Cerebrospinal Fluid Aspiration Research Articles

The Use of Histoacryl Injections to Treat Subgaleal Cerebrospinal Fluid Collection After Cranioplasty

BACKGROUND AND OBJECTIVES: Cranioplasty is an important and basic operation in the neurosurgical field. An emergency craniectomy is performed to control malignant cerebral edema. If the patient survives, cranioplasty is performed to restore the skull defect; however, subgaleal cerebrospinal fluid collection (SCSFC) may occur. The authors aimed to identify risk factors for postoperative SCSFC and effective solutions with the subgaleal Histoacryl injection. METHODS: From January 2020 to December 2022, 154 craniectomies were performed at our hospital to relieve significant cerebral edema after traumatic brain injury; of these, 67 patients survived and underwent cranioplasty. Ten cases of postcranioplasty SCSFC were identified, among which 6 received subgaleal Histoacryl injection. RESULTS: Among the 10 SCSFC cases, 3 resolved with compression after cerebrospinal fluid aspiration, and 1 resolved after revision surgery and dural closure. Histoacryl injection was attempted for the other 6 patients. A single injection was sufficient for SCSFC resolution in 3 patients. One patient required 2 injections, and another required 3 injections. The remaining patient underwent epiduroperitoneal shunt surgery because of SCSFC persistence after 3 Histoacryl injections. Five of 6 patients (83.3%) showed an improvement of more than 80% after Histoacryl injection. CONCLUSION: Subgaleal Histoacryl injection is not considered a fundamental treatment for postoperative SCSFC but can be a successful alternative treatment.

15-Year Retrospective Survey of the Cytopathologic Spectrum of Cerebrospinal Fluid Aspirate in a Teaching Hospital in Uyo, Southern Nigeria

Background: The cytopathologic evaluation of cerebrospinal fluid (CSF) aspirates is a vital diagnostic tool for neurological disorders. This research aimed to characterize the diverse range of cytopathological diagnoses encountered in the CSF specimens within 15 years in a teaching hospital while highlighting their clinical significance.
 Materials and Methods: A thorough review of cytopathology records from January 1, 2006, to December 31, 2020, was conducted. CSF samples were collected through lumbar punctures and subsequently subjected to cytopathological examination. The data were collected from the Department of Histopathology, University of Uyo Teaching Hospital archives. The inclusion criteria encompassed all cases with available CSF cytopathology results during the study period. Cases with inadequate or missing data were excluded from the analysis. Data regarding patients’ ages, sex, clinical, and cytopathologic diagnoses were extracted and analyzed.
 Results: Thirty-four (34) CSF samples were analyzed during the study period. The mean age was 11.45 ± 12.20 years. The most common clinical indication for CSF analysis was suspected Burkitt’s Lymphoma (34.78%), followed by other Non-Hodgkin Lymphoma (13.04%). The cytopathologic diagnoses exhibited a diverse spectrum, including Acellular Smear (26.5%), Inflammatory Smear (2.9%), Negative for Malignant Cells (52.9%), Positive for Malignant Cells (14.7%), and Suspicious for Malignant Cells (2.9%). This study also observed a significant association between age groups (particularly 0-10 years) and cytopathological diagnoses, with a p-value of 0.023.
 Conclusion: A retrospective survey of CSF cytopathology in a Nigerian teaching hospital reveals diverse cytopathological diagnoses, providing insights for neuropathology clinicians and researchers.

Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations During Spinal Anaesthetic Drug Injection

Introduction: Spinal Anaesthesia (SA) has stood as the most favoured and dependable technique in regional anaesthesia for the past century. However, despite its widespread use, there are instances of occasional SA failure. Currently, there is no straightforward, cost-effective, and easily administered real-time test-aside from the positive aspiration of Cerebrospinal Fluid (CSF)-that can reliably confirm the deposition of local anaesthetic in the subarachnoid space. Aim: To evaluate the predictive value of subjective sensations (warmth/tingling/numbness) during the administration of SA for enhancing success rates. Materials and Methods: A prospective observational study preceeded the recruitment of 500 patients for this investigation. Following the confirmation of CSF aspiration upon injecting the SA drug, Bupivacaine, patients were queried about the sensations of warmth and/or tingling numbness in the lower limb, saddle part, and inner thighs. This assessment was conducted at 30 seconds and one minute after injection. Additionally, patients were asked to report any increase in the area and/or intensity of these sensations. The adequacy of SA was determined by achieving a sensory block upto the desired dermatome level and reaching a Bromage scale score of IV. Evaluations were performed at two minutes, five minutes, 10 minutes, and 15 minutes from the initiation of SA. Results: The population, predominantly ASA Class-I (60%) and II (40%), exhibited a median age of 45 years, with 54% being male. Intraoperative vital signs, including Heart Rate (HR), Systolic Blood Pressures (SBP), and Diastolic Blood Pressures (DBP), showed a consistent declining trend post-SA administration. Efficacy assessments revealed that Bromage Grade-IV was achieved in 99% of patients at 15 minutes. Notably, subjective sensations of warmth, tingling, and/or numbness proved to be robust predictors of successful SA, with a 218-fold increased likelihood. The diagnostic model demonstrated a high sensitivity of 98%, specificity of 85%, and a Positive Predictive Value (PPV) exceeding 99%. Conclusion: This study highlights the crucial role of warmth, tingling, and numbness as reliable indicators for successful SA, supported by a robust 97% success rate. Incorporating these patient-reported sensations in assessments provides a practical and accessible approach to improve the efficacy of SA procedures.

Association of Primate Veterinarians Guidelines for Cerebrospinal Fluid Aspiration for Nonhuman Primates in Biomedical Research.

Invasive bacterial disease in young infants in rural Gambia: Population-based surveillance.

Invasive bacterial diseases (IBD) cause significant mortality in young infants. There are limited population-based data on IBD in young infants in Sub-Saharan Africa. We conducted population-based surveillance for IBD among infants aged 0-90 days in a demographic surveillance area in rural Gambia between 1 March 2011 and 31 December 2017. Infants admitted to health facilities within the study area had standardised clinical evaluation plus conventional microbiological investigation. We defined IBD as isolation of pathogenic bacteria from blood, cerebrospinal fluid, lung, or pleural aspirate. We determined incidence, aetiology and case-fatality of IBD. A total of 3794 infants were admitted and 3605 (95%) had at least one sample collected for culture. We detected 254 (8.0%) episodes of IBD (bacteraemia 241; meningitis 14; pneumonia seven). The incidence of IBD in infants aged 0-90 days was 25 episodes/1000 person-years (95% confidence interval (CI) = 22-28), the incidence in neonates was 50 episodes/1000 person-years (95% CI = 43-58) and the incidence in infants aged 29-90 days was 12 episodes/1000 person-years (95% CI = 9-15). The most common pathogens causing IBD were Staphylococcus aureus (n = 102, 40%), Escherichia coli (n = 37, 15%), Streptococcus pneumoniae (n = 24, 9%) and Klebsiella pneumoniae (n = 12, 5%). Case-fatality was 29% (95% CI = 23-37) in neonates and 19% (95% CI = 11-29) in infants aged 29-90 days. A minimum of 7.3% of all young infant deaths in the population were caused by IBD. IBD are common in young infants in rural Gambia and have a high case-fatality. Strategies are needed to prevent IBD in young infants. Overcoming barriers to widespread implementation of existing vaccines and developing new vaccines against the most common pathogens causing IBD should be among top priorities for reducing the high mortality rate in young infants.

Role of Bangladesh Medical College Hospital (B.M.C.H) Protocol in Achieving Zero Shunt Infection in Paediatric Hydrocephalus

Ventriculoperitoneal shunt infection is one of the most dreadful complications of shunt surgery. Though topical, intravenous, and intraventricular antibiotics have been used; the infection rate is still high. It is a retrospective cohort study from Jan 2018 to Dec 2022 in Bangladesh Medical College, performed by a single Neurosurgeon. Objective: To see the effectiveness of the B.M.C.H protocol of shunt surgery in minimizing shunt infection. Method: 83 pediatric Ventriculo Peritoneal shunt cases were selected, who met the inclusion criteria. They were divided into 2 groups. One group had an Ommaya reservoir with or without endoscopic third ventriculostomy (failed) and was subject to cerebrospinal fluid aspiration for a considerable period followed by a shunt. The other group had conventional shunt (non-Ommaya) surgery. Results: The overall infection rate in our hospital in shunt surgery is 3.6%. Among the non-Ommaya or conventional shunt group, it reached 7.1%, while among the Ommaya group, there was not a single shunt infection in the follow-up period. 47% of babies came from the poorest population of the country. There was no significant relationship found between infection with a history of previous infection, per operative use of an endoscope, early age, or preterm birth. Follow up period was between 6 to 18 months. Conclusions: In a non-specialized hospital in a third-world country with limited neurosurgical capacity, following B.M.C.H. protocol, we found the babies who had Ommaya reservoir and underwent regular cerebrospinal fluid aspiration for a period of time before Ventriculo peritoneal shunt surgery were infection free in the long and short time follow up.

Diagnostic Approach to Extrapulmonary Tuberculosis by Cartridge-based Nucleic Acid Amplification Test.

Tuberculosis (TB) is a highly infectious disease causing millions of cases worldwide. Though pulmonary TB is the most common form of infection, extrapulmonary cases are also very rampant and are responsible for a large number of cases. But the diagnosis of extrapulmonary cases is quite difficult because of varied manifestations and the paucibacillary nature of the infection. Cartridge-based nucleic acid amplification test (CBNAAT) is a simple, rapid test that is very efficient in the early diagnosis of these extrapulmonary cases [extrapulmonary TB (EPTB)]. A study was done to establish the usefulness of CBNAAT in the early diagnosis of EPTB cases. A comparative study was conducted in a rural tertiary care hospital in West Bengal, India, for 8 months (July 2021-February 2022). Samples were collected from different sites like pleural fluid, lymph nodes, cerebrospinal fluid (CSF), pus, ascitic fluid, and tissue aspirate and subjected to both CBNAAT and smear staining and examination under a fluorescent microscope. Positive samples were cultured, examined, and compared. From 593 samples collected from different sites in suspected cases of EPTB-52 samples were positive by CBNAAT, and six cases showed rifampicin resistance (RIF resistant). Smear staining of the samples by auramine-rhodamine stains and examined under the fluorescent microscope for acid-fast bacilli identifying 33 samples; the rest were negative. Slides showing acid-fast bacilli were cultured on Lowenstein-Jensen media. Cartridge-based nucleic acid amplification test (CBNAAT) is a very useful assay for the early diagnosis of extrapulmonary cases as it can accurately identify false negative samples by smear microscopy.

Retinoblastoma management: a systematic review

Retinoblastoma is a rare cancer that occurs in children under 5 years of age from which leukocoria and strabismus are the characteristic signs of this disease. For every 16,000 to 18,000 newborns worldwide, one will get retinoblastoma, while at the Latin American context there are no reported data due to scant research. Therefore, the reason for this research is to describe the management of retinoblastoma. Trauma, human papillomavirus (HPV), and genetic alterations in the RB1 gene are possible causative factors for retinoblastoma. The diagnosis is based on the clinic, genetic tests, imaging tests and in cases of metastasis, a cerebrospinal fluid (CSF) aspiration is performed through lumbar puncture. There is another method such as non-invasive prenatal diagnosis (NIPD), here the main diagnosis is indirect ophthalmoscopy. The treatment is directly related to the evolution of the disease using different methods such as enucleation, cryotherapy, chemotherapy and radiotherapy that can be used individually or in combination to improve the quality of life of the patient; however, enucleation followed by chemotherapy remain as the main method of treatment.

Peripartum neurological complications and labor epidural: an anesthesiologist predicament

BackgroundDismissing the process of labor, postpartum neurological complications tend to implicate anesthetic interventions as the cause, a predicament to the anesthesiologist mandating utmost periprocedural vigilance.Case presentationTwo obstetric patients with no comorbidities received uneventful labor epidurals. They presented with rare peripartum neurological complications.ConclusionsUnrecognized dural puncture is often a retrospective diagnosis made with the onset of symptoms in a presumed uneventful epidural. Negative aspiration of cerebrospinal fluid (CSF) during epidural insertion does not completely rule out the dural puncture. Th dural puncture can be obscured by initial dural tenting and tear without loss of CSF, followed by a breach in the weakened arachnoid during maternal efforts (Reynolds and Speedy, Anaesthesia 45:120-3, 1990). Obstruction of the TUOHY l umen with clot or ligamentum flavum, preventing CSF flow into the needle and subarachnoid migration of a subdurally placed catheter, is another cause.Delay in management of neurological complications resulting from unrecognized dural punctures can occur.

Clinical features of the first critical case of acute encephalitis caused by the avian influenza A (H5N6) virus

ABSTRACT Highly pathogenic avian influenza viruses (HPAIV), such as H5N1, H5N6, and H7N9, have been reported to frequently infect humans, but acute encephalitis caused by HPAIV in humans has been rarely reported. We report the first critical case of acute encephalitis with mild pneumonia caused by the H5N6 virus. On January 25 of 2022, a 6-year-old girl with severe neurological symptoms was admitted to our hospital and rapidly developed into seizures and coma. Brain imaging showed abnormalities. Electroencephalogram (EEG) presented abnormal slow waves. Cerebrospinal fluid (CSF) contained elevated protein (1.64 g/L) and white cells (546 × 106/L). Laboratory investigations revealed abnormally elevated transaminases, lactate dehydrogenase, and cytokines in serum. A novel reassortant H5N6 virus was identified from the patient’s serum, CSF, and tracheal aspirate specimens. Phylogenic analysis indicated that this virus was a novel reassortant avian-origin influenza A (H5N6) virus that belonged to clade 2.3.4.4b. This patient was diagnosed with acute encephalitis and discharged from the hospital accompanied by a language barrier. An epidemiological investigation confirmed that wild waterfowls were the direct source of infection in this case. Our study highlights the urgent need to pay attention to acute encephalitis caused by HPAIV.

Molecular detection of some virulence genes of Proteus mirabilis in rheumatoid Ar-thritis patient’s urine and other clinical samples

This study was aimed to detecting three different virulence genes (UreC, HmpA and ZapA ) for Proteus mirabilis isolated from different clinical samples ( urine from  UTI non-Rheumatoid arthritis  patients, urine from UTI Rheumatoid arthritis  patients, wound swaps , chronic supportive otitis media(CSOM) and cerebrospinal fluid aspirate(CSF).  Three hundred (300) different clinical samples were collected and cultured on blood agar and macConky agar. 40 of samples were identified as P. mirabilis , biochemical test and VITEK 2 system used to complete the identification. Phenotypic detection appeared the present 100% of   urease enzyme (on  urea agar) hemolysin enzyme (  on blood agar), swarming phenomena (on agar plate ) while protease enzyme detection (on skim milk agar) present  in 54% of isolates.  Molecular results by PCR  present  UreC, HmpA and ZapA genes in 100 % in 40 isolates. Antibiotic Susceptibility test of Proteus mirabilis based on Kirby-Bauer disk diffusion method on Muller-Hinton agar to (14) different antimicrobial agents appeared 100% resistance to Aminoxicillin /clav, Cefotaxime and Erythromycin while the lowest resistance was against Impenem, Ciprofloxacin, Meropenem and Gentamicin (12.5%, 15 %, 20% and 47.5%), respectively.

Incidence of Subdural Catheter Placement During Epidural Procedure Based on Fluoroscopic Imaging

(Reg Anesth Pain Med. 2021;46:538–539) The percentage of failed epidural anesthesia placement due to subdural catheter placement is unknown. Subdural catheter placement is difficult to identify because it can occur despite having a negative test dose and negative aspiration of cerebrospinal fluid. This poses a problem to the patient because subdural placement may not penetrate anterior nerve roots, resulting in continued pain. This study utilized real-time fluoroscopic imaging in an effort to determine the incidence of subdural catheter placement during epidural anesthesia.

Differential Diagnosis of Pneumonia as a Complication of Nasal Liquorrhea in the Context of the COVID-19 Pandemic

Nasal liquorrhea — the outflow of cerebrospinal fluid from the cerebrospinal fluid spaces of the cranial cavity into the nasal cavity or paranasal sinuses due to the presence of a congenital or acquired defect in the bones of the skull base and meninges of various etiologies. Nasal liquorrhea leads to potentially fatal complications: meningitis, meningoencephalitis, pneumocephalus, brain abscess. Also, with nasal liquorrhea, less dangerous complications may occur: aspiration bronchopneumonia and gastritis. The article presents a case of aspiration pneumonitis in two patients with nasal liquorrhea treated at the N.N. N.N. Burdenko during the COVID-19 pandemic. Both patients noted the profuse nature of the nasal liquorrhea, complained of coughing in a horizontal position. In both cases, no RNA virus (SARS-CoV-2) was detected during the polymerase chain reaction. Antibodies (IgG, IgM) to coronavirus were not detected. Computed tomography of the chest organs in both cases revealed areas of frosted glass darkening. Since no data was obtained for coronavirus infection (negative tests for coronavirus, lack of antibodies), changes in the lungs were interpreted as a consequence of constant aspiration of cerebrospinal fluid. The patients were admitted to a separate ward. Both patients underwent endoscopic endonasal plasty of the skull base defect. The postoperative period in both cases was uneventful. In both cases, the patients underwent computed tomography scan of the chest organs one month later. On the photographs, the signs of pneumontis completely regressed.

Comparison of Landmark-guided, Nerve Stimulation-guided, and Ultrasound-guided Techniques for Pediatric Caudal Epidural Anesthesia: A Prospective Randomized Controlled Trial.

Traditionally, caudal epidurals are performed by a landmark-guided approach using the loss of resistance technique. Improvisations to increase the success rate can be attained by implementing modalities, namely neurostimulation and ultrasound, but there is a paucity of literature comparing these 3 approaches. Here, we compare the 3 techniques in terms of the success rate. The primary outcome of this study was to compare the success rate of the 3 techniques, and the secondary outcome was the blood or cerebrospinal fluid aspiration during the procedure. It was a prospective, randomized, open-label parallel-group study. Three hundred children aged 1 to 5 years scheduled for circumcision, hypospadias repair, and minor lower extremity surgeries were enrolled after taking written informed consent from the parents. Demographic profiles were comparable in terms of age, weight, sex distribution, and types of surgeries. Success rates in landmark-guided, neurostimulation-guided, and ultrasound-guided were 97%, 97%, and 98%, respectively which was comparable (P=0.879). There was no significant difference in the incidence of blood or cerebrospinal fluid aspiration. We found a similar success rate of the caudal epidural block by using landmark-guided, nerve stimulation-guided, or ultrasound-guided techniques in children aged 1 to 5 years with normal anatomy.

Supratentorial subdural hematoma following microvascular decompression

BackgroundHemorrhage is the most common during microvascular decompression (MVD) for hemifacial spasm (HFS), trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GN). However, remote supratentorial subdural hematoma is very rare, especially for those patients who reveal severe intraoperative venous bleeding without a definite bleeding source in the suboccipital surgical area, and immediate postoperative computed tomography (CT) reveals supratentorial subdural hematoma. The underlying mechanisms remain obscure. We report 10 cases to discuss the pathophysiology and develop appropriate therapeutic strategies for prevention and treatment. Patients and methodsWe retrospectively analyzed clinical data of patients who underwent microvascular decompression in Nanjing Drum Tower Hospital between December 1, 2018 and December 31, 2020. Among 764 patients, bleeding events occurred in 10 cases, whose bleeding origin was not confirmed intraoperatively and immediate postoperative CT revealed supratentorial subdural hematoma. We reviewed characteristics, the intraoperative situations and the prognosis of the 10 cases. ResultsThe mean age of the patients was 55.4 years; 2 was male and 8 were female. All patients revealed draining large amounts of intraoperative cerebrospinal fluid (CSF) during the operation. Primary unknown cause of severe venous bleeding of 8 patients occurred in different time periods intraoperatively. However, hemorrhage all occurred in a very early stage before decompression. The operation was completed successfully in the 8 patients through the irrigation and drainage of the bloody cerebrospinal fluid. patient Postoperative CT indicated supratentorial acute subdural hematoma (ASDH) with hematoma volume <30 ml. All patients recovered after conservative treatment. ConclusionsRemote supratentorial subdural hematoma is rare, and the acute venous hemorrhage with no origin during MVD always means remote supratentorial subdural hematoma, which is different from traumatic acute subdural hematoma. We suggest that it is important to avoid excessive CSF aspiration. If bleeding occurred in the operative field without origin, we should keep irrigating and removing the bloody CSF, the decompression of responsible arteries can be completed and all the cases could be managed conservatively.

Retractorless brain surgery: technical considerations

BackgroundRetraction is necessary to access deep areas in the brain and skull base, but prolonged and forceful use of fixed retraction might be injurious. Several techniques were developed, in the concept of minimally invasive neurosurgery, to eliminate or minimize the use of fixed retractors. The authors discuss the technical considerations and limits in applying dynamic retraction in brain surgery for a variety of lesions using different approaches.ResultsWe retrospectively collected 123 cases with brain lesions in diverse locations, were dynamic retraction, using the tools in the operator hands and was achieved successfully instead of fixed retraction. Cases with aneurysms were excluded, although retraction was applied during clipping only. Superficial and large masses that do not require fixed retraction as a routine were excluded also. We relied mainly on patient positioning to benefit from the gravity, proper design of the craniotomy, arachnoid dissection, cerebrospinal fluid aspiration, and internal decompression of the mass when possible.Different approaches for different lesions were utilized in our patients, subfrontal or pterional and their modifications in 45.5% of cases, suboccipital in 21.1%, retrosigmoid in 13%, the interhemispheric approach in 10.5%, transcortical to lateral ventricles in 7.3%, and posterior subtemporal in 2.4%.Dynamic retraction with the surgical tools was used successfully in all cases except 7 patients (5.6%) where we had to use fixed retraction transiently.ConclusionSeveral considerations are helpful and amenable to achieve successful brain surgery without fixed retraction. Utilizing the gravity, unlocking of the brain, choosing the surgical corridor, cerebrospinal fluid suctioning, and mastering of the microsurgical techniques are the keys.

Acute subdural hematoma post ventricular puncture in infants: A case report and review of the literature.

Introduction and importanceAcute subdural hematoma in infants is often due to non-accidental causes such as shaken baby syndrome or abuse. Occasionally a rupture of the cerebral bridge veins after ventricular puncture can lead to a subdural hematoma in infant. In this article we report the very first case of acute subdural hematoma after ventricular puncture of cerebrospinal fluid.Case presentationIt is a 40-day-old male infant received at the pediatric emergency room for an infectious syndrome. An etiological assessment was carried out including a ventricular puncture of the cerebrospinal fluid. Two days after the puncture, the child develops a sudden alteration of consciousness during hospitalization, with a Blantyre coma score of 3/5. The CT scan performed showed a right subdural parieto-temporal hematoma associated with a right fronto-temporal parietal parenchymal hypodensity. A right temporo-parietal decompressive craniectomy was performed with evacuation of the acute subdural hematoma. Clinical improvement was obtained and the child was discharged after 3 weeks of hospitalization.Clinical discussionAcute subdural hematoma post ventricular puncture is rarely reported in the literature. The mechanism would probably be a rupture of the bridging veins by sudden collapse of the parenchyma following rapid and excessive aspiration of cerebrospinal fluid. Its management is medico-surgical. This manuscript further demonstrates the importance of mastering the ventricular puncture technique which must be performed by an experienced neurosurgeon.ConclusionThe ventricular puncture remains a delicate gesture which must be carried out by a qualified neurosurgeon because of the risks of complications such as an acute subdural hematoma.

The Anaesthetic Biobank of Cerebrospinal fluid: a unique repository for neuroscientific biomarker research.

BackgroundThe pathophysiology of numerous central nervous system disorders remains poorly understood. Biomarker research using cerebrospinal fluid (CSF) is a promising way to illuminate the neurobiology of neuropsychiatric disorders. CSF biomarker studies performed so far generally included patients with neurodegenerative diseases without an adequate control group. The Anaesthetic Biobank of Cerebrospinal fluid (ABC) was established to address this. The aims are to (I) provide healthy-control reference values for CSF-based biomarkers, and (II) to investigate associations between CSF-based candidate biomarkers and neuropsychiatric symptoms.MethodsIn this cross-sectional study, we collect and store CSF and blood from adult patients undergoing spinal anaesthesia for elective surgery. Blood (20.5 mL) is collected during intravenous cannulation and CSF (10 mL) is aspirated prior to intrathecal local anaesthetic injection. A portion of the blood and CSF is sent for routine laboratory analyses, the remaining material is stored at −80 °C. Relevant clinical, surgical and anaesthetic data are registered. A neurological examination and Montreal Cognitive Assessment (MoCA) are performed pre-operatively and a subset of patients fill in questionnaires on somatic and mental health (depression, anxiety and stress).ResultsFour-hundred-fifty patients (58% male; median age: 56 years) have been enrolled in the ABC. The planned spinal anaesthetic procedure was not attempted for various reasons in eleven patients, in fourteen patients the spinal puncture failed and in twelve patients CSF aspiration was unsuccessful. A mean of 9.3 mL CSF was obtained in the remaining 413 of patients. Most patients had a minor medical history and 60% scored in the normal range on the MoCA (median score: 26).ConclusionsThe ABC is an ongoing biobanking project that can contribute to CSF-based biomarker research. The large sample size with constant sampling methods and extensive patient phenotyping provide excellent conditions for future neuroscientific research.

Description of two fatal cases of melioidosis in Mexican children with acute pneumonia: case report

BackgroundMelioidosis is an infectious disease caused by Burkholderia pseudomallei. In Mexico, the disease is rarely diagnosed in humans and there is no evidence of simultaneous environmental isolation of the pathogen. Here, we describe clinical profiles of fatal cases of melioidosis in two children, in a region without history of that disease.Case presentationAbout 48 h before onset of symptoms, patients swam in a natural body of water, and thereafter they rapidly developed fatal septicemic illness. Upon necropsy, samples from liver, spleen, lung, cerebrospinal fluid, and bronchial aspirate tissues contained Burkholderia pseudomallei. Environmental samples collected from the locations where the children swam also contained B. pseudomallei. All the clinical and environmental strains showed the same BOX-PCR pattern, suggesting that infection originated from the area where the patients were swimming.ConclusionsThe identification of B. pseudomallei confirmed that melioidosis disease exists in Sonora, Mexico. The presence of B. pseudomallei in the environment may suggest endemicity of the pathogen in the region. This study highlights the importance of strengthening laboratory capacity to prevent and control future melioidosis cases.

Safety of Ventricular Reservoir Sampling in Pediatric Posthemorrhagic Hydrocephalus Patients: Institutional Experience and Review of the Literature.

INTRODUCTION: Posthemorrhagic hydrocephalus (PHH) is a common disease process encountered in neonates. Management often includes cerebrospinal fluid (CSF) aspiration through ventricular access devices (VADs). However, a common concern surrounding serial access of implanted subcutaneous reservoirs includes introduction of infection. In addition, there is great variability in aseptic technique. Therefore, the authors sought to evaluate the incidence of VAD access-associated infections in the literature and compare them with the rate of infection found at our institution. We also highlight the use of a preassembled VAD access kit and standardized access protocol, as well as the role of provider education, in maintaining safety and sterility during serial VAD access. METHODS: A single-institution retrospective review was performed for PHH patients younger than 1 year old undergoing serial CSF aspirations via implanted VADs (2009-2019). Patients were excluded if they had a ventriculoperitoneal shunt placed as primary intervention. MEDLINE search for reports of serial VAD access in PHH was also performed. Reports were excluded if they did not include full-text articles in the English literature. RESULTS: At our institution, subcutaneous reservoirs were placed in 37 neonates with PHH for serial CSF aspiration. No infections occurred after a total of 630 taps (average, 17 taps per reservoir; range, 0-83) and 10 420 collective reservoir days (average, 282 per patient; range, 6-3700). Only 2 reservoirs required revision for malfunction. Serial VAD taps for PHH were described in 14 articles in the medical literature, with 7.9% (n = 47/592) of patients reported with tap-related infectious complications. CONCLUSION: A standardized VAD access kit, along with stringent adherence to access protocol, can significantly minimize risk of infection associated with serial VAD access. These principles can be generalized to percutaneous aspiration of CSF from subcutaneous reservoirs placed for other indications to promote safety and sterility of this common procedure.