSS accurately predicted outcome at 36 months; the low, medium, and high chance of success strata had mean predicted probabilities of success of 82%, 63%, and 36%, and actual success of 76%, 66%, and 42%, respectively. The overall complication rate was 6%. Conclusions The ETVSS closely predicted the overall long-term success rates in high-, moderate-, and low-risk groups. The results of this study suggest that the ETVSS will aid clinical decision making in predicting outcome of ETV.

scholarly journals Influence of Maternal Preeclampsia on Neurodevelopmental Outcomes of Preterm Infants

2018 ◽  
Vol 24 (2) ◽  
pp. 99
Author(s):  
Halil Degirmencioglu ◽  
Birgul Say ◽  
Zeynep Ustunyurt ◽  
Serife Suna Oguz
Keyword(s):  
Cerebral Palsy ◽  
Preterm Infants ◽  
Gestational Age ◽  
Infant Development ◽  
Neurodevelopmental Outcome ◽  
Control Group ◽  
Neurodevelopmental Outcomes ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Mean

<p><strong>Objective:</strong> The aim of this study was to determine the neurodevelopmental outcome of preterm infants born to mothers with preeclampsia and to compare them with preterm controls.</p><p><strong>Study design:</strong> This was a retrospective, observational study in a large, tertiary, neonatal intensive care unit. Neurodevelopmental evaluations using Bayley Scales of Infant Development II were performed in 226 two-year-old infants with birth weight ≤1500 g and gestational age ≤32 weeks who were born to mothers with preeclampsia and in 493 infants who were born after normotensive pregnancies, matched for gestational age and gender.</p><p><strong>Results:</strong> The mean gestational ages of the infants in the preeclampsia and control groups were 29.9±2.3 weeks and 28.7±4.1 weeks, respectively (p&lt;0.001). A total of 372 infants with a mean age of 19.2±3.2 months were assessed for long-term outcome. The mean mental developmental index score was significantly higher, and the percentage of infants with cerebral palsy was significantly lower, in the preeclampsia group compared with the control group (p=0.03 and p=0.02, respectively). However, no overall significant differences in neurodevelopmental impairment rates were found between the two groups (p=0.08).</p><p><strong>Conclusion:</strong> Maternal preeclampsia seems to be a protector factor for the development of cerebral palsy in preterm infants.</p>

Comprehensive Evaluation of Time-to-Response Parameter as a Predictor of Long-Term Outcomes Following Imatinib Therapy in Chronic Phase Chronic Myeloid Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1110-1110
Author(s):  
Dong Hwan (Dennis) Kim ◽  
Jung A. Kim ◽  
Jina Yun ◽  
Lakshmi Sriharsha ◽  
Jun Ho Jang ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Chronic Phase ◽  
Cytogenetic Response ◽  
Imatinib Therapy ◽  
Long Term Outcomes ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Log Reduction

Abstract Abstract 1110 Poster Board I-132 Introduction Early recognition of high-risk patients is important when planning further therapeutic intervention for imatinib treatment failure in patients with chronic myeloid leukemia (CML). Current guideline such as European Leukemia Network (ELN) emphasizes 3, 6, 12, and 18 months cutoff as decision point of imatinib therapy for CML. However, direct evidence of ELN guideline is still lacking. In addition, some controversy surrounds the questions: 1) which of the short-term response parameters (major cytogenetic response [MCyR], complete cytogenetic response [CCyR], or major molecular response [MMR]) is the best surrogate for long-term outcomes, 2) which time point (6, 12 or 18 months) reflect the best correlation with long-term outcomes and 3) if we exclusively use BCR/ABL quantitative PCR to monitor the response, what value for BCR/ABL levels is the best predictor for long-term outcomes. Methods In this comprehensive analysis, we adopted the landmark analysis method, time-dependent Cox's proportional hazard model and receiver-operating characteristics (ROC) method to analyze time-to-response parameter as predictor of long-term outcomes in 187 chronic phase (CP) CML patients receiving imatinib at least for one year at the Princess Margaret Hospital (Toronto, Canada). Results Regardless of the method of analysis, we found that the earlier achievement of short-term response such as CCyR or MMR could predict the higher probability of achieving better interim outcome (such as treatment failure or loss of response), but not a long-term outcome (such as overall survival). Similar to the finding from other studies, our ROC analysis provided cutoff time range for MMR (18-36 months) and CCyR (6-12 months) that were the best predictors for CMR, LOR or treatment failure. Accordingly, the cutoffs of 12 months of CCyR or 18 months of MMR in the ELN guideline for the definition of suboptimal response could be justified based on the current result. In addition, BCR/ABL transcripts of 1.5-2.0 log reduction at 6 months and 2.0-2.5 log reduction at 12 months were better predictors of long-term outcomes following imatinib therapy in CP CML patients than the achievement of CCyR or MMR at 12 months. Conclusion The results of the current study confirm that regardless of the analytic method used (landmark analysis or time-dependent Cox's analysis), the time-to-response short-term parameter could predict the interim subsequent outcome (i.e., loss of response), but not a long-term outcome (i.e. overall survival). The ROC analysis method could provide the answer of when CML patients will be evaluated for appropriate response following imatinib therapy (i.e. MMR at 18-36 months and CCyR at 6-12 months). The current data can be a supporting evidence of ELN criteria definition of suboptimal response. In addition, the present study also suggested that the BCR/ABL transcript levels at 6 or 12 months could be an alternative early predictor of long-term outcomes. Disclosures No relevant conflicts of interest to declare.

scholarly journals Long-Term Outcome of Pyogenic Vertebral Osteomyelitis: A Cohort Study of 260 Patients

2014 ◽  
Vol 1 (3) ◽  
Author(s):  
Arjun Gupta ◽  
Todd J. Kowalski ◽  
Douglas R. Osmon ◽  
Mark Enzler ◽  
James M. Steckelberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Back Pain ◽  
Treatment Failure ◽  
Vertebral Osteomyelitis ◽  
Term Outcome ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Pyogenic Vertebral Osteomyelitis

Abstract Background.  The long-term outcome of patients with pyogenic vertebral osteomyelitis (PVO) has not been fully assessed. Methods.  We conducted a retrospective cohort study to describe the long-term outcome of PVO and to assess risk factors for treatment failure in patients evaluated at our institution between 1994 and 2002. Patients were observed until July 1, 2013. Results.  Two hundred sixty patients with PVO were included in this study. Twenty-seven percent (70) of patients developed their infection after an invasive spinal procedure. Staphylococcus aureus accounted for 40% (103) of infections. Forty-nine percent (128) of patients underwent spinal surgery as part of their initial therapy. The median duration of parenteral antimicrobial therapy was 42 days (interquartile range, 38–53). The estimated 2-, 5-, and 10-year cumulative probability of treatment failure-free survival was 72%, 69%, and 69%, respectively. Seventy-five percent of patients who developed treatment failure did so within 4.7 months of diagnosis. Residual neurological defects and persistent back pain were seen in 16% and 32% of patients, respectively. In a multivariate analysis, longer duration of symptoms before diagnosis and having an infection with S. aureus were associated with increased risk of treatment failure. Conclusions.  Increasing duration of symptoms and infection with S. aureus were associated with treatment failure in patients with PVO. Most treatment failures occurred early after initiation of treatment. Pyogenic vertebral osteomyelitis is associated with a high 2-year failure rate. Persistent neurological deficits and back pain are common after therapy.

Long-Term Outcome of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

2007 ◽  
Vol 50 (5) ◽  
pp. 265-269 ◽  
Author(s):  
M. Gangemi ◽  
C. Mascari ◽  
F. Maiuri ◽  
U. Godano ◽  
P. Donati ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventriculostomy ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Roos E. Barth ◽  
Hugo A. Tempelman ◽  
Robert Moraba ◽  
Andy I. M. Hoepelman
Keyword(s):  
Treatment Failure ◽  
Virological Failure ◽  
Hiv Treatment ◽  
Early Mortality ◽  
Term Outcome ◽  
Rural South ◽  
Long Term Outcome ◽  
Hiv Rna ◽  
Low Performance

Objective. To define the long-term (2–4 years) clinical and virological outcome of an antiretroviral treatment (ART) programme in rural South Africa.Methods. We performed a retrospective observational cohort study, including 735 patients who initiated ART. Biannual monitoring, including HIV-RNA testing, was performed. Primary endpoint was patient retention; virological suppression (HIV-RNA < 50 copies/mL) and failure (HIV-RNA > 1000 copies/mL) were secondary endpoints. Moreover, possible predictors of treatment failure were analyzed.Results. 63% of patients (466/735) have a fully suppressed HIV-RNA, a median of three years after treatment initiation. Early mortality was high: 14% died within 3 months after treatment start. 16% of patients experienced virological failure, but only 4% was switched to second-line ART. Male gender and a low performance score were associated with treatment failure; immunological failure was a poor predictor of virological failure.Conclusions. An “all or nothing” phenomenon was observed in this rural South African ART programme: high early attrition, but good virological control in those remaining in care. Continued efforts are needed to enrol patients earlier. Furthermore, the observed viro-immunological dissociation emphasises the need to make HIV-RNA testing more widely available.

scholarly journals Endoscopic third ventriculostomy for hydrocephalus: a study of thirty cases

2019 ◽  
Vol 6 (4) ◽  
pp. 1120
Author(s):  
Paresh Sodhiya ◽  
Zafar Ahmed Sheikh ◽  
Mukesh Sharma ◽  
Meen Morey
Keyword(s):  
Success Rate ◽  
Age Groups ◽  
Third Ventriculostomy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Abnormal Accumulation ◽  
Threatening Condition ◽  
Life Threatening ◽  
Surgical Modality

Background: Raised intracranial pressure because of abnormal accumulation of CSF with in the ventricles of brain is a potentially life-threatening condition. Ventriculoperitoneal shunt remains mainstay of treatment even today. However, shunt failure is not uncommon. Hence endoscopic procedures are now gaining popularity. The outcome of ETV with respect to age ,etiology and long-term outcome needs further elucidation.Methods: Thirty patients with hydrocephalus who underwent endoscopic treatment were analysed retrospectively with respect to age, diagnosis, surgical outcome, treatment failure and complications.Results: Total of 28 patients successfully underwent ETV and with an overall success rate of 78%. Moreover, the success rate of ETV was found to be 100% in the 0-1 and 80% in 1-2 years age groups. 2 patients required re operation in the form of VP shunt.Conclusions: ETV is a safe and effective surgical modality with comparable outcome in paediatric and adult populations. 

scholarly journals Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative

Respiration ◽  
2022 ◽  
pp. 1-12
Author(s):  
Yuanyuan Wang ◽  
Victor Pera ◽  
H. Marike Boezen ◽  
Jan-Willem C. Alffenaar ◽  
Bob Wilffert ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Failure ◽  
Antibiotic Treatment ◽  
Real World ◽  
Reference Group ◽  
Chronic Obstructive ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome

<b><i>Background:</i></b> Although antibiotic treatment is recommended for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), its value in real-world settings is still controversial. <b><i>Objectives:</i></b> This study aimed to evaluate the short- and long-term effects of antibiotic treatment on AECOPD outpatients. <b><i>Methods:</i></b> A cohort study was conducted under the PharmLines Initiative. We included participants with a first recorded diagnosis of COPD who received systemic glucocorticoid treatment for an AECOPD episode. The exposed and reference groups were defined based on any antibiotic prescription during the AECOPD treatment. The short-term outcome was AECOPD treatment failure within 14–30 days after the index date. The long-term outcome was time to the next exacerbation. Adjustment for confounding was made using propensity scores. <b><i>Results:</i></b> Of the 1,105 AECOPD patients, antibiotics were prescribed to 518 patients (46.9%) while 587 patients (53.1%) received no antibiotics. The overall antibiotic use was associated with a relative risk reduction of AECOPD treatment failure by 37% compared with the reference group (adjusted odds ratio [aOR] 0.63 [95% CI: 0.40–0.99]). Protective effects were similar for doxycycline, macrolides, and co-amoxiclav, although only the effect of doxycycline was statistically significant (aOR 0.53 [95% CI: 0.28–0.99]). No protective effect was seen for amoxicillin (aOR 1.49 [95% CI: 0.78–2.84]). The risk of and time to the next exacerbation was similar for both groups. <b><i>Conclusion:</i></b> Overall, antibiotic treatment, notably with doxycycline, supplementing systemic glucocorticoids reduces short-term AECOPD treatment failure in real-world outpatient settings. No long-term beneficial effects of antibiotic treatment on AECOPD were found for the prevention of subsequent exacerbations.

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