World Neurosurg
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Cerebrospinal fluid (CSF) shunt infection is a major cause of morbidity and mortality in the treatment of hydrocephalus and is associated with significant medical cost. Several studies have demonstrated the efficacy of antibiotic-impregnated (AI) shunt catheters in reducing CSF shunt infection; however, providers remain reluctant to adopt AI catheters into practice because of the increased upfront cost. The objective of this study was to determine if the use of AI catheters provided cost savings in a large nationwide database. ⋯ In analysis of this large, nationwide database, AI catheters were found to be associated with a significant reduction in infection incidence, resulting in tremendous cost savings. AI catheters were associated with a cost savings of $42,125 and $230,390 per 100 de novo shunts placed in adult and pediatric patients, respectively.
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Road traffic accidents are a leading cause of injury in low- and middle-income countries, where mortality rates are disproportionately higher. Patients with severe traumatic brain injury (TBI) tend to have very poor outcomes. To reduce the burden from severe TBI, we describe its distribution at Mulago National Referral Hospital (Kampala, Uganda) and identify the associations between outcomes and patient characteristics, offering insights into prevention and future research efforts to improve clinical care. ⋯ Severe TBI was a common condition for injury-related hospital admissions at Mulago Hospital. The capacity for neurosurgery may have explained the relatively lower mortality rate than previously reported from Sub-Saharan Africa. Further investigations are needed. Targeted prevention programs focused on motorcycle users and helmet law enforcement should decrease the incidence of severe TBI.
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Lumbar pedicle screws are placed for internal fixation and help to enhance bony fusion. Optimal screws are medially directed, should be parallel or pointing to the superior endplate, and penetrate 50%-80% of the vertebral body. "Nonparallel" pedicle screws can be inadvertently placed within the confines of the pedicle and vertebral body but are sometimes replaced to obtain a more acceptable postoperative image. A nonparallel (suboptimal) screw is one that is located within the pedicle and body and does not violate bone; however, it is not parallel to the superior endplate. These "cored-out" grooves left in the bone from the initial tap and screw placement may compromise the integrity of the bone and the construct. ⋯ Great care is warranted in the initial placement of lumbar pedicle screws. Revising a nonparallel screw placement decreases pullout strength and alters biomechanical movements (axial rotation and flexion/extension) in patients with decreased bone mineral density. If a screw is inadvertently placed nonparallel to the endplate but is within the confines of the pedicle and vertebral body with adequate bone purchase, it should not be revised and rather be left in its place.