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Villeneuve LM, Evans AR, Bowen I, Gernsback J, Balsara K, Jea A, Desai VR. A systematic review of the power of standardization in pediatric neurosurgery. Neurosurg Rev 2023; 46:325. [PMID: 38049561 DOI: 10.1007/s10143-023-02218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Abstract
In the current neurosurgical field, there is a constant emphasis on providing the best care with the most value. Such work requires the constant optimization of not only surgical but also perioperative services. Recent work has demonstrated the power of standardized techniques in limiting complication while promoting optimal outcomes. In this review article, protocols addressing operative and perioperative care for common pediatric neurosurgical procedures are discussed. These articles address how various institutions have optimized procedures through standardization. Our objective is to improve patient outcomes through the optimization of protocols.
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Affiliation(s)
- Lance M Villeneuve
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA.
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA.
| | - Alexander R Evans
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
| | - Ira Bowen
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
| | - Joanna Gernsback
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
| | - Karl Balsara
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
| | - Andrew Jea
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
| | - Virendra R Desai
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
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2
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Lopez-Ayuso CA, Garcia-Contreras R, Manisekaran R, Figueroa M, Arenas-Arrocena MC, Hernandez-Padron G, Pozos-Guillén A, Acosta-Torres LS. Evaluation of the biological responses of silver nanoparticles synthesized using Pelargonium x hortorum extract. RSC Adv 2023; 13:29784-29800. [PMID: 37829709 PMCID: PMC10565737 DOI: 10.1039/d3ra00201b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
Silver nanoparticles (AgNPs) are one of the widely studied nanomaterials for diverse biomedical applications, in particular, as antimicrobial agents to kill bacteria, fungi, and viruses. In this report, AgNPs were synthesized using a geranium (Pelargonium x hortorum) leaves extract and tested for their antimicrobial and cytotoxic activity and reactive oxygen species (ROS) production. Using green biosynthesis, the leaves extract was employed as a reducing and stabilizing agent. Synthesis parameters like reaction time and precursor (silver nitrate AgNO3) volume final were modified, and the products were tested against Streptococcus mutans. For the first time, the metabolomic analysis of extract, we have identified more than 50 metabolites. The UV-Vis analysis showed a peak ranging from 410-430 nm, and TEM confirmed their nearly spherical morphology for all NPs. The antimicrobial activity of the NPs revealed a minimum inhibitory concentration (MIC) of 10 μg mL-1. Concerning cytotoxicity, a dose-time-dependent effect was observed with a 50% cellular cytotoxicity concentration (CC50) of 4.51 μg mL-1 at 24 h. Interestingly, the cell nuclei were visualized using fluorescence microscopy, and no significant changes were observed. These results suggest that synthesized spherical AgNPs are promising potential candidates for medical applications.
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Affiliation(s)
- Christian Andrea Lopez-Ayuso
- Programa de Doctorado en Ciencias Odontológicas, Universidad Nacional Autónoma de México (UNAM) Mexico
- Interdisciplinary Research Laboratory (LII), Nanostructures and Biomaterials Area, Escuela Nacional de Estudios Superiores (ENES) Unidad León, Universidad Nacional Autónoma de México Predio el Saucillo y el Potrero, Comunidad de los Tepetates 37684 León Mexico
| | - Rene Garcia-Contreras
- Interdisciplinary Research Laboratory (LII), Nanostructures and Biomaterials Area, Escuela Nacional de Estudios Superiores (ENES) Unidad León, Universidad Nacional Autónoma de México Predio el Saucillo y el Potrero, Comunidad de los Tepetates 37684 León Mexico
| | - Ravichandran Manisekaran
- Interdisciplinary Research Laboratory (LII), Nanostructures and Biomaterials Area, Escuela Nacional de Estudios Superiores (ENES) Unidad León, Universidad Nacional Autónoma de México Predio el Saucillo y el Potrero, Comunidad de los Tepetates 37684 León Mexico
| | | | - Ma Concepción Arenas-Arrocena
- Interdisciplinary Research Laboratory (LII), Nanostructures and Biomaterials Area, Escuela Nacional de Estudios Superiores (ENES) Unidad León, Universidad Nacional Autónoma de México Predio el Saucillo y el Potrero, Comunidad de los Tepetates 37684 León Mexico
| | - Genoveva Hernandez-Padron
- Centro de Física Aplicada y Tecnología Avanzada (CFATA), Departamento de Nanotecnología, Universidad Nacional Autónoma de México Campus Juriquilla Juriquilla 76230 Mexico
| | - Amaury Pozos-Guillén
- Basic Science Laboratory, Faculty of Stomatology, San Luis Potosí University Av. Dr. Manuel Nava #2, Zona Universitaria 78290 San Luis Potosí SLP Mexico
| | - Laura Susana Acosta-Torres
- Interdisciplinary Research Laboratory (LII), Nanostructures and Biomaterials Area, Escuela Nacional de Estudios Superiores (ENES) Unidad León, Universidad Nacional Autónoma de México Predio el Saucillo y el Potrero, Comunidad de los Tepetates 37684 León Mexico
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Preston J, Biglino G, Harbottle V, Dalrymple E, Stalford H, Beresford MW. Reporting involvement activities with children and young people in paediatric research: a framework analysis. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:61. [PMID: 37525218 PMCID: PMC10388467 DOI: 10.1186/s40900-023-00477-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The active involvement of patients and the public in the design and delivery of health research has been increasingly encouraged, if not enforced. Knowledge of how this is realised in practice, especially where children and young people (CYP) are concerned, is limited, partly due to the low level of reporting of patient and public involvement (PPI) in general. The aim of this work was to assess how researchers funded by the National Institute for Health and Care Research (NIHR) report the involvement of CYP in the design and conduct of child health research to better understand the opportunities offered to CYP, and the realities of involvement in practice. METHODS A participation matrix, analysis framework and accompanying tools were adapted from existing frameworks, including a child-rights informed framework, the Guidance for Reporting Involvement of Patients and the Public Checklist Short Form (GRIPP2SF), and NIHR reporting expectations. Child-focused research reports were identified from the NIHR Journals Library, including any interventional or observational study involving CYP aged 0-< 24 years. In two co-design workshops with healthcare professionals and CYP, we tested and refined the participation matrix, analysis framework and accompanying tools. RESULTS Only thirty-two NIHR reports out of 169 (19%) were identified as relevant and included reporting of PPI with CYP. We identified significant variability in the way PPI with CYP was reported. Only 4/32 (12%) reports fully met NIHR (and GRIPP2SF) reporting criteria. Only 3/32 (9%) reports formally evaluated or self-reflected on PPI activities with CYP, whilst 15/32 (47%) provided minimal information about CYP involvement. The most common approach to involving CYP (23/32, 72%) was through the medium of existing groups or networks. CONCLUSION Despite the NIHR's commitment to increase the quality, transparency, and consistency of reporting PPI, the reporting of involvement with CYP remains sub-optimal. Neglecting to report key details of involvement methods and impacts deprives the research community of knowledge to advance the field of delivering 'meaningful' PPI with CYP. Practical guidance on how researchers can report the processes and outputs of CYP involvement more rigorously may help child health researchers to involve them more meaningfully. This research offers practical tools informed by CYP to aid the reporting process.
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Affiliation(s)
- Jennifer Preston
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | | | - Victoria Harbottle
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
- Rehabilitation Department, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Emma Dalrymple
- Institute of Child Health, University College London, London, UK
| | - Helen Stalford
- School of Social Justice and Law, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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4
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Whitehead WE, Weiner HL. Infantile and Childhood Hydrocephalus. N Engl J Med 2022; 387:2067-2073. [PMID: 36449422 DOI: 10.1056/nejmra2116504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- William E Whitehead
- From the Department of Neurosurgery, Baylor College of Medicine, and the Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital - both in Houston (W.E.W., H.L.W.)
| | - Howard L Weiner
- From the Department of Neurosurgery, Baylor College of Medicine, and the Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital - both in Houston (W.E.W., H.L.W.)
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Sun Z, Dong S, Fu L, Miao X, Duan X, Xue F. Factors Affecting Development of Infection After Implantation of Ventriculoperitoneal Shunts in Patients with Posttraumatic Hydrocephalus. World Neurosurg 2022; 166:e435-e442. [PMID: 35843578 DOI: 10.1016/j.wneu.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with posttraumatic hydrocephalus (PTH) have a high incidence of infection after ventriculoperitoneal shunt (VPS). In this study, we investigated different risk factors affecting infection after VPS in PTH patients. METHODS Clinical data on PTH patients with VPS in Shaanxi Provincial People's Hospital from March 2012 to November 2020 were collected and analyzed retrospectively. We evaluated the relevance of patients' sex, age, cause of hydrocephalus, severity of hydrocephalus, types of hydrocephalus, hypertension, diabetes, decompressive craniectomy (DC), abdominal surgery, and duration of VPS surgery in the development of postoperative infection. Predictive values of different risk factors for the development of postoperative infection were analyzed using the receiver operating characteristic curve. RESULTS Shunt infection occurred in 38 patients (10.2% of cases). We found that patients >60 years of age with severe hydrocephalus, hypertension, diabetes, DC, and duration of surgery for VPS >60 minutes were at a significantly higher risk of developing an infection after VPS (P < 0.05). The area under the curve was used to predict shunt infection using age (0.611), severe hydrocephalus (0.589), hypertension (0.641), diabetes (0.657), DC (0.640), and duration of operation (0.600) as independent risk factors. The area under the curve of shunt infection predicted by whole index was 0.871. CONCLUSIONS Age, severe hydrocephalus, hypertension, diabetes, DC, as well as duration of operation for VPS (>60 minutes) were factors that significantly and independently correlated with the incidence of infection after VPS. The receiver operating characteristic curve that we have developed can predict the occurrence of shunt infection.
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Affiliation(s)
- Zhen Sun
- Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Shengpu Dong
- Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Lei Fu
- Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Xingyu Miao
- Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Xianglong Duan
- Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China; Affiliated Hospital of Northwestern Polytechnical University, Xi'an, Shaanxi, China
| | - Fei Xue
- Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China; Affiliated Hospital of Northwestern Polytechnical University, Xi'an, Shaanxi, China.
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Current practice in the measurement and interpretation of intervention adherence in randomised controlled trials: A systematic review. Contemp Clin Trials 2022; 118:106788. [PMID: 35562000 DOI: 10.1016/j.cct.2022.106788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ideally all participants in a randomised controlled trial (RCT) should fully receive their allocated intervention; however, this rarely occurs in practice. Intervention adherence affects Type II error so influences the interpretation of trial results and subsequent implementation. We aimed to describe current practice in the definition, measurement, and reporting of intervention adherence in non-pharmacological RCTs, and how this data is incorporated into a trial's interpretation and conclusions. METHODS We conducted a systematic review of phase III RCTs published between January 2018 and June 2020 in the National Institute for Health Research Journals Library for the Health Technology Assessment, Programme Grants for Applied Research, and Public Health Research funding streams. RESULTS Of 237 reports published, 76 met the eligibility criteria and were included. Most RCTs (n = 68, 89.5%) reported adherence, though use of terminology varied widely; nearly three quarters of these (n = 49, 72.1%) conducted a sensitivity analysis. Adherence measures varied between intervention types: behavioural change (n = 10, 43.5%), psychological therapy (n = 5, 83.3%) and physiotherapy/rehabilitation (n = 8, 66.7%) interventions predominately measured adherence based on session attendance. Whereas medical device and surgical interventions (n = 17, 73.9%) primarily record the number of participants receiving the allocated intervention, a third (n = 33, 67.3%) of studies reported a difference in findings between primary and sensitivity analyses. CONCLUSIONS Although most trials report elements of adherence, terminology was inconsistent, and there was no systematic approach to its measurement, analyses, interpretation, or reporting. Given the importance of adherence within clinical trials, there is a pressing need for a standardised approach or framework.
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Juhler M, Hansen TS, Novrup HVG, MacAulay N, Munch TN. Hydrocephalus Study Design: Testing New Hypotheses in Clinical Studies and Bench-to-Bedside Research. World Neurosurg 2022; 161:424-431. [PMID: 35505563 DOI: 10.1016/j.wneu.2021.12.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 10/18/2022]
Abstract
In this article, we aimed to describe some of the currently most challenging problems in neurosurgical management of hydrocephalus and how these can be reasons for inspiration for and development of research. We chose 4 areas of focus: 2 dedicated to improvement of current treatments (shunt implant surgery and endoscopic hydrocephalus surgery) and 2 dedicated to emerging future treatment principles (molecular mechanisms of cerebrospinal fluid secretion and hydrocephalus genetics).
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Affiliation(s)
- Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Hans V G Novrup
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna MacAulay
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Tina Nørgaard Munch
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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Udayakumaran S, Pillai S, Dwarakanath S, Bhattacharjee S, Mehrotra N, Raju S, Gupta D, Panigrahi M, Venkataramana NK, Rajshekhar V, Sankhla S. Indian Society of Pediatric Neurosurgery Consensus Guidelines on Preventing and Managing Shunt Infection: Version 2020-21. Neurol India 2021; 69:S526-S555. [PMID: 35103012 DOI: 10.4103/0028-3886.332268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Shunt infection is the most significant morbidity associated with shunt surgery. Based on the existing literature for the prevention and management of shunt infection, region and resource-specific recommendations are needed. Methods In February 2020, a Guidelines Development Group (GDG) was created by the Indian Society of Paediatric Neurosurgery (IndSPN) to formulate guidelines on shunt infections, which would be relevant to our country and LMIC in general. An initial email survey identified existing practices among the membership of the IndSPN, and eight broad issues pertaining to shunt infection were identified. Next, members of the GDG performed a systematic review of the literature on the prevention and management of shunt infection. Then, through a series of virtual meetings of the GDG over 1 year, evidence from the literature was presented to all the members and consensus was built on different aspects of shunt infection. Finally, the guidelines document was drafted and circulated among the GDG for final approval. Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to grade the evidence and strength of recommendation. Results The guidelines are divided into eight sections. Level I and Level II evidence was available for only five recommendations and led to a moderate level of recommendations. Most of the available evidence was at Level III and below, and hence the level of recommendation was low or very low. A consensus method was used to provide recommendations for several issues. Conclusions Although most of the recommendations for the prevention and management of shunt infections are based on a low level of evidence, we believe that this document will provide a useful reference to neurosurgeons not only in India but also in other low and middle income countries. These guidelines need to be updated as and when new evidence emerges.
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Affiliation(s)
- Suhas Udayakumaran
- Division of Paediatric Neurosurgery, Department of Neurosurgery, Amrita Institute Of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Shibu Pillai
- Department of Neurosurgery, Narayana Institute of Neurosciences, Bengaluru, Karnataka, India
| | - Srinivas Dwarakanath
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suchanda Bhattacharjee
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Naveen Mehrotra
- Consultant Neurosurgeon, Sunshine Hospitals, Secunderabad, Telangana, India
| | - Subodh Raju
- Institute of Neurosciences, AIG Hospitals, Hyderabad, Telangana, India
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Science, Hyderabad, Telangana, India
| | | | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Suresh Sankhla
- Department of Neurosurgery, Global Hospital, Mumbai, Maharashtra, India
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Abstract
Background Ventriculoperitoneal shunt surgery (VPS) is a simple solution to the problem of hydrocephalus. However, it is associated with significant complications. Meticulous attention to a variety of factors, techniques, and nuances in VPS can reduce these complications. Objective To review the various techniques and nuances during the different stages of VPS. Methods and Material PubMed search for original and review articles dealing with various techniques used during VPS. Results Thorough preoperative planning for VPS reduces operative time and complications. A standardized shunt surgery protocol significantly reduces shunt infection. Good and appropriate surgical technique can enhance the safety of the procedure. Anterior entry point is better than posterior entry point. Shunt tip should be away from choroid plexus, but the exact location is not vital for shunt survival. Proper placement of the shunt in the subgaleal and subcutaneous plane reduces wound and skin breakdown over the shunt. The trocar and laparoscopic methods to access the peritoneum are associated with fewer distal obstructions compared to mini-laparotomy. Perioperative antibiotic prophylaxis, use of antibiotic-impregnated shunts, and sutures are proven techniques to reduce shunt infection. Conclusions Preoperative planning, a standardized shunt surgery protocol, good surgical technique, gentle tissue handling, and short surgery duration are essential to reduce VPS complications. Specifically, use of anterior entry point, correct tunneling of the shunt in the subgaleal and subcutaneous plane, appropriate antibiotic prophylaxis, use of antibiotic-impregnated shunts, and meticulous skin closure using antimicrobial sutures can lead to a reduction in shunt malfunction and infection.
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Affiliation(s)
- Shibu V Pillai
- Department of Neurosurgery, Institute of Neurosciences, Mazumdar Shaw Medical Center, Narayana Health City, Hosur Road, Bangalore, Karnataka, India
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Ferreira Furtado LM, Da Costa Val Filho JA, Moreira Faleiro R, Lima Vieira JA, Dantas Dos Santos AK. Abdominal Complications Related to Ventriculoperitoneal Shunt Placement: A Comprehensive Review of Literature. Cureus 2021; 13:e13230. [PMID: 33585146 PMCID: PMC7877257 DOI: 10.7759/cureus.13230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have been saved. In addition, abdominal complications have become an important issue as the peritoneum is now the main place to insert the distal catheter. The most common complications were abdominal pseudocyst, distal catheter migration, inguinal hernia, catheter disconnection, and intestinal obstruction. The pediatric population is more prone to develop most of these complications due to their rapidly growing body, weaker abdominal musculature, and increased intraabdominal pressure. The goal of this review was to study the main aspects associated with abdominal complications after ventriculoperitoneal shunt (VPS) insertion, including the pathophysiology, epidemiological aspects, as well as the rationale for management and prevention according to the current “state-of-the-art.” It is paramount to recognize the risk factors associated with various types of complications to manage them properly.
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Affiliation(s)
| | | | - Rodrigo Moreira Faleiro
- Department of Neurosurgery, João XXIII Hospital/Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, BRA
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Shah S, Singhal T, Naik R, Thakkar P. Predominance of multidrug-resistant Gram-negative organisms as cause of surgical site infections at a private tertiary care hospital in Mumbai, India. Indian J Med Microbiol 2020; 38:344-350. [PMID: 33154245 DOI: 10.4103/ijmm.ijmm_20_284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background This study aims to study the incidence, microbial aetiology and antimicrobial susceptibility of surgical site infections (SSIs) at a private tertiary care hospital in Mumbai, India, and compare it with previously published data from the same institute as well as literature. Methods This is a prospective observational study done over 6 years (January 2013-December 2018) at a 750-bed private multi-specialty hospital in Mumbai, India, among all patients undergoing clean and clean-contaminated surgeries. Standard guidelines for preventing, diagnosing and classifying SSIs were followed. The incidence rates of SSI (overall and specialty specific), microbial aetiology and antibiotic susceptibility of SSI were calculated and expressed as percentages. Results A total of 55,553 patients underwent clean and clean-contaminated surgeries during the study period. The overall SSI rate was 1.0% (555 cases). The SSI rate in clean surgeries was 0.97% and in clean-contaminated surgeries was 1.03%. Sixty-five per cent of SSIs were due to Gram-negative bacilli, 30% were due to Gram-positive cocci and 4% were due to Candida. Klebsiella pneumoniae (19%), Escherichia coli (17%), Pseudomonas aeruginosa (13%), Staphylococcus aureus(12%) and Enterococcus (10%) were the top five organisms. The overall susceptibility rate of the Gram-negative isolates to beta-lactam-beta-lactamase inhibitor combinations was 60% and carbapenems was 73%. The prevalence of methicillin resistance in S. aureus was 44% and coagulase-negative Staphylococcus was 84%. The crude mortality rate was 1%. Conclusions Although the SSI rate is comparable to established international benchmarks, the predominance of multidrug-resistant Gram-negative organisms is a matter of serious concern.
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Affiliation(s)
- Sweta Shah
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Tanu Singhal
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Reshma Naik
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Pooja Thakkar
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
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