Incidence and nature of complications associated with ventriculoatrial shunt placement: A systematic review and single-arm meta-analysis.

BACKGROUND: Ventriculoatrial shunt (VAS) is considered the second option for treating hydrocephalus, but there remains a lack of robust evidence regarding its complications profile. PURPOSE: Evaluate the complications associated with VAS. METHODS: Adhering to PRISMA guidelines, the authors searched Embase, PubMed, and Web of Science databases to identify articles reporting on the complications of VAS. Eligible articles were required to report whether complications occurred in a cohort of at least four patients. The extraction process focused on various outcome measures, including overall complications, pulmonary complications, cardiac complications, mortality, shunt revisions, glomerulonephritis, intracranial hemorrhage, and hygroma. Complications were defined as any adverse events related to the procedure, including revisions. RESULTS: After retrieving a total of 2828 articles, 53 studies met the predefined criteria, involving 2862 patients. The overall complication rate was estimated at 33 % (95 % CI: 25-42 %), while the long-term complications rate was found to be 49 % (95 % CI: 32-67 %). Among the pediatric population, the complication rate was calculated to be 53 % (95 % CI: 39-68 %). The overall revision rate was estimated at 32 % (95 % CI: 23-41 %), with an infection rate of 5 % (95 % CI: 3-7 %). Notably, in the pediatric group, the infection rate was 10 % (95 % CI: 6-13 %). The random analysis indicated an estimated risk of 0 % for glomerulonephritis, intracranial hemorrhage, hygroma, cardiac complications, pulmonary complications, and shunt-related mortality. CONCLUSION: VAS is a safe alternative when ventriculoperitoneal shunting is not feasible. Risk of classic severe complications is minimal. Nevertheless, caution is required when shunting critical patients. Further randomized studies are warranted to establish the ideal shunt for different patients.

Restarting Elective Bariatric and Metabolic Surgery Under a Security Protocol During the COVID-19 Pandemic-a Prospective Observational Cohort Study.

BACKGROUND: During the SARS-CoV-2 pandemic, in order to protect the patient and to save hospital beds, cancelation of elective surgeries has become a great challenge. Considering that obesity is a chronic disease and the possible effect imposed by quarantine on weight gain with worsening rates of obesity and metabolic comorbidities, the creation of a protocol for a safe return to bariatric surgery became essential. OBJECTIVE: The aim of this study was to identify the incidence of new-onset severe acute respiratory syndrome coronavirus (SARS-CoV-2) symptoms in patients who underwent bariatric procedures during the declining curve period. SETTING: Private practice METHODS: A prospective observational cohort study was conducted and included patients with indications for bariatric surgery during the decreasing curve period of the SARS-CoV-2 pandemic who underwent surgery under a hospital security protocol. Patients were asked to answer a questionnaire and had a swab PCR test for SARS-CoV-2 detection. The primary outcome measure was the presence of 14-day and 30-day postoperative symptoms associated with COVID-19. Mortality was also analyzed. RESULTS: Three hundred patients with negative RT-PCR were operated on from May to June 2020. Seventeen patients had their surgery postponed because of a positive RT-PCR test or close contact. None of the patients developed new-onset SARS-CoV-2 symptomatic infection after 30 days of observation. No deaths were reported. Eleven had complications not related to SARS-CoV-2. CONCLUSIONS: Even though this population may have a poorer outcome when infected with SARS-CoV-2, this security protocol has shown that the procedure can be safely performed during the outbreak.

Simulation of Appointment Scheduling Policies: a Study in a Bariatric Clinic.

PURPOSE: Appointment scheduling systems traditionally book patients at fixed intervals, without taking into account the complexity factors of the health system. This paper analyzes several appointment scheduling policies of the literature and proposes the most suitable to a bariatric surgery clinic, considering the following complexity factors: (i) stochastic service times, (ii) patient unpunctuality, (iii) service interruptions, and (iv) patient no-shows. MATERIALS AND METHODS: We conducted the study using data collected in a bariatric surgery clinic located in Rio de Janeiro, Brazil. The dataset presented 1468 appointments from June 29, 2015, to June 29, 2016. We comparatively evaluate the main literature policies through a discrete event simulation (DES). RESULTS: The proposed policy (IICR) provides a 30% increase in attendance and allows a decrease in the total cost, maintaining the level of service in terms of average waiting time. CONCLUSION: IICR was successfully implemented, and the practical results were very close to the simulated ones.

Predicting Patient No-show Behavior: a Study in a Bariatric Clinic.

PURPOSE: No-shows of patients to their scheduled appointments have a significant impact on healthcare systems, including lower clinical efficiency and higher costs. The purpose of this study was to investigate the factors associated with patient no-shows in a bariatric surgery clinic. MATERIALS AND METHODS: We performed a retrospective study of 13,230 records for 2660 patients in a clinic located in Rio de Janeiro, Brazil, over a 17-month period (January 2015-May 2016). Logistic regression analyses were conducted to explore and model the influence of certain variables on no-show rates. This work also developed a predictive model stratified for each medical specialty. RESULTS: The overall proportion of no-shows was 21.9%. According to multiple logistic regression, there is a significant association between the patient no-shows and eight variables examined. This association revealed a pattern in the increase of patient no-shows: appointment in the later hours of the day, appointments not in the summer months, post-surgery appointment, high lead time, higher no-show history, fewer numbers of previous appointments, home address 20 to 50 km away from the clinic, or scheduled for another specialty other than a bariatric surgeon. Age group, forms of payment, gender, and weekday were not significant predictors. Predictive models were developed with an accuracy of 71%. CONCLUSION: Understanding the characteristics of patient no-shows allows making improvements in management practice, and the predictive models can be incorporated into the clinic dynamic scheduling system, allowing the use of a new appointment policy that takes into account each patient's no-show probability.

Takotsubo Syndrome as a Cause of False Acute Abdomen in the Early Postoperative Period After Bariatric Surgery-a Report of Two Cases.

Takotsubo syndrome, also known as broken-heart syndrome, stress-induced cardiomyopathy or transient apical ballooning syndrome, is a transient disorder characterized by segmental left ventricular failure in the absence of obstructive coronary artery disease. Most cases of Takotsubo syndrome are caused by acute stress that leads to a sudden, temporary weakening of the cardiac musculature. This stress triggers a rise in circulating catecholamine levels that results in acute ventricular dysfunction. In this report, we describe two cases of Takotsubo syndrome in the early postoperative period after bariatric surgery.

Prevalence of deep vein thrombosis in patients with paraplegia caused by traumas / Prevalência de trombose venosa profunda em paraplégicos de causa traumática

BACKGROUND: Deep vein thrombosis is a common disease among people who are immobilized. Immobility is inherent to paraplegia and leads to venous stasis, which is one of the factors covered by Virchow's triad describing its development. Trauma is the primary cause of paraplegia and is currently increasing at a rate of 4% per year. OBJECTIVE: To determine the prevalence of deep vein thrombosis in paraplegic patients whose paraplegia was caused by traumas, using color Doppler ultrasonography for diagnosis. METHODS: This was a cross-sectional observational study of 30 trauma-induced paraplegia patients, selected after analysis of medical records at the neurosurgery department of a University Hospital in Curitiba, Brazil, and by a proactive survey of associations that care for the physically disabled. The prevalence of deep vein thrombosis was analyzed using 95% confidence intervals. RESULTS: Spinal cord trauma was the cause of paraplegia in 29 patients. The most common cause of trauma was gunshot wounding, reported by 17 patients. Deep vein thrombosis was diagnosed by color Doppler ultrasonography in 14 patients in the sample. The most often affected vein was the posterior tibial, in 11 patients. The left lower limb was involved three times more often than the right. Edema was observed in 25 individuals, cyanosis in 14, ulcers in 8 and localized increase in temperature in 13. CONCLUSIONS: Deep vein thrombosis was prevalent, occurring in 46.7% of the patients. .

CONTEXTO: A trombose venosa profunda é uma doença comum em indivíduos imobilizados. A imobilização, inerente aos pacientes paraplégicos, gera a estase venosa, que é um dos fatores descritos da tríade de Virchow para o seu desenvolvimento. O trauma é a principal causa de paraplegia e, atualmente, vem aumentando a uma taxa de 4% ao ano. OBJETIVO: Avaliar a prevalência de trombose venosa profunda em paraplégicos, em que o trauma foi o agente causal da paraplegia, utilizando como método diagnóstico o eco Doppler colorido. MÉTODOS: Estudo observacional transversal, composto por 30 pacientes paraplégicos por trauma, selecionados segundo uma análise de prontuários do Serviço de Neurocirurgia de um Hospital Universitário de Curitiba e por busca ativa em associações de assistência aos deficientes físicos. A análise da prevalência de trombose venosa profunda foi efetuada pelo intervalo de confiança de 95%. RESULTADOS: O traumatismo raquimedular foi a causa da paraplegia em 29 pacientes. A causa mais frequente do trauma foi o ferimento por arma de fogo, relatado por 17 pacientes. A presença de trombose venosa profunda diagnosticada por eco Doppler colorido foi observada em 14 pacientes da amostra. Dentre estes, a veia mais acometida foi a tibial posterior, em 11 pacientes. O membro inferior esquerdo foi três vezes mais acometido que o direito. O edema foi observado em 25 indivíduos, a cianose em 14, a úlcera em oito e o aumento de temperatura local em 13. CONCLUSÃO: A trombose venosa profunda foi prevalente, ocorrendo em 46,7% dos pacientes. .

Meningite de mollaret: relato de caso e revisão de literatura / Mollarets meningitis: case report and literature review

Introdução: Meningite de Mollaret consiste em uma forma de meningite asséptica, sendo considerada uma patologia rara,haja visto a revisão literária mundial apresentar aproximadamente50 casos descritos até o momento. Objetivo: Descrição de caso de meningite asséptica decorrente de lesão expansiva epidermóide. Método: Mulher submetida à ressecção retrossigmoidéiade tumor epidermóide em ângulo ponto-cerebelara direita evoluindo sem déficits no pós-operatório imediato,mas evoluindo, no pós-operatório tardio, com meningismo e deficit de nervos cranianos contralaterais à lesão primária.Exames de propedêutica liquórica evidenciaram meningites em crescimento de microorganismos. Discussão: A cascata inflamatória sistêmica desencadeada por essa patologia pode gerar um estado toxêmico, assemelhando-se clinicamente a meningite bacteriana. O estudo liquórico não evidencia agente causador, a despeito da elevação de polimorfonucleares e a redução da glicorraquia. O risco de desenvolver meningite asséptica pode ser reduzido, evitando-se contaminação do conteúdo cístico no espaço subaracnóide, removendo cuidados amentetodo tecido cístico e administrando corticoterapiano perioperatório. Conclusão: Meningite asséptica é uma patologiarara, sem consenso a respeito de seu manejo, justificando a necessidade de acúmulo de conhecimentos a partir de relatos de casos em todo o mundo.

Introduction: Mollaret’s aseptic meningitis represents a raredisease of unknown etiology with up to 50 cases described in literature.Aim: To report a case about a patient presenting withrecurrent aseptic meningitis followed by epidermoid tumor resection.Method: Patient submitted to a retrosigmoid approachfor epidermoid tumor resection presented later with repetitiveepisodes of meningism and cranial nerve palsies contralateralto primary lesion. Cerebrospinal fluid analysis suggested asepticmeningitis. Discussion: Systemic inflammatory cascade due tothe respective pathology may produce a toxemic condition similarto bacterial meningitis. Cerebrospinal fluid analysis demonstrateshigh white blood cells counting, low glucose level, andnegative cultures for pathological agent. Aseptic meningitisrisk may be reduced by avoiding cystic fluid contamination intothe subarachnoid space, cystic tissue completely removal, andinitiating corticotherapy during surgery. Due to the severity ofsymptoms and sequels, new studies must be developed in order toreduce recurrence during remission periods. Conclusion: Mollaretmeningitis is considered a rare pathology without treatmentconsensus, justifying the need to develop new studies and amplifyingresearch and knowledge on the pathological process andtreatment of the disease.