Predictors and Outcome of Ventriculoperitoneal Shunt Infection: A Retrospective Single-Center Study.

BACKGROUND: Shunt infection critically affects approximately 8-10% of all inserted shunts, leading to significant morbidity and mortality. This study aimed to assess the clinical and laboratory factors associated with shunt infection and outcomes in patients treated for hydrocephalus. Methods: A retrospective study was performed on patients who underwent ventriculoperitoneal shunt (VPS) surgery for hydrocephalus between January 2015 and June 2018. The primary outcome was the development of shunt infection following VPS surgery. Records were reviewed, and variables were analyzed, including patients' demographics, perioperative laboratory and shunt data, and outcomes. The patients had five years of follow-up from surgery, including a minimum of two years from the onset of VPS infection. RESULTS: A total of 132 shunts were inserted in 103 patients with a mean age of 2 years (range; 2 days to 73 years), and 53.4% were males. Twenty-two patients were suspected of having VPS infection (16.7% per procedure); only six (4.5%) had positive cerebrospinal fluid (CSF) detected organisms. Patients with preoperative hemoglobin, white blood cells, and serum glucose within normal values had a lower shunt infection rate. The pediatric population had an elevated risk of VPS infection, particularly those who underwent surgery at a younger age than 7.5 months, weighed less than 10 Kg, and were associated with myelomeningocele. in addition, a shorter surgery time of less than 82 min, single surgeon, and operating room of fewer than four attendees are associated with lower risk of VPS infection. CONCLUSION: We emphasize that early identification and modifications of the risk factors can minimize the probability of developing VPS infection and improve patients outcome.

Refractory Hyperammonemic encephalopathy in Fibrolamellar hepatocellular carcinoma, a case report and literature review.

Fibrolamellar hepatocellular carcinoma is a rare type of hepatocellular carcinoma with unclear etiology. Its prevalence ranges from 0.6%-5%. One of the rare manifestations of FHCC includes hyperammonemic hepatic encephalopathy (HAE). Data regarding HAE in FHCC is limited to case reports, and much is unknown, including its precipitating factors, clinical course, and management. We have reported one such case of FHCC associated HAE and presented an extensive literature review on the topic. We report the case of a 26-year-old Pakistani male who was diagnosed with fibrolamellar hepatocellular carcinoma. On day five after the first chemotherapy, he presented with nausea, vomiting, and confusion. His serum ammonia level was raised, and he was treated with lactulose and rifaximin. The patient continued chemotherapy and had recurrent admissions with HAE. A detailed workup revealed acquired ornithine transcarbamylase deficiency. Ammonia level peaked at 694 umol/L during the clinical course of his disease. He received treatment with multiple ammonia scavengers, including sodium benzoate + phenylacetate, with relief of symptoms and reduction in ammonia level. The patient was eventually lost to follow-up. HAE presents as a paraneoplastic manifestation of FHCC. Patients have laboratory features suggestive of acquired ornithine transcarbamylase deficiency. There is a variable frequency of episodes reported in the literature. Most patients respond well to ammonia scavenger therapies rather than conventional HE management with lactulose or rifaxmin.

Content Analysis of Media Coverage of Childhood Obesity Topics in UAE Newspapers and Popular Social Media Platforms, 2014-2017.

The 2017 prevalence of obesity among children (age 5-17 years) in the United Arab Emirates (UAE) is 13.68%. Childhood obesity is one of the 10 top health priorities in the UAE. This study examines the quality, frequency, sources, scope and framing of childhood obesity in popular social media and three leading UAE newspapers from 2014 to 2017. During the review period, 152 newspaper articles from three leading national newspapers - Gulf News, The National and Al Ittihad - met the eligibility criteria for this study. There were 57 Facebook posts, 50 Twitter posts, 14 posted YouTube videos, and 13 Media releases on related to childhood obesity between 2014 and 2017. Childhood obesity was consistently problematized, primarily in health terms, but was not strongly linked to socio-economic and geographical factors. Childhood obesity was framed as being predominantly influenced by individual and parental behaviours more frequently (n = 76) compared with structural or environmental factors such as the roles of the food and beverage industry (n = 22). Unlike findings from studies with adult obesity, articles advocating individual behavior changes to address childhood obesity were relatively few (n = 29). Social media may be an effective way to help children overcome obesity, in part through online interaction with health care providers and health conscious obese peers. Areas for improvement in social media use to reduce childhood obesity prevalence in UAE include enhancing public engagement with social media posts on childhood obesity, as reflected in the numbers of Likes and Retweets or Shares.