Antibiotic treatment, coupled with neurosurgical and otolaryngological interventions, is the typical course of treatment. Infrequently, children presenting to the authors' pediatric referral center have experienced intracranial infections related to sinusitis or otitis media, historically. The COVID-19 pandemic's impact has manifested itself in an increased incidence of intracranial pyogenic complications at this healthcare hub. This study's objective was a comparative analysis of pediatric intracranial infections related to sinusitis and otitis, examining the incidence, disease severity, microbial involvement, and treatment approaches across the periods before and during the COVID-19 pandemic.
From January 2012 to December 2022, a retrospective analysis was performed on all patients under 21 years of age at Connecticut Children's who underwent neurosurgical intervention for intracranial infections associated with sinusitis or otitis media. A systematic collation of demographic, clinical, laboratory, and radiological data was performed, and statistical comparisons were made between variables pre- and post-COVID-19.
Eighteen patients undergoing treatment for intracranial infections, 16 cases stemming from sinusitis and 2 cases from otitis media, were observed throughout the study period. From January 2012 through February 2020, a total of ten patients (representing 56%) presented. No patients presented between March 2020 and June 2021. Subsequently, from July 2021 to December 2022, eight patients (44%) presented. The pre-COVID-19 and COVID-19 cohorts exhibited no noteworthy demographic disparities. For the pre-COVID-19 group of 10 patients, the total number of procedures included 15 neurosurgical and 10 otolaryngological procedures; the COVID-19 cohort of 8 patients saw 12 neurosurgical and 10 otolaryngological procedures. A range of bacteria, including Streptococcus constellatus/S., was observed in cultures derived from surgical wounds. S. anginosus/ chromatin immunoprecipitation A statistical analysis revealed a significantly higher prevalence of intermedius in the COVID-19 cohort (875% vs 0%, p < 0.0001) and a similarly significant increase in the occurrence of Parvimonas micra (625% vs 0%, p = 0.0007).
There was a roughly threefold increase in sinusitis- and otitis media-related intracranial infections observed at an institutional level during the COVID-19 pandemic. Multicenter studies are indispensable for substantiating this observation and exploring whether SARS-CoV-2, adjustments to the respiratory microbiome, or delayed interventions are causally implicated in infection mechanisms. The next steps in this study will include an expansion to other pediatric facilities across the United States and Canada.
Sinusitis and otitis media-associated intracranial infections have experienced approximately threefold growth in institutional cases during the COVID-19 pandemic. A comprehensive multicenter investigation is necessary to corroborate this observation and explore whether SARS-CoV-2 infection mechanisms stem from the virus itself, changes in respiratory microbial communities, or delayed healthcare access. Further research will entail extending this study to encompass pediatric medical centers across the United States and Canada.
For brain metastases (BMs) originating from lung cancer, stereotactic radiosurgery (SRS) remains the principal treatment. Over the recent years, the use of immune checkpoint inhibitors (ICIs) in metastatic lung cancer has provided improved clinical outcomes for patients. A research project investigated the relationship between simultaneous SRS and ICIs, and their effect on overall survival, intracranial tumor control, and the potential risks involved in patients with brain metastases from lung cancer.
Aizawa Hospital's patient cohort for this study comprised individuals who received SRS for lung cancer biopsies between January 2015 and December 2021. No more than three months separated the SRS and ICI administrations when considering concurrent use. Two comparable treatment groups, in terms of their likelihood of concomitant immunotherapy, were established through propensity score matching (PSM) with a 1:11 match ratio, using 11 potential prognostic factors. Survival and intracranial disease control metrics were compared across cohorts treated with and without concomitant immune checkpoint inhibitors (ICI + SRS vs SRS), utilizing time-dependent analyses that accounted for competing events.
Five hundred eighty-five patients, categorized with lung cancer BM, were eligible for the study (494 patients with non-small cell lung cancer and 91 with small cell lung cancer). Of the affected patients, 93 (16%) received concurrent immunotherapeutic treatments. Propensity score matching procedures resulted in two groups of 89 patients each, one assigned to receive both immunotherapy and surgical resection (ICI + SRS), the other to receive only surgical resection (SRS). After the initial surgical resection (SRS), one year survival rates were 65% in the group receiving ICI + SRS and 50% in the SRS only group. The corresponding median survival times were 169 months and 120 months, respectively (hazard ratio 0.62, 95% confidence interval 0.44-0.87, p = 0.0006). Over a two-year period, the cumulative neurological mortality rate was 12% and 16% respectively. The hazard ratio was 0.55 (95% CI 0.28-1.10), p = 0.091. At the one-year mark, intracranial progression-free survival rates were 35% and 26% (hazard ratio 0.73, 95% confidence interval 0.53-0.99, p-value 0.0047). In the two-year follow-up, local failure rates were observed at 12% and 18% (HR 072, 95% CI 032-161, p = 043). Simultaneously, distant recurrence rates during the same period were 51% and 60% (HR 082, 95% CI 055-123, p = 034). Within each cohort, one patient suffered a severe adverse reaction from radiation (Common Terminology Criteria for Adverse Events [CTCAE] grade 4). Toxicity at CTCAE grade 3 was observed in three patients receiving immunotherapy and supplemental radiation, and five patients receiving supplemental radiation alone (odds ratio [OR] 1.53, 95% confidence interval [CI] 0.35-7.70, p=0.75).
The study demonstrated that administering immune checkpoint inhibitors along with immunotherapy for lung cancer patients with brain metastases was linked to a longer survival period and enduring intracranial disease control, without any noticeable increase in adverse reactions related to the treatment.
Concurrent SRS and ICIs in the treatment of lung cancer patients harboring brain metastases yielded positive outcomes, including increased survival duration and sustained control of intracranial disease, with no observed escalation of adverse events.
Vertebral osteomyelitis, a rare complication, can sometimes be a consequence of a coccidioidomycosis infection. In cases where medical management proves inadequate or neurological deficits, epidural abscesses, or spinal instability are present, surgical intervention is deemed essential. The interplay between the timing of surgical procedures and the recovery of neurological function remains unexamined. Our investigation aimed to explore the link between the duration of neurological deficits present at the time of initial presentation and the degree of neurological recovery post-surgical intervention.
A single tertiary care center's records were examined retrospectively to identify all patients with coccidioidomycosis of the spine, covering the period between 2012 and 2021. Data points included patient information, how the condition presented, imaging results, and the surgical operations. A change in neurological examination, subsequent to surgical intervention, was evaluated and measured using the American Spinal Injury Association Impairment Scale, defining the primary outcome. The complication rate, a secondary outcome, was carefully monitored. read more A logistic regression model was utilized to investigate the connection between the duration of neurological deficits and the extent of neurological examination enhancement following surgical intervention.
Spinal coccidioidomycosis was diagnosed in 27 patients between 2012 and 2021; vertebral involvement was evident in 20 of these patients on spinal imaging, with a median follow-up period of 87 months (interquartile range 17-712 months). Twelve of the 20 patients with vertebral issues (600%) experienced a neurological deficit, lasting a median of 20 days (ranging from 1 to 61 days). Neurological deficit (11/12, 917%) prompted surgical intervention for the majority of patients. Surgery resulted in improved neurological examinations in nine (812%) of these eleven patients; the other two patients maintained stable deficits. According to the AIS assessment, seven patients' recoveries improved sufficiently to merit a one-grade elevation. A Fisher's exact test (p = 0.049) demonstrated no meaningful connection between the duration of neurological deficits at initial presentation and the subsequent neurological recovery after surgical intervention.
Surgeons should not hesitate to perform surgery for spinal coccidioidomycosis, even if neurological deficits are apparent on initial assessment.
Neurological deficits observed at presentation should not hinder surgical treatment of spinal coccidioidomycosis cases.
The stereoelectroencephalography (SEEG) technique provides a distinctive three-dimensional view of the location where seizures start. Institute of Medicine Success in stereoelectroencephalography (SEEG) is intrinsically linked to the precision of depth electrode placement, yet how various implantation techniques and operative variables influence accuracy is poorly understood. This research examined the impact of two electrode implantation methods (external versus internal stylet) on implantation accuracy, accounting for other operative factors.
Post-implantation computed tomography (CT) or magnetic resonance imaging (MRI) scans were overlaid with the pre-operative trajectory maps to assess the implantation accuracy of 508 depth electrodes in 39 subjects who underwent stereotactic electroencephalography (SEEG). Comparing two methods of implantation, the first utilizing a preset internal stylet length and the second relying on an external stylet for measured lengths, was the subject of this investigation.