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关键词： Hydrocephalus   Ventriculoatrial   Ventriculopleural   Cerebrospinal fluid diversion  

摘要： Purpose Ventriculoatrial (VA) and ventriculopleural (VPL) shunts are used as alternatives when CSF diversion to the peritoneal compartment with a ventriculoperitoneal (VP) shunt is not possible. The objective of this study is to compare directly the shunt survival and complications for both procedures in this setting in children. Methods A retrospective analysis of 54 consecutive patients who underwent VA (36) or VPL (18) shunt insertion between January 2002 and December 2017 was conducted. Results The overall mean follow-up was 4.1 (SD 4.3) years, 2.8 (SD 4.1) for VPL and 4.7 (SD 4.4) for VA shunts, respectively (p = 0.11). Twenty-four (66.7%) patients in the VA group and 9 (50.0%) in the VPL group underwent shunt revision (p = 0.236);mean number of revisions was 2.2 (SD 3.0) and 0.94 (SD 1.4) in the VA and VPL groups (p = 0.079). Median time to failure was 8.5 (IQr 78, range 0-176) months for VA and 5.50 (IQr 36, range 0-60) for VPL shunts (log rank (Mantel-Cox) 0.832). Shunt survival at 3, 6, 12 and 30 months was 60.6, 51.5, 36.4 and 27.3%, respectively, for VA and 56.3, 43.8, 37.5 and 37.5% for VPL shunts (log rank (Mantel-Cox) test value 0.727). The infection rate was 13.8% for VA and 5.6% for VPL shunts (p = 0.358). Four patients with VPL shunts (22.2%) developed pleural effusions. Fourteen deaths (25.9%) were recorded during follow-up, 8 (22.2%) in the VA and 6 (33.3%) in the VPL group (p = 0.380);two of the deaths in the VA group were shunt-related. Conclusion This study demonstrates that the outcomes of VA and VPL shunts, when used as second-line surgical treatment in paediatric hydrocephalus, were similar, as were the revision, infection and survival rates. The shorter longevity of these shunts compared with the general shunted population may reflect the complex nature of these children.

关键词： Urinary tract infection   Lower urinary tract dysfunction (LUTD)   Clean intermittent catheterization   Intravesical instillations   Bladder washouts   Bladder irrigation  

摘要： Background Little has been reported to date on the instillation of antimicrobials directly into the bladder in children. Children with complex urinary tract anomalies struggle frequently with recurrent urinary tract infections (UTI), with frequent emergence of antibiotic resistance. Gentamicin bladder instillation to treat and prevent UTI was described in children since 2006. Objective We adopted gentamicin bladder instillation in 2016 and evaluate herein our intermediate-term experience with it. Study design and Methods This study is a retrospective review of a prospectively initiated database and a clinical audit of our practice. The gentamicin bladder instillation was employed in 24 cases. A treatment regime was initiated for symptomatic documented UTI when resistance patterns precluded an oral alternative (14 cases), avoiding hospitalisation for parenteral antibiotics. A prophylaxis regime (19 cases-including 9 of the 14 who received an initial treatment regime) followed at least one breakthrough UTI while receiving oral prophylactic antibiotics. Two instillation volumes (8 mg gentamicin in 20 mL 0.9% NaCl or 20 mg gentamicin in 50 mL 0.9% NaCl) were used to suit different bladder capacities. The irrigation is given twice a day for 7 days in the treatment regime or once a day, every other day, in the prophylactic regime. Gentamicin serum levels (all cases) and audiology/audiometry testing (17/24 cases) were checked to assess the safety of this method. Results The median age when either the treatment course or prophylaxis regime was started was 3.8 years. The treatment regime was 86% successful (12/14) to suppress an acute UTI. The mean duration of prophylaxis was 252 days (median: 256 days). The percentage of patients on the prophylactic regime who had no breakthrough UTI was 58%. No serum gentamicin was detectable secondary to the intravesical instillation. No attributable cases of sensorineural hearing loss were detected. Gentamicin resistance emerged in one c

关键词： BORSA   Staphylococcus aureus   Neonatal intensive care unit   Infection control   Whole-genome sequencing   Core genome multi-locus   sequence typing   Antimicrobial resistance  

摘要： Background: During a meticillin-resistant Staphylococcus aureus contact tracing and screening investigation, two borderline oxacillin-resistant Staphylococcus aureus (BORSA)positive screening cultures were encountered among neonatal intensive care unit (NICU) healthcare workers (HCWs). This finding led to further investigations. Aim: To assess the likelihood of an outbreak with direct transmission among HCWs. Methods: An infection control team was initiated after the discovery. The team initiated additional infection control measures and evaluated new findings. All NICUs and paediatric ward HCWs were screened for BORSA carriage, and a prospective BORSA seven-week monitoring period for patients was observed. To assess the likelihood of an outbreak with direct transmission among HCWs, the BORSA isolates were analysed using augmented fragment length polymorphism and whole-genome sequencing (WGS). Findings: Positive HCWs were prohibited from clinical work while awaiting the results from the screening programme. In all, 127 NICU and 77 general paediatric ward HCWs were screened for BORSA carriage;five HCWs were BORSA positive. Seventy-two patients were screened during the seven-week period yielding a total of 138 cultures, ranging from one to nine cultures per patient. No spread from HCWs to patients occurred, and the BORSA screening programme was discontinued. WGS analysis with core genome multi-locus sequence typing of all five BORSA strains showed relatedness between two NICU strains. Conclusion: During a seven-week period, no transmission from BORSA-positive HCWs to neonates was observed in either screening or clinical cultures. More vigilance and experience is needed to design adequate evidence-based interventions in the future for this vulnerable population. (c) 2020 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

关键词： Computed tomography (CT)   Radiation dose   X-ray spectrum   Volume averaged CT Dose index (CTDIvoi)   Size-specific dose estimate (SSDE)   Water-equivalent diameter (D-w)   Effective diameter (ED)  

摘要： The size-specific dose estimate (SSDE) concept is based on converting volume averaged CT dose index (CTDIvol) measured in cylindrical PMMA head and body phantoms of reference sizes to values for doses absorbed in individual patients. The original conversion factors used for SSDE is related to the effective diameter (ED) of the region of interest for the patient. ED is simple to measure, but does not include attenuation, which affects estimation of the dose absorbed. Water-equivalent diameter (Dw) which takes account of attenuation through the CT number, based on the linear attenuation coefficients, has been recommended to replace ED. The main scan parameter that affects Dw values is the x-ray spectrum. In this study, a library of 363 phantoms (168 paediatric and 195 adult) of a wide range of sizes from newborn to large adult were used to investigate the influence of the x-ray spectrum on Dw and the correlation between ED and Dw. Values were assessed for each phantom over seven scanned regions: head, chest, abdomen, pelvis, chest-abdomen, abdomen-pelvis, and the whole trunk using x-ray spectra of 80-140 kVp. The results show the effect of x-ray spectrum on the relationship between Dw and ED for the trunk regions was minimal, and almost all Dw/ED ratios were within a factor of +/- 1.01. However, Dw/ED values for the head region varied by a factor of up to 1.10 with the x-ray spectra. Energy-independent correlations between ED and Dw values for the trunk regions have been established. The correlations were compared with published results calculated by AAPM using another method and gave an average difference of 2.9%. Use of the correlations should simplify determination of the SSDE taking account of attenuation based on ED that is more readily measurable than Dw, which requires advanced software.

关键词： Computed tomography   CT thorax   CT abdominopelvic   Radiation dose   Image quality   Paediatric   Exposure  

摘要： The widespread use of computed tomography (CT) has led researchers to study CT dose exposure associated with carcinogenic effects, especially in pediatric populations. The number of pediatric patients undergoing CT scans increases every year and there is a wide range of exposure doses from the examination. In this study, we carried out systematic reviews and meta-analysis study on radiation dose received by paediatric patients during CT thorax, CT abdomen, CT abdomen-pelvis and CT thorax-abdomen-pelvis (TAP) examinations. Furthermore, the relationship between the radiation dose and the associated factors, such as scanning protocols, CT parameters, and body weight inclusive of the image quality produced was investigated. Four different databases, namely PubMed, Ovid MEDLINE, ScienceDirect, and Scopus have been used to get eligible studies published from 2010 to 2019. A total of 95 articles related to CT thorax, abdomen, and/or pelvis for paediatric patients are collected. After the final screening process, 38 articles are included in the study where 19, 8, 6 and 5 articles involving CT thorax, CT abdomen, CT abdomen-pelvis, and CT TAP examinations, respectively. Dose data, volume-weighted CT dose index (CTDIvol), dose length product (DLP), effective dose (E) and size-specific dose estimates (SSDE) are extracted in each selected studies. The highest value of mean CTDIvol, DLP, E and SSDE is found in CT abdomenpelvis with the weight-based protocol for a patient with > 40 kg are 9.1 +/- 1.2 mGy, 440.7 +/- 0.0 mGy cm, 10.0 +/- 0.0 mSv, and 13.7 +/- 1.9 mGy respectively. We conducted a meta-analysis of selected cohort studies to explore the association between paediatric dose and region of examination which categorized based on weight. There is no difference found in CTDIvol between the group of CT thorax, CT abdomen-pelvis and CT TAP with It is established that the application of size or weight - base protocol with the adjustment of CT acquisition parameter and used of i

摘要： The Article by Clara Agudelo and colleagues1 highlights the potential for comprehensive regional surveillance of invasive pneumococcal disease to assess the impact of pneumococcal conjugate vaccines (PCVs) in the Latin America and Caribbean region.1 Nonetheless, the inferences drawn by the authors do not accurately portray the reported data on the impact of ten-valent PCV (PCV10) and 13-valent PCV (PCV13) in the region. By contrast, comparing the percentage that a specific serotype or serotype group contributes to all cases of invasive pneumococcal disease, as reported throughout the summary and main text of the Article, reflects relative rather than absolute changes in disease burden, and so is of little public health value. Furthermore, the analysis did not adjust for several crucial factors that affect the population-level effect of vaccines: imbalances in vaccine coverage; duration of the vaccination programme; trends in incidence of invasive pneumococcal disease before introduction of the PCV programme (incidence was decreasing in all four PCV10 countries vs increasing in two PCV13 countries), which could have been addressed partly with a time-series analysis; use of seven-valent PCV (PCV7) during the period before introduction of the PCV10 and PCV13 programmes in two PCV13 countries (Mexico and Uruguay), which then provided less opportunity for additional reduction of PCV7 serotypes; and large differences in annual reporting rates of invasive pneumococcal disease before introduction of PCV programmes, ranging from one per 100 000 population in Mexico to 23 per 100 000 in Uruguay and Chile.

关键词： Academic surgery   Pediatric surgery   Surgical training   University   Innovation  

摘要： This article offers a brief overview of academic pediatric surgery in its broadest perspective(s). These include the challenge of the surgeons' journey in the pursuit of becoming an academic surgeon and acquiring excellence in clinical pediatric surgery to become university faculty leaders. The marriage of these demanding roles serving "two masters" notably clinical hospital services and academic institution(s) requires 'life skills' training coupled with buckets of resilience. It could be argued an academic pediatric surgical career is not for the 'faint hearted'. Success is rewarded by personal growth and inspiring those around us every day. Witnessing the birth of new academic pediatric surgeons we are privileged to train is very special. Scientific Discovery and research (clinical and / or basic sciences) are worthy vocational pursuits for surgeons. Good luck on your journey! .... (c) 2021 Elsevier Inc. All rights reserved.

关键词： adverse event   intrathecal baclofen   paediatrics   paediatric rehabilitation  

摘要： Aim This study aims to examine the adverse event (AE) rate for intrathecal baclofen (ITB) therapy in an Australian paediatric population and to clarify type and frequency of AEs. Methods AE data were extracted from the Australian Paediatric ITB Research Group national database, to include the first 5 years of data collection. Raw data were collated and analysed descriptively. Results Data were collected for 40 patients. Forty-seven AEs in 23 patients were reported. Ten (25%) patients required surgical intervention related to their AE. Five patients (12.5%) required pump removal. The most frequent ITB-related AEs were catheter dysfunction (24%), drug overdose, withdrawal or sensitivity (19%), seromas and haematomas (15%) and infections (13%). Conclusions The AE rate for ITB therapy is high and needs to be considered when counselling patients regarding ITB as a therapeutic option.