scholarly journals 2333. Influenza-Related Neurologic Complications in Hospitalized Children with Underlying Neurologic Disorders

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S801-S801
Author(s):  
Sarah Frankl ◽  
Susan E Coffin ◽  
Sanjeev Swami ◽  
Jennifer McGuire
Keyword(s):  
Vaccine Coverage ◽  
Neuromuscular Disorders ◽  
Tertiary Care ◽  
Severe Infection ◽  
Neurological Complications ◽  
Post Exposure Prophylaxis ◽  
Neurologic Complication ◽  
Neurologic Complications ◽  
Neurologic Disorders ◽  
Increased Risk

Abstract Background Children with underlying neurological and neuromuscular conditions are considered “high risk” for developing severe infection due to influenza. Prior reports highlighted this population’s increased risk for respiratory failure. Little is known about neurological complications experienced by children with pre-existing neurologic disorders (PNDs) when infected with influenza. Methods Retrospective cohort study of children 0.5–18.0 years old hospitalized at a tertiary care pediatric hospital between August 2010 and June 2017 with laboratory-confirmed influenza. Eligible children were identified by electronic medical record query for influenza assay CPT codes with positive results during an admission; cases were confirmed by chart review. Demographics and clinical data were abstracted. Results A total of 1217 immune competent children (median age 5.5 [IQR 2.2–9.8] years) were hospitalized with laboratory-confirmed influenza during the study period. About 28% (341/1217) had at least one PND, including epilepsy (n = 105), developmental delay or intellectual disability (n = 234), neurogenetic or metabolic disorders (n = 77), neuromuscular disorders (n = 22) and others (n = 253). Compared with previously healthy peers, these children were more often admitted to the intensive care unit (31% vs. 16%, P < 0.001), had a longer length of stay (3 vs. 2 days, P < 0.001), and had a higher incidence of neurologic complications (23% vs. 6%, P < 0.001). Seizures (18% vs. 4%, P < 0.001) and encephalopathy (8% vs. 2%, P < 0.001) in particular were more common in children with PNDs, but other neurologic complications occurred in comparable proportions (3% vs. 1%, P = 0.088). Only 49% of the overall cohort had documented annual influenza vaccine; coverage was slightly better for children with PNDs than those without (55% vs. 48%, P = 0.017). The odds of having a neurologic complication in children with documented vaccination was nearly half that of other children when adjusted for age, influenza strain, and any PND (adjusted OR 0.64, 95% CI 0.44–0.94, P = 0.021). Conclusion The excess risk of neurological complications in children with PNDs highlights the importance of vaccinating this population. Additional consideration should be given to post-exposure prophylaxis for children with PNDs who have not received vaccine. Disclosures All authors: No reported disclosures.

scholarly journals Factors for Hospitalizations and Neurologic Complications in Zika Virus Infection in the Department of Veterans Affairs (VA)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S319-S319
Author(s):  
Patricia Schirmer ◽  
Aaron Wendelboe ◽  
Cynthia Lucero-Obusan ◽  
Russell Ryono ◽  
Gina Oda ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Zika Virus ◽  
Neurological Complications ◽  
Clinical Samples ◽  
Prior History ◽  
Neurologic Complications ◽  
Department Of Veterans Affairs ◽  
Neurologic Symptoms ◽  
Factors Associated ◽  
Increased Risk

Abstract Background Zika virus (ZIKV) is an important flavivirus, but severity of infection is poorly described in adults. We investigated factors associated with hospitalization and neurologic complications as measures of severity. Methods ZIKV cases from December 1, 2015 to October 31, 2016 were identified from clinical samples tested in VA, state and commercial laboratories, and patients were followed until 3/31/2017. ZIKV positive patients (RT-PCR or screening IgM positive confirmed by a plaque-reduction neutralization test [PRNT] IgM positive for ZIKV alone or including dengue virus) were reviewed for demographic and clinical factors. Logistic regression analysis was performed to evaluate factors associated with 1) hospitalization and 2) neurologic complications in VA ZIKV positive patients. Results 736 of 1,538 (48%) patients tested were ZIKV positive; 655 (89%) were male and 683 (93%) were diagnosed at the VA Caribbean Healthcare System (VACHCS). In total, 94 (13%) were hospitalized with 91 (12%) at VACHCS. 19 (3%) patients, all at VACHCS, died from any cause after ZIKV diagnosis. Hospitalization was more likely with increased age, co-morbidities, neurologic symptoms, thrombocytopenia, or preadmission glucocorticoid use, and less likely if rash was present (Table 1). Hospitalization, prior cerebrovascular disease and dementia were associated with neurologic complications. Conclusion Older Veterans with multiple comorbidities or presenting with neurologic symptoms were more likely to be hospitalized after ZIKV infection, and those with a prior history of cerebrovascular disease and dementia were at increased risk for neurological complications. Disclosures All authors: No reported disclosures.

scholarly journals Neurological Complications after Lateral Transpsoas Approach to Anterior Interbody Fusion with a Novel Flat-Blade Spine-Fixed Retractor

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Pierce Nunley ◽  
Faheem Sandhu ◽  
Kelly Frank ◽  
Marcus Stone
Keyword(s):  
Surgical Approach ◽  
Interbody Fusion ◽  
Neurological Complications ◽  
Neurologic Complication ◽  
Neurologic Complications ◽  
Residual Symptoms ◽  
Transpsoas Approach ◽  
Retrospective Data Collection ◽  
One Year

Introduction. The lateral lumbar interbody fusion (LLIF) surgical approach has potential advantages over other approaches but is associated with some unique neurologic risks due to the proximity of the lumbosacral plexus. The present study analyzed complications following LLIF surgical approach using a novel single flat-blade retractor system.Methods. A retrospective data collection of patients receiving LLIF using a novel single flat-blade retractor system at two institutions in the US. Inclusion criteria were all patients receiving an LLIF procedure with the RAVINE® Lateral Access System (K2M, Inc., Leesburg, VA, USA). There was no restriction on preoperative diagnosis or number of levels treated. Approach-related neurologic complications were collected and analyzed postoperatively through a minimum of one year.Results. Analysis included 253 patients with one to four treated lateral levels. Immediate postoperative neurologic complications were present in 11.1% (28/253) of patients. At one-year follow-up the approach-related neurologic complications resolved in all except 5 patients (2.0%).Conclusion. We observed an 11.1% neurologic complication rate in LLIF procedures. There was resolution of symptoms for most patients by 12-month follow-up, with only 2% of patients with residual symptoms. This supports the hypothesis that the vast majority of approach-related neurologic symptoms are transient.

scholarly journals Frequency of Cardiovascular Complications in Coronavirus-19 infected Patients during the second wave in a tertiary care Hospital of Lahore, Pakistan

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Ayesha Tariq ◽  
Aneeza Jamshed ◽  
Muhammad Saad Shabbir ◽  
Muhammad Arsalan Aslam ◽  
Ali Sajjad ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Tertiary Care ◽  
Severe Infection ◽  
Cardiovascular Complications ◽  
Cardiac Complication ◽  
Cardiac Complications ◽  
Care Hospital ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Second Wave

Coronavirus 2019 (COVID-19) affects the cardiorespiratory systems by causing inflammation of the circulatory systems, hence, causing more cardiac complications in COVID-19 patients Objective: To observe the frequency of cardiac complications in COVID-19 patients during the second wave Methods: 235 COVID-19 patients presenting with cardiac complication to the Cardiology Department of Mayo Hospital, Lahore during 6 month periods of second wave of COVID-19 were included. Data regarding the medical history, age, gender was taken and the observed cardiac complication were noted Results: There were 76.6% male patients and 23.4% female patients. 56.2 % patients were already hypertensive, 37.9% were diabetic, 18.3% had familial history of cardiac diseases. The cardiovascular manifestations observed were, myocardial infarction (57.82%), 7.3% had angina, 21.3% had acute coronary syndrome and 12.3% had non ST elevation myocardial infarction. Conclusions: Our study suggests that there is a prevalence of cardiovascular diseases in COVID-patients which is a major concern as they are at increased risk for severe infection.

scholarly journals 724. Neurologic Complications in Hospitalized Pediatric Patients with Influenza Infection, A Multicenter Retrospective Study in Korea

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S260-S260
Author(s):  
Gwang-Jun Choi ◽  
Ji Young Park ◽  
Joon-Sik Choi ◽  
Bitna Kim ◽  
Sae Rom Choi ◽  
...  
Keyword(s):  
Febrile Seizure ◽  
Influenza A ◽  
Pediatric Patients ◽  
Influenza Infection ◽  
Influenza B ◽  
Neurologic Complication ◽  
Neurologic Complications ◽  
Neurologic Diseases ◽  
Increased Risk ◽  
Common Diagnosis

Abstract Background The aim of the study was to evaluate the incidence and characteristics of influenza associated neurologic complications (IANCs) in hospitalized pediatric patients in Korea. Methods We performed retrospective review of hospitalized cases of confirmed influenza infection from October 2010 to April 2017. Patient’s data were collected from three referral hospitals in different regions of the country. Results A total 2,002 laboratory confirmed influenza cases were identified. The median age was 3.3 years old (range 0.0–18.9 years) and 1,003 patients were male (54%). Influenza A was diagnosed in 1,357 cases (68%), influenza B in 624 (31%) and both influenza A and B in 21 (1%). Other combined respiratory virus infection was detected in 104 (5.2%) cases. Out of 2,002 cases, IANCs were identified in 167 cases (8.3%); influenza virus A was detected in 116 (69.4%), B in 50 (29.9%) and both A and B in one case (0.6%). Of 167 cases with IANCs, 25 patients (15%) had underlying neurologic diseases. Eleven patients (11/167, 6.5%) had combined respiratory viral infection (Rhinovirus = 5; respiratory syncytial virus = 3; coronavirus = 2; and bocavirus = 1). The most common diagnosis was a simple febrile seizure (112/167, 67.1%), followed by other seizures (26/167, 15.6%), encephalopathy/encephalitis (17/167, 10.2%), meningitis (7/167, 4.2%), meningism (4/167, 2.4%) and acute ataxia (1/167, 0.6%). In two patients with encephalitis/meningitis, one patient had influenza A and the other patient had influenza B detected by PCR in cerebrospinal fluid. Most of the patients were fully recovered (162/167, 97%) and no neurologic complication occurred in patients who had only initial manifestation of simple febrile seizure. Ten patients (10/167, 6.0%) required hospitalization in intensive care unit. Three patients (3/167, 1.8%) died of encephalopathy (n = 1) and combined encephalopathy/myocarditis (n = 2). Pre-existing neurologic disease was a risk factor of IANCs with an odds ratio of 3.94 (95% confidence interval 2.37 to 6.56, P &lt; 0.0001). Conclusion IANCs is not rare and may cause serious outcome including death. Clinicians should be aware of the increased risk for IANCs in certain patients with neurologic diseases. Disclosures All authors: No reported disclosures.

scholarly journals Safety of the transventricular approach to deep brain stimulation: A retrospective review

2019 ◽  
Vol 10 ◽  
pp. 192
Author(s):  
Kevin Ray ◽  
Mark Krel ◽  
Jacob Bernstein ◽  
Samir Kashyap ◽  
Ajay Ananda
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Neurologic Complications ◽  
Data Set ◽  
Increased Risk ◽  
Deep Brain

Background: Anatomically, deep brain stimulation (DBS) targets such as the ventral intermediate and subthalamic nucleus are positioned such that the long axis of the nucleus is often most accessible through a transventricular trajectory. We hypothesize that using this trajectory does not place patients at increased risk of neurologic complications. Methods: A series of 206 patients at a single institution between 2000 and 2017 were reviewed. All patients had a confirmed transventricular trajectory and their clinical course was reviewed to assess neurologic complication rates in the postoperative period. Results: The average length of hospital stay was 2.4 days. The most common neurologic complication was altered mental status in 1.2% of cases (four patients). This was followed by seizure in 0.6% of cases (two patients). No patients had ischemic stroke or postoperative hemiparesis. There were two mortalities in this series, one with lobar hemorrhage contralateral from the surgical site and one with a thalamic hemorrhage. There was only one confirmed intraventricular hemorrhage postoperatively; however, this was clinically asymptomatic. Conclusion: Although the total incidence of intraventricular or intracerebral hemorrhage cannot be reliably assessed from this data set, the low incidence of neurologic complications challenges the notion that DBS electrode trajectories that transgress the ventricle significantly increase the risk of complications.

Study of sharp injuries and blood splash exposures among healthcare workers in a tertiary hospital in Bangalore

2016 ◽  
Vol 12 (3) ◽  
Author(s):  
Shalini Sivananjiah Pradeep ◽  
Suman Gadicherla Raghu ◽  
Prathab A G ◽  
Banashankari G Rudresh ◽  
Radhika Kunnavil
Keyword(s):  
Healthcare Workers ◽  
Tertiary Hospital ◽  
Post Exposure Prophylaxis ◽  
Care Hospital ◽  
Post Exposure ◽  
Increased Risk ◽  
Management Procedures ◽  
Exposure Prophylaxis ◽  
Sharps Injury ◽  
Sharps Injuries

The working environment of healthcare workers (HCW) exposes them to sharp injuries. This communication attempts to examine the injury registers, incidence of sharps injuries and blood splash exposures, and the post-exposure prophylaxis status of employees in a tertiary care hospital. Analysis included records form 54 locations of two units of a tertiary hospital attached to a Medical College. Maintenance of the injury register overall was highly satisfactory in both units. Two hundred and nine injuries were recorded from both units of the hospital. The majority of injuries (60.5%) occurred in the age group of 20-30 years with 70% among females. Waste handlers were at increased risk during waste management procedures. Thirty two percent of sharps injury injuries occurred in wards. Of the ward nursing staff, 25.3% received sharps injuries. Post-exposure prophylaxis for Hepatitis B (primary dose) was given to 25 HCWs; 11 received booster doses. The basic regimen for HIV post-exposure prophylaxis was given to 4 HCWs. Awareness about records maintenance, regular documentation, awareness and training, and implementation of appropriate preventive measures can reduce the incidence of injuries. Key words: Sharps, injury register, Health care workers (HCW),Post exposure prophylaxis (PEP)

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

scholarly journals Cross-sectional observational study of epidemiology of COVID-19 and clinical outcomes of hospitalised patients in North West London during March and April 2020

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044384
Author(s):  
Guduru Gopal Rao ◽  
Alexander Allen ◽  
Padmasayee Papineni ◽  
Liyang Wang ◽  
Charlotte Anderson ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Severe Infection ◽  
Older Age ◽  
Cross Sectional ◽  
North West ◽  
Icu Admission ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk

ObjectiveThe aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.DesignObservational cohort study.SettingLondon North West Healthcare NHS Trust (LNWH).ParticipantsPatients tested and/or admitted for COVID-19 at LNWH during March and April 2020Main outcome measuresDescriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19.ResultsThe outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients.ConclusionThe findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.

scholarly journals Hematopoietic Stem Cell Transplantation-Associated Neurological Complications and Their Brain MR Imaging Findings in a Pediatric Population

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 3090
Author(s):  
Hyewon Shin ◽  
Mi-Sun Yum ◽  
Min-Jee Kim ◽  
Jin Kyung Suh ◽  
Ho Joon Im ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Malignant Disease ◽  
Brain Mri ◽  
Neurological Complications ◽  
Neurologic Complications ◽  
Hematopoietic Stem ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group

Purpose: To determine the prognostic indicators for hematopoietic stem cell transplantation (HSCT)-associated neurological complications, the clinical characteristics and brain magnetic resonance imaging (MRI) lesions in pediatric HSCT recipients were reviewed. Methods: This retrospective study included 51 patients who had underwent a brain MRI due to newly developed neurological symptoms or infection signs during chemotherapy or HSCT. We reviewed the demographics, received treatments, treatment-related morbidities, laboratory findings and brain MRI findings, which were compared between good and poor neurologic outcome groups. Results: Thirty-seven patients (72.5%) fully recovered from the neurologic deficits and fourteen (27.5%) persisted or aggravated. The children with an underlying malignant disease had significantly poorer neurological outcomes (p = 0.015). The neurologic complications associated with infection were more frequent in the poor outcome group (p = 0.038). In the neuroimaging findings, the extent of the white matter lesions was significantly higher in the poor outcome group, as was that of abnormal enhancement, ventriculomegaly, cortical change, deep gray matter abnormalities and cerebellar abnormalities. Conclusion: Most children with neurologic complications and neuroimaging abnormalities during HSCT had recovered. However, children with neurologic complications associated with infectious causes, malignant disease or severe brain MRI abnormalities should be more carefully monitored during HSCT.

scholarly journals Risk of Depression among Early Onset Type 2 Diabetes Mellitus Patients

2021 ◽  
pp. 1-11
Author(s):  
Baizid Khoorshid Riaz ◽  
Shahjada Selim ◽  
Megan Neo ◽  
Md Nazmul Karim ◽  
M. Mostafa Zaman
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Early Onset ◽  
Tertiary Care ◽  
Positive Family History ◽  
Depression Symptoms ◽  
Mixed Effect ◽  
Increased Risk

<b><i>Methodology:</i></b> Biochemically confirmed type 2 diabetes mellitus (T2DM) patients (<i>n</i> = 1,114) were recruited from the outpatient department of 2 tertiary care hospitals in Dhaka, Bangladesh. Face-to-face interview was conducted using a semi-structured questionnaire containing sociodemographic parameters and relevant information about depression and diabetes. Biochemical test results and treatment-related information were taken from patients’ records. The Hospital Anxiety and Depression Scale (HADS) was used to screen all patients for psychiatric manifestation. Those diagnosed by HADS were subsequently reassessed using structured clinical interview for DSM-5 Disorders – Clinician Version. T2DM diagnosed at age &#x3c;40 years were considered as early onset T2DM. Association between age of onset category and depression was assessed using multivariable mixed-effect logistic regression adjusting for random variation of the area of residence and plausible confounders. <b><i>Results:</i></b> Around a third of the participants (32.5%) were diagnosed with T2DM before the age of 40 years. Early onset T2DM patients were found to have 57% increase in the risk of developing depression (OR 1.57; 95% CI 1.13–2.28; <i>p</i> = 0.011) in comparison to those with usual onset T2DM (≥40 years). Among other factors a positive family history for diabetes (OR 1.33; 95% CI 1.03–1.78; <i>p</i> = 0.038), poor glycemic control (OR 1.31; 95% CI 1.03–1.68; <i>p</i> = 0.028), presence of 1, or more diabetic complications (OR 1.37; 95% CI 1.03–1.78; <i>p</i> = 0.011) also showed increased risk of depression. <b><i>Conclusion:</i></b> Early onset T2DM patients are at greater risk of developing depression. The finding is likely to help in setting preventive strategies aiming to reduce the presence of concomitant depression symptoms among diabetes.

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