Incidence Of Neurological Complications Research Articles

Infective endocarditis in patients with diabetes

Diabetes mellitus (DM) is an adverse premorbid background for the development, course and outcome of infective endocarditis (IE), and therefore the combination of these diseases requires study. Objective: to study the clinical features and outcomes of infective endocarditis in patients with diabetes mellitus. Material and methods A retrospective (from 2001 to 2007) and a prospective (from 2008 to 2018) analysis of 347 patients with specifi c IE, 243 men and 104 women, aged from 17 to 83 (median age 44.8; 34–54). Results. 22 patients with IE, were diagnosed with diabetes, that is, the incidence of this pathology was 6.3%. Type 1 diabetes was observed in 7 (2% of the total number of patients and 32% among patients with a combination of IE and diabetes). Type 2 diabetes was diagnosed in 15 patients (4.3% and 68%, respectively). In subgroups of patients with IE and diabetes and without it, statistically signifi cant diff erences in age (p < 0.05), Charlson comorbidity index (p < 0.001), incidence of neurological complications ((p < 0.05), hospital mortality (p < 0.05) were noted, while patients with IE on the background of type 1 diabetes, had a more severe course of the disease. According to key characteristics of the pathological process in IE, localization, severity of systemic infl ammation, clinical and biochemical parameters, no signifi cant diff erences in the studied groups were found. Findings. The obtained results confi rm the literature data on fundamentally identical regularities of the course of IE in patients with and without diabetes. At the same time, the development of IE on the background of diabetes is a prognostically unfavorable combination of comorbid conditions, which requires special attention of physicians to such a contingent of patients, interaction of specialists for their successful management.

Neurologic Complications in Heart Transplant Recipients Readmitted to the Intensive Care Unit

IntroductionNeurologic complications after transplantation surgery are major causes of morbidity, and the incidence of neurologic complications among heart transplant recipients varies from 7% to 81%.In our study, we aimed to determine the incidence, etiologies, and risk factors of neurologic complications among patients readmitted to the intensive care unit (ICU) after heart transplantation.MethodIn this retrospective cohort study, the medical records of all patients who underwent cardiac transplantation from February 2003 to July 2019 were reviewed, and those admitted to the ICU due to neurologic complications during the early and late postoperative period were evaluated. The patients were divided into two groups based on the development of neurologic complications to compare demographic and other characteristics.ResultsA total of 130 heart transplant recipients were analyzed. We excluded 33 patients from the study because they either had neurologic complications or died postoperatively without discharge from the intensive care unit. The mean age of the cohort was 35.4 ± 18.5 years, and 74 (76.3%) were male. Out of those 97 heart transplant recipients, 22 (22.7%) developed neurologic complications. Five patients (22.7% ) were admitted to the ICU in the first month, six patients (27.3%) were admitted to the ICU between one and six months, and 11 patients (50%) were admitted to the ICU six months after transplantation due to neurologic complications. The most common diagnosis was posterior reversible encephalopathy syndrome (PRES) (n = 6, 27.3%). The other diagnoses were calcineurin inhibitor toxicity (n = 5, 22.7%), intracranial hemorrhage (n = 3, 13.6%), seizures (n = 2, 9.2%), stroke (n = 2, 9.2%), femoral neuropathy (n = 1, 4.5%), myopathy (n = 1, 4.5%), phrenic nerve damage (n = 1, 4.5%), and cerebral abscess (n = 1, 4.5%). The rate of neurologic complications was higher in males when compared with females (p = 0.03). Both groups were similar in terms of the etiologies of cardiac failure, coexisting disease, and anticoagulant and immunosuppressive usage. The requirement for mechanical ventilation, renal replacement therapy, and the incidence of acute kidney injury were similar in both groups (p > 0.05). The incidence of sepsis was significantly higher in patients with neurologic complications (n = 8, 36.4%, versus n = 5, 6.7%; p < 0.001). The mean length of hospital stay was significantly higher in patients with neurologic complications (21.4 ± 15.8 versus 11.1 ± 13.3 days, p = 0.01).The risk of developing neurologic complications is 3.036 times higher in males, and this is statistically significant (odds ratio (OR), 3.036; 95% confidence interval (CI), 1.078-8.444; p = 0.036).ConclusionOur results suggest that neurologic complications develop in 22.7% of heart transplant recipients admitted to the ICU, and half of them are seen after six months postoperatively. PRES was the most frequent (27.3%) neurologic complication. The risk of neurologic complications is three times higher for males. The mean length of hospital stay and incidence of sepsis were significantly higher in heart transplant recipients who developed neurologic complications.

High-grade L5-S1 spondylolisthesis with lumbosacral kyphosis: Long-term results of non-instrumented circumferential arthrodesis in children, adolescents

IntroductionThe choice of surgical technique for high-grade spondylolisthesis (HGS) associated with lumbosacral kyphosis remains controversial. Are non-instrumented techniques still relevant, what with the multiplicity and modernity of patient-specific instrumentation? HypothesisOur hypothesis was that a non-instrumented circumferential arthrodesis performed after a period of gradual reduction of HGS, associated with lumbosacral kyphosis, provided satisfactory long-term functional and radiographic results in children and adolescents while minimizing the risk of complications. Materials and methodsThirty-one L5-S1 HGS associated with a lumbosacral kyphosis operated by non-instrumented circumferential arthrodesis after a period of traction and suspension were included in our study. The first stage of this technique consisted of a gradual reduction using traction followed by immobilization in the corrected position. The second stage involved a posterior, followed by an anterior, surgical procedure and a spica cast immobilization for 4 months. The mean age at surgery was 13.9±2.3 years (6–18) and the mean follow-up was 10.3±4.5 years (2.1–17.8). ResultsThe overall complication rate was 26% (n=8/31): 13% neurologic complications, 10% bone fusion defects and 3% skin complications. The reoperation rate was 13% (n=4/31). The mean ODI (/50) was 3±4.6 (0–22) and the SRS-30 126.7±15 (72–143). The Taillard index decreased by 25% (p<.001) and remained stable throughout the follow-up period (p=.65). The lumbosacral angle was corrected by 13.5% (p=.03) and the correction was maintained throughout the follow-up period (p=.71). At the last follow-up, the lumbosacral angle was significantly correlated with a low ODI score and a high SRS-30 score (p<.05). ConclusionEven though this technique achieved a smaller reduction of the lumbosacral angle, it reduced by at least a factor of three the incidence of neurologic complications and resulted in satisfactory functional outcomes when compared to instrumented and intraoperative correction series. Level of evidenceIV.

Neurological Complications of Veno-Arterial Extracorporeal Membrane Oxygenation: A Retrospective Case-Control Study.

Background: To explore the epidemiology, clinical features, risk indicators, and long-term outcomes of neurological complications caused by veno-arterial extracorporeal membrane oxygenation (V-A ECMO).Methods: We retrospectively analyzed 60 adult patients who underwent V-A ECMO support in our unit from February 2012 to August 2020. These patients were separated into the neurological complications group (NC group) and the non-neurological complications group (nNC group). The differences in basic data and ECMO data between the two groups were compared. The data of long-term neurological prognosis were collected by telephone follow-up.Results: Thirty-nine patients (65.0%) had neurological complications. There were significant differences between the two groups in terms of median age, hypertension, median blood urea nitrogen, median troponin I (TNI), median lactic acid, pre-ECMO percutaneous coronary intervention, continuous renal replacement therapy (CRRT), median Sequential Organ Failure Assessment score, median Acute Physiology and Chronic Health Evaluation II score, median peak inspiratory pressure, median positive end expiratory pressure, and median fresh frozen plasma (P < 0.05). The median Intensive Care Unit length of stay (ICU LOS), 28-day mortality, median post-ECMO vasoactive inotropic score, non-pulsate perfusion (NP), and median ECMO duration of the NC group were significantly higher than those of the nNC group (P < 0.05). Furthermore, multiple logistic regression analysis revealed that TNI (P = 0.043), CRRT (P = 0.047), and continuous NP > 12 h (P = 0.043) were independent risk indicators for neurological complications in patients undergoing ECMO. Forty-four patients (73.3%) survived after discharge, and 38 patients (63.3%) had Cerebral Performance Category score of 1–2. And there were significant differences between the two groups in long-term neurological outcomes after discharge for 6 months (P < 0.05).Conclusion: The incidence of neurological complications was higher in patients undergoing V-A ECMO and was closely related to adverse outcomes (including ICU LOS and 28-day mortality). TNI, CRRT, and continuous NP > 12 h were independent risk indicators for predicting neurological complications in ECMO supporting patients. And the neurological complications of patients during ECMO support had significant adverse effect on long-term surviving and neurological outcomes of patients after discharge for 6 months.

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support.

Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0-76.0), median injury severity score was 34.0 (IQR, 27.0-43.0), and the median duration of ECMO support was 11 days (IQR, 7.5-20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

Surveillance for Enteroviruses Associated with Hand, Foot, and Mouth Disease, and Other Mucocutaneous Symptoms in Spain, 2006–2020

Hand, foot, and mouth disease (HFMD) is a mild illness caused by enteroviruses (EV), although in some Asian countries, large outbreaks have been reported in the last 25 years, with a considerable incidence of neurological complications. This study describes epidemiological and clinical characteristics of EV infections involved in HFMD and other mucocutaneous symptoms from 2006 to 2020 in Spain. EV-positive samples from 368 patients were included. EV species A were identified in 85.1% of those typed EV. Coxsackievirus (CV) A6 was the prevalent serotype (60.9%), followed by EV-A71 (9.9%) and CVA16 (7.7%). Infections affected children (1–6 years old) mainly, and show seasonality with peaks in spring–summer and autumn. Clinical data indicated few cases of atypical HFMD as well as those with neurological complications (associated with the 2016 EV-A71 outbreak). Phylogenetic analysis of CVA6 VP1 sequences showed different sub-clusters circulating from 2010 to present. In conclusion, HFMD or exanthemas case reporting has increased in Spain in recent years, probably associated with an increase in circulation of CVA6, although they did not seem to show greater severity. However, EV surveillance in mucocutaneous manifestations should be improved to identify the emergence of new types or variants causing outbreaks and more severe pathologies.

Effective Antiviral Activity of the Tyrosine Kinase Inhibitor Sunitinib Malate against Zika Virus

IntroductionZika virus (ZIKV), a mosquito-borne flavivirus, causes the outbreaks of Latin America in 2015 - 2016, with the incidence of neurological complications. Sunitinib malate, an orally bioavailable malate salt of the tyrosine kinase inhibitor, is suggested as a broad-spectrum antiviral agent against emerging viruses like severe acute respiratory syndrome coronavirus (SARS-CoV) and SARS-CoV-2.Materials and MethodsThis study investigated the antiviral efficacy and antiviral mechanisms of sunitinib malate against ZIKV infection using cytopathic effect reduction, virus yield, and time-of-addition assays.ResultsSunitinib malate concentration-dependently reduced ZIKV-induced cytopathic effect, the expression of viral proteins, and ZIKV yield in supernatant with 50% inhibitory concentration (IC50) value of 0.015 μM, and the selectivity index of greater than 100 against ZIKV infection, respectively. Sunitinib malate had multiple antiviral actions during entry and post-entry stages of ZIKV replication. Sunitinib malate treatment at entry stage significantly reduced the levels of ZIKV RNA replication with the reduction of (+) RNA to (-) RNA ratio and the production of new intracellular infectious particles in infected cells. The treatment at post-entry stage caused a concentration-dependent increase in the levels of ZIKV (+) RNA and (-) RNA in infected cells, along with enlarging the ratio of (+) RNA to (-) RNA, but caused a pointed increase in the titer of intracellular infectious particles by 0.01 and 0.1 μM, and a substantial decrease in the titer of intracellular infectious particles by 1 μM.ConclusionThe study discovered the antiviral actions of sunitinib malate against ZIKV infection, demonstrating a repurposed, host-targeted approach to identify potential antiviral drugs for treating emerging and global viral diseases.

Neurological Complications and Recovery Rates of Patients With Adult Cervical Deformity Surgeries.

Study Design:Retrospective cohort study.Objective:This study aims to report the incidence, risk factors, and recovery rate of neurological complications (NC) in patients with adult cervical deformity (ACD) who underwent corrective surgery.Methods:ACD patients undergoing surgery from 2013 to 2015 were enrolled in a prospective, multicenter database. Patients were separated into 2 groups according to the presence of neurological complications (NC vs no-NC groups). The types, timing, recovery patterns, and interventions for NC were recorded. Patients’ demographics, surgical details, radiographic parameters, and health-related quality of life (HRQOL) scores were compared.Results:106 patients were prospectively included. Average age was 60.8 years with a mean of 18.2 months follow-up. The overall incidence of NC was 18.9%; of these, 68.1% were major complications. Nerve root motor deficit was the most common complication, followed by radiculopathy, sensory deficit, and spinal cord injury. The proportion of complications occurring within 30 days of surgery was 54.5%. The recovery rate from neurological complication was high (90.9%), with most of the recoveries occurring within 6 months and continuing even after 12 months. Only 2 patients (1.9%) had continuous neurological complication. No demographic or preoperative radiographic risk factors could be identified, and anterior corpectomy and posterior foraminotomy were found to be performed less in the NC group. The final HRQOL outcome was not significantly different between the 2 groups.Conclusions:Our data is valuable to surgeons and patients to better understand the neurological complications before performing or undergoing complex cervical deformity surgery.

Ascending aortic aneurysm: propensity score matching analysis of hemiarch and non-hemiarch replacement

Aim. To compare the shortand medium-term outcomes of hemiarch and nonhemiarch replacement for ascending aortic aneurysm (AAA).Material and methods. The study included 151 patients with non-syndromic AAA who underwent an elective replacement. Patients were divided into two groups: group 1 (non-hemiarch, n=40) — standard ascending aortic replacement; group 2 (hemiarch, n=111) — ascending aortic replacement with the hemiarch anastomosis in conditions of moderate hypothermia and circulatory arrest with unilateral antegrade cerebral perfusion. To eliminate systematic differences between the compared groups, the propensity score matching (PSM) method was used.Results. Before PSM, there were no significant intergroup differences in the incidence of neurological complications, myocardial infarction, prolonged ventilation, or acute kidney injury. Bleeding-related reoperation rates and hospital mortality significantly differed between groups. After pseudo-randomization between the non-hemiarch and hemiarch groups, there were no significant differences in the incidence of neurological events, myocardial infarction, prolonged ventilation, reoperations for bleeding, acute renal injury, and hospital mortality. Median-term survival and freedom from aortic reoperations also did not show significant intergroup differences.Conclusion. Hemiarch replacement for AAA does not lead to an increase in the incidence of postoperative complications, as well as the risk of shortand mediumterm mortality compared with non-hemiarch.

Study of multimodal monitoring in neurocritical care patients

To explore the significance of multimodal monitoring in the monitoring and treatment of neurocritical care patients. 104 neurocritical care patients admitted to the department of Critical Care Medicine of Fujian Provincial Hospital from March 2019 to January 2020 were enrolled. Patients were randomly assigned into two groups, with 52 in each group. In the routine monitoring treatment group, heart rate, blood pressure, respiratory rate and the changes in consciousness and pupils were monitored after operation. The patients were treated with routine medicine to reduce intracranial pressure (ICP), maintain proper cerebral perfusion pressure (CPP), balance fluid intake and output, and maintain the airway clear. Patients in the multimodal monitoring treatment group were treated with invasive ICP monitoring, ultrasound to assess brain structure, ultrasound to measure optic nerve sheath diameter (ONSD), transcranial color doppler (TCCD), internal jugular venous blood oxygen saturation monitoring, near-infrared spectroscopy (NIRS), non-invasive cerebral blood oxygen saturation monitoring and quantitative electroencephalogram monitoring. According to the monitoring results, the patients were given targeted treatment with the goal of controlling ICP and improving brain metabolism. The length of intensive care unit (ICU) stay, the incidences of neurological complications (secondary cerebral infarction, cerebral hemorrhage, high intracranial pressure, etc.), and the incidences of poor prognosis [6 months after the onset of Glasgow outcome score (GOS) 1 to 3] were compared between the two groups. Spearman rank correlation analysis of the correlation between invasive ICP and the ICP value which was calculated by TCCD. The receiver operating characteristic (ROC) curve of invasive ICP and pulsatility index of middle cerebral artery (PIMCA) were used to predict poor prognosis. The length of ICU stay in the multimodal monitoring treatment group was significantly shorter than that of the routine monitoring treatment group (days: 6.27±3.81 vs. 9.61±5.09, P < 0.01), and the incidence of neurological complications was significantly lower than that in the routine monitoring treatment group (9.62% vs. 25.00%, P < 0.05). In the multimodal monitoring treatment group, 37 cases had a good prognosis and 15 cases had a poor prognosis, while the routine monitoring treatment group had a good prognosis in 27 cases and a poor prognosis in 25 cases. The incidence of poor prognosis in the multimodal monitoring treatment group was lower than that of the routine monitoring treatment group (28.85% vs. 48.08%, P < 0.05). In the multimodal monitoring treatment group, the invasive ICP and PIMCA of patients with good prognosis were significantly lower than those of patients with poor prognosis [invasive ICP (mmHg, 1 mmHg = 0.133 kPa): 16 (12, 17) vs. 22 (20, 24), PIMCA: 0.90±0.33 vs. 1.39±0.58, both P < 0.01]. There was no significant difference in resistance index of the middle cerebral artery (RIMCA) between the good prognosis group and the poor prognosis group (0.63±0.12 vs. 0.66±0.15, P > 0.05). There was a positive correlation between the invasive ICP and the ICP value which was calculated by TCCD (r = 0.767, P < 0.001). ROC curve analysis showed that the area under ROC curve (AUC) of invasive ICP for poor prognosis prediction was 0.906, the best cut-off value was ≥ 18 mmHg, the sensitivity was 86.49%, and the specificity was 86.67%. The AUC of PIMCA for poor prognosis prediction was 0.759, the best cut-off value was ≥ 1.12, the sensitivity was 81.08%, and the specificity was 60.00%. The AUC of invasive ICP was greater than PIMCA (Z = 2.279, P = 0.023). Comprehensive analysis of multimodal monitoring indicators for neurocritical care patients to guide clinical treatment can reduce the length of hospital stay, and reduce the risk of neurosurgery complications and disability; invasive ICP can predict poor prognosis of neurocritical care patients.

Influence of Age-Related Complications on Clinical Outcome in Patients With Small Ruptured Cerebral Aneurysms

Background: Small ruptured cerebral aneurysms (≤5 mm) account for the majority of aneurysmal subarachnoid hemorrhages, and its clinical management remains a challenge. The aim of this study was to identify the effect of age-related complications on the outcome of patients with small ruptured aneurysm.Methods: A retrospective review was performed in patients with small ruptured aneurysms who underwent microsurgical clipping or endovascular coiling from September 2012 to December 2018. According to their ages, the patients were divided into the elderly group and the non-elderly group. Baseline characteristics, clinical complications, and outcome of patients were analyzed between the two groups. A multivariate logistic regression analysis was used to determine the risk factors associated with the poor outcome of the elderly patients.Results: In the elderly group, 83 patients were treated with clipping and 50 were treated with coiling. In the non-elderly group, 188 patients were treated with clipping and 117 were treated with coiling. The incidence of neurological complications with neurologic deficit in the elderly group was significantly higher compared with that in the non-elderly group (P = 0.006). The elderly patients had a longer hospital stay (P = 0.032) and a poorer outcome (P = 0.001) compared with the non-elderly patients. A multivariate analysis showed that irregular aneurysms (P = 0.045) and ischemic events (P < 0.001) were independent risk factors associated with poor outcome in the elderly.Conclusions: Neurological complications with neurologic deficit, especially ischemic complications, were clearly more common in the elderly patients. Irregular small aneurysms or postoperative ischemic events should be paid attention as the higher risk of poor outcome in the elderly.

Long-term Outcome of Neurological Complications after Infective Endocarditis

Severe neurological complications following infective endocarditis remain a major problem with high mortality rate. The long-term neurological consequences following infective endocarditis remain uncertain. Otherwise, neurosurgeries could be performed after these complications; however, few clinical series have reported the results. Therefore, we utilized a large, nationwide database to unveil the long-term mortality and neurosurgical outcome following infective endocarditis. We included patients with a first-time discharge diagnosis of infective endocarditis between January 2001 and December 2013 during hospitalization. Patients were further divided into subgroups consisting of neurological complications under neurosurgical treatment and complications under non-neurosurgical treatment. Long-term result of symptomatic neurological complications after infective endocarditis and all-cause mortality after different kinds of neurosurgeries were analyzed. There were 16,495 patients with infective endocarditis included in this study. Symptomatic neurological complications occurred in 1,035 (6.27%) patients, of which 279 (26.96%) accepted neurosurgical procedures. Annual incidence of neurological complications gradually increased from 3.6% to 7.4% (P < 0.001). The mortality rate among these patients was higher than that among patients without complications (48.5% vs. 46.1%, P = 0.012, increased from 20% initially to nearly 50% over the 5-year follow-up). However, neurosurgery had no effect on the long-term mortality rate (50.9% vs. 47.6%, P = 0.451). Incidence of neurological complications post-infective endocarditis is increasing, and patients with these complications have higher mortality rates than patients without. Neurosurgery in these populations was not associated with higher long-term mortality. Therefore, it should not be ruled out as an option for those with neurological complications.

Predictive factors of postoperative deficit and functional outcome after surgery for upper limb schwannomas: Retrospective study of 21 patients

Schwannomas are the most frequent benign tumors of the peripheral nerves. Tumor enucleation is the traditional surgical treatment. The incidence of neurological complications after surgery varies and predictive factors for these complications are not clearly defined. The aim of this study was to find predictive factors of postoperative neurological deficit after surgical treatment of schwannomas of the upper limb. Twenty-four schwannomas removed from 21 patients were analyzed retrospectively. The patients’ mean age was 45.4years and the mean follow-up was 64.4months. Clinical parameters studied were age, gender, nature of preoperative symptoms, duration of symptoms, type of surgery performed, tumor location and size, nerve involved, QuickDASH and DN4 scores. Postoperative neurological deficits occurred in 14 patients (67%), with 11 having a sensory deficit and 7 a motor weakness. Eleven did not exist before surgery (6 sensory, 5 motor). In the postoperative deficit subgroup, 6 schwannomas involved the brachial plexus, 4 the ulnar nerve, and 4 the median nerve. All patients who had a fascicular resection because tumor enucleation was not feasible were in the postoperative deficit subgroup. Ten patients had either unchanged or worse QuickDASH and/or DN4 scores after surgery. Surgical treatment of schwannomas can lead to postoperative complications. Although none of our findings were statistically significant, advanced age, large tumor size, more than 16months between the first symptoms and surgery, and brachial plexus location seem to be more frequently observed in those with a postoperative neurological deficit.

Нейросенсорная тугоухость после перенесенного бактериального менингита у детей в г. Нур-Султан

Bacterial meningitis (BM) is a widespread health problem characterized by severe clinical manifestations and high incidence of neurological complications. BM remains one of the main causes of disability and mortality among young children all over the world. Hearing loss is one of neurological complications associated with BM. It accounts for up to 60%–90% of all cases of acquired sensorineural hearing loss (SNHL). Between 2015 and 2018, we performed screening for SNHL among children who had had BM. Seven out of 62 patients examined (11.3%) were found to have SNHL. BM was primarily caused by Streptococcus pneumoniae (n = 4) and Neisseria meningitidis (n = 3). Three out of 4 patients had grade 3–4 SNHL. Computed tomography revealed cochlear ossification in two children and cochlear fibrosis in one child (who had successful cochlear implantation later). For the rest of the patients, we recommended hearing aids. We also found that hearing loss usually develops after BM and does not affect patients with viral meningitis (caused by enteroviruses). We recommend that children with BM undergo regular screening for SNHL (every 3 days during treatment) using otoacoustic emission. These patients should be also examined by an audiologist after discharge from hospital and then every three months for a year. Key words: children, cochlear implantation, meningitis, sensorineural hearing loss, acquired deafness

Spectrum of Neurologic Complications after Allogeneic Hematopoietic Cell Transplantation for Hematologic Diseases in Adults: Systematic Review and Meta-Analysis

Introduction: Neurologic adverse events remain challenging complications with poor morbidity and mortality post adult allogeneic hematopoietic cell transplantation (alloHCT) for hematologic diseases. We conducted a systematic review and meta-analysis to determine their spectrum, incidence and impact on survival. Methods: We searched MEDLINE, COCHRANE, EMBASE through March 2019 for studies published in English. We deemed eligible all types of primary studies including randomized controlled trials (RCTs), controlled observational studies (both cohort and case control), case series and case reports. The eligibility criteria were: (a) adult population specified as patients fifteen years old or older, (b) alloHCT for hematologic diseases, (c) neurologic disorders' diagnosis. Two independent reviewers screened, extracted data and assessed risk of bias (RoB). The primary outcome being the incidence of neurologic complications was assessed in a form of a proportion of adult patients with the neurologic manifestation (n) from the total group of patients that received alloHCT for hematologic diseases (N). We performed a random-effects meta-analysis of proportions using the Freeman-Tukey double arcsine transformation, including only cohort studies. Secondary outcome was impact of neurologic complications on overall survival of patients presented with symptoms after allo-HCT. Pre-planned sensitivity analysis integrating the risk of bias assessment by excluding studies evaluated as high risk was performed as well as prespecified subgroup analyses according to the type of neurologic event. Results: We identified 552 eligible studies describing 57.972 patients; one randomized controlled trial, two case-control, 17 prospective, 86 retrospective cohort studies, 21 case-series and 425 case-reports (PRISMA flow diagram). RoB ranged from fair to high although case-series were of low-risk. The majority of studies traced infectious or drug-related neurologic manifestations. Incidence rates of neurologic complications varied, according to type of complications and studies, from 0.6% for immune-mediated disorders in retrospective cohorts to 13% for drug-related events in prospective cohorts. In meta-analysis of proportions, we included only cohort studies, retrospective or prospective, with homogenous population to estimate a proportion. Neurologic clinical signs or symptoms were detected in 1415 out of 37450 [6.2% (95%CI 4.8-7.7), Ι2= 96.1% (p&lt;0.001)] patients described in 78 included cohort studies. Heterogeneity of results remained high, even after sensitivity analysis excluding studies of high RoB. Infectious complications were present in 2.7% (95%CI 1.9-3.6) and 3.3% (95%CI 0.8-7.1) of patients in retrospective and prospective cohort studies respectively. In retrospective studies, 3.4% (95%CI 2.1-4.9) of patients suffered from drug-related neurologic events. In prospective cohorts, the equivalent incidence was 13% (95%CI 4.2-24.8). Other neurologic complications included cerebrovascular events, thrombotic microangiopathy, immune-mediated complications, relapse and metabolic events. Regarding the severity of neurologic complications and death rate in patients with outcome of interest, data were too diverse to provide any safe conclusion. Neurologic complications had a detrimental impact on survival depending on type of complication in various studies. Based on study type, high RoB in most of the included studies, as well as significant heterogeneity in results from observational data, high imprecision and suspected publication bias, quality of evidence was very low applying the GRADE tool. Conclusion: Our study highlights the wide spectrum and significant impact of neurologic complications on survival post alloHCT. This systematic review summarizes existing data and provides the necessary background information for every physician involved in the management of these patients. Disclosures No relevant conflicts of interest to declare.

281. C5 palsy and neurological complications after cervical spine surgery

BACKGROUND CONTEXT Neurologic complications of cervical spine surgery include C5 palsy, monoplegia, paraplegia and quadriplegia and can have significant impact on quality of life. C5 palsy has a reported incidence of 0-30% with few well-established risk factors. Postoperative cervical spine iatrogenic monoplegia, paraplegia and quadriplegia have little literature supporting their incidence. The Charlson Comorbidity Index is a measure of comorbidity in patients that is associated with surgical outcomes. PURPOSE The objective of this study was to identify the incidence and risk factors for severe neurological complications including C5 palsy after cervical spine surgery using a nationwide patient database. STUDY DESIGN/SETTING Retrospective database study. PATIENT SAMPLE Patients from the Humana national database who underwent cervical spine surgery between 2007 and 2016. OUTCOME MEASURES Neurological complications, CCI, patient demographics. METHODS The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9), The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10), and Current Procedural Terminology (CPT) codes were used to identify and evaluate patients from the Humana national database for neurological complications following posterior fusion cervical spine surgery, anterior fusion cervical spine surgery, laminectomy/laminotomy of the cervical spine, and artificial disc replacement of the cervical spine. Neurological complications were evaluated over a 14-day postoperative period. Using Chi-squared testing, complication incidences and relative risk ratios were calculated with respect to type of cervical spine surgery, CCI, patient age, and patient sex. RESULTS A total of 45,373 patients from the Humana database fit the inclusion criteria for cervical spine surgery. Of these, 732 (1.61%) patients experienced a neurological complication within 14 days after cervical spine surgery. C5 palsy had an incidence of 0.06% across all cervical spine surgeries (29 of 45,373 patients). A CCI >3 had a 5.44 times relative risk for any neurological complication (RR: 5.44; 95% CI: 4.70 - 6.30; p CONCLUSIONS Patients who underwent cervical spine surgery and had a CCI > 3 were at a significantly increased relative risk for neurological complications including C5 palsy within 14 days after surgery. Compared to female patients, male patients had a statistically significant increased incidence in neurological complications, but no significant increase in incidence for C5 palsy. Posterior fusion cervical spine surgery had the highest incidence of neurological complications. Age was correlated with greater incidence of neurological complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Staged and Simultaneous Approaches in the Surgical Treatment of Multisystem Disorders of the Carotid and Coronary Bloodflow

Aim of study . A comparative analysis of the early outcomes of simultaneous and staged methods of revascularization in patients with a combined coronary and carotid artery stenosis. Materials and methods. The study included 45 patients with combined carotid and coronary artery stenosis, operated at the Republican Research Centre of Emergency Medicine in 2014-2018. Patients were divided into two groups: “simultaneous”, 20 patients (simultaneous interventions on the carotid and coronary arteries were performed) and “staged”, 25 patients (carotid and coronary artery stenoses were operated in a staged manner). In all cases, surgical intervention was performed on the beating heart. Results. According to the results of work in the postoperative period, the incidence of neurological complications in the group of staged interventions and in the group of simultaneous interventions was 4.0% vs 5.0%, respectively. In the group of staged interventions, no deaths were observed, whereas in the group of simultaneous interventions, one lethal outcome was observed (5%) associated with pulmonary complications. Conclusion. According to the results of the work, the simultaneous and staged approaches in the treatment of combined lesions of the carotid and coronary arteries did not differ statistically significantly regarding to cerebral and cardiovascular outcomes.

Clinical analysis of children with group B streptococcal meningitis in 2013-2017 in a single center

Objective: To explore the clinical features, the risk factors of mortality and drug resistance of the isolates in patients with group B streptococcus (GBS) meningitis. Methods: A retrospective analysis was performed in 96 children with GBS meningitis (46 males and 50 females) at Beijing Children's Hospital Affiliated to Capital Medical University from January 2013 to October 2017. The clinical characteristics, prognosis and drug resistance were reviewed and analyzed. According to the onset time, the patients were divided into early onset disease (EOD, 0-6 days), late onset disease (LOD, 7-89 days) and very late onset disease (VLOD, 90 days-16 years), the clinical features were compared. According to the results of cranial imaging examination, the patients were divided into two groups: those with neurological complications and those without neurological complications. The influencing factors of neurological complications were analyzed. According to the outcome of 28 days after discharge, patients were divided into death group and survival group. The risk factors of mortality were analyzed by multivariate Logistic regression analysis. Non-numeric variables were analyzed with χ(2) test or Fisher's exact test. Numeric variable between groups were compared with nonparametric test. Results: A total of 96 patients were enrolled, including 18 (19%) EOD, 71 (74%) LOD and 7 (7%) VLOD cases. The median age of EOD cases was 2 days, with a range from 0 to 6 days. The median age of LOD cases was 31 days, with a range from 7 to 81 days. The median age of VLOD cases was 153 days, with a range from 95 to 214 days. Before the onset of the disease, the mother had mastitis in 6 cases and premature rupture of membranes in 6 cases. The common clinical manifestations of patients were fever (95%, 91/96), anorexia (65%, 62/96), seizure (56%, 54/96), and consciousness changes (36%, 35/96). The differences were statistically significant in gender (13/18 vs. 28/71 vs. 5/7, χ(2)=7.705, P=0.024), the number of cases who was admitted to intensive care unit (ICU) (5/18 vs. 31/71 vs. 0, χ(2)=6.065, P=0.042) and peripheral blood leukocyte (12(4, 18)×10(9)/L vs. 6(3, 11)×10(9)/L vs. 13(6, 17)×10(9)/L, H=9.885, P=0.007) in EOD group, LOD group and VLOD group. Cranial imaging was performed in 94 patients, 60 patients (64%) developed neurological complications, including subdural effusion (31/94, 33%), followed by intracranial hemorrhage (26/94, 28%), cerebral softening (19/94, 20%), cerebral atrophy (15/94, 16%), ependinitis (8/94, 9%) and hydrocephalus (4/94, 4%). By univariate χ(2) test analysis, seizure (63% (38/60) vs.41% (14/34), χ(2)=4.310, P=0.038) was a risk factor of neurological complications. Within 28 days after discharge, 88 patients survived and 8 patients died, with a fatality rate of 8%. The independent risk factors for the death were septic shock (OR: 9.548, 95% CI 1.439-63.356, P=0.019) and respiratory failure (OR: 7.053, 95% CI 1.160-42.888, P=0.034). All of isolates were susceptible to penicillin (68/68), ceftriaxone (47/47), cefepime (50/50), vancomycin (60/60) and linezolid (54/54), while the rates of resistance to tetracycline, levofloxacin, clindamycin and erythromycin were 5/12, 17/45, 38/46 and 32/37, respectively. Conclusions: The main type of GBS meningitis is late onset cases. The incidence of neurological complications was high. The independent risk factors for death were septic shock and respiratory failure. The strains were severely resistant to clindamycin and erythromycin.

Central neurological complications following obstetric neuraxial blockade.

Central neuraxial blockade is increasingly the anaesthetic management of choice for parturients, including in higher risk pregnancies. Although they are usually effective and safe, there are potentially devastating neurological complications that may present either overtly or insidiously. A thorough understanding of the variety of potential neurological complications is essential to adequately consent patients in addition to diagnosing and managing complications following neuraxial anaesthesia. This review aims to describe a number of potential neurological injuries that may occur and suggested management based on available evidence. Current evidence supports neuraxial anaesthesia as a safe management strategy in low and many higher risk pregnancies, with a low overall incidence of neurological complications. Neuraxial blockade is safe in patients with platelet counts greater than 70 000/μl and the risk of infective complications secondary to epidural catheterization remains low until day five post procedure. There is also some early evidence supporting the use of transnasal local anaesthetic as a strategy for managing postdural puncture headache. Difficulty remains in establishing absolute risk of complications and optimal management strategies given the low overall number of patients affected and heterogeneity of therapy. There may be a role for centralized registration of postneuraxial complications in obstetric patients to further develop our collective understanding of these conditions.

Effects of Combined Remote Ischemic Pre-and Post-Conditioning on Neurologic Complications in Moyamoya Disease Patients Undergoing Superficial Temporal Artery-Middle Cerebral Artery Anastomosis.

Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is the most commonly used treatment for Moyamoya disease. During the perioperative period, however, these patients are vulnerable to ischemic injury or hyperperfusion syndrome. This study investigated the ability of combined remote ischemic pre-conditioning (RIPC) and remote ischemic post-conditioning (RIPostC) to reduce the occurrence of major neurologic complications in Moyamoya patients undergoing STA-MCA anastomosis. The 108 patients were randomly assigned to a RIPC with RIPostC group (n = 54) or a control group (n = 54). Patients in the RIPC with RIPostC group were treated with four cycles of 5-min ischemia and 5-min reperfusion before craniotomy and after STA-MCA anastomosis (RIPostC). The incidence of postoperative neurologic complications and the duration of hospital stay were determined. The overall incidence of neurologic complication was significantly higher in the control group than in the RIPC with RIPostC group (13 vs. 3, p = 0.013). The duration of hospital stay was significantly longer in the control group than in the RIPC with RIPostC group (17.8 (11.3) vs. 13.8 (5.9) days, p = 0.023). Combined remote ischemic pre- and post-conditioning can be effective in reducing neurologic complications and the duration of hospitalization in Moyamoya patients undergoing STA-MCA anastomosis.