RESUMEN
BACKGROUND AND IMPORTANCE: Infection following ventriculoperitoneal shunt (VPS) placement is a recognized complication, with variable incidence rates worldwide. Development of post-infectious multiloculated hydrocephalus (MLH) is likely if VPS infection is improperly managed, in turn affecting the prognosis. There is a lack of studies from Saudi Arabia regarding patients' functional outcome in relation to different variables. OBJECTIVES: To study the causative organisms, related variables and patient outcomes in MLH after VPS infection. METHODS: This case series is a retrospective chart review of pediatric patients diagnosed with hydrocephalus from 2011 to 2019. Patients were included if they were aged <18 years, had confirmed cerebrospinal fluid/blood infection with radiological evidence of MLH, and were regularly followed-up. Functional status score was used to evaluate the outcomes. RESULTS: A total of 150 patients underwent VPS insertion during the study period, of which 12 (8%) had postinfection MLH. The mean age at diagnosis and follow-up was 9 and 19 months, respectively. Ten patients developed MLH after their first VPS infection and one each developed MLH following the second and third VPS infections. Cerebrospinal fluid cultures mostly grew only single organisms (6/12), with Staphylococcus species being the most common. All patients underwent navigated endoscopic fenestration; nine patients required VPS placement and three required redo endoscopic fenestration surgery. All patients were developmentally delayed, with the majority (75%) having a functional status score of 6-10. CONCLUSION: Development of MLH after VPS infection is debilitating and requires prompt treatment. Although the overall functional outcome is poor, evolving neuroendoscopic techniques with tailored preoperative planning may play a role in reducing the adverse effect of shunt multiplicity, shunt infections and the higher failure rate among patients with complex hydrocephalus.
RESUMEN
A death certificate is an official document in which the medical practitioner primarily records the cause of death sequence, the time interval between the onset of the cause of death and death, and personal details of the deceased. Errors in death certificate documentation are not uncommon. We aim to review the common errors in writing the cause of death certificate in the Middle East. For this review, we searched the PubMed database using a comprehensive search strategy to identify studies from the Middle East that reported errors in the cause of death certification from inception to August 17, 2019. Of the 308 items initially identified, 5 were eligible for inclusion. These studies were reported from only a few countries (Saudi Arabia, Iran, Lebanon and Palestine) in the Middle East and did not represent all the countries geographically located in the Middle East. The Middle East is not immune to errors in the medical certification of the cause of death. The absence of the cause of death, inappropriate listing and sequencing of the causes of death, mentioning the mechanism or mode of death instead of the cause of death, absence of time interval between the onset of the cause of death and death, use of abbreviations and symbols instead of formal medical terminology, and absence of the certifying medical practitioner's signature were the commonly death certification errors observed in this regional literature review. Additional studies to assess death certification errors in all the Middle East countries are needed. Efforts should be made to compulsorily include the teaching and learning of the cause of death certification in the undergraduate medical curriculum. Interactive workshops on drafting the cause of death certificate should be periodically conducted for the benefit of the interns and residents.