Cutaneous Clues for the Diagnosis of Immunodeficiencies in Infancy

( Adrian Martin Pierini ) 대한피부과학회 2008 초록집 Vol.46 No.10

Clinical Outcomes and Cost Profiles for Cage and Allograft Anterior Cervical Discectomy and Fusion Procedures in the Adult Population: A Propensity Score-Matched Study

Rodrigues Adrian John,Varshneya Kunal,Stienen Martin Nikolaus,Schonfeld Ethan,Than Khoi Duc,Veeravagu Anand 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.4

Study Design: Retrospective cohort study.Purpose: To characterize the postoperative outcomes and economic costs of anterior cervical discectomy and fusion (ACDF) procedures using synthetic biomechanical intervertebral cage (BC) and structural allograft (SA) implants.Overview of Literature: ACDF is a common spine procedure that typically uses an SA or BC for the cervical fusion. Previous studies that compared the outcomes between the two implants were limited by small sample sizes, short-term postoperative outcomes, and procedures with single-level fusion.Methods: Adult patients who underwent an ACDF procedure in 2007–2016 were included. Patient records were extracted from MarketScan, a national registry that captures person-specific clinical utilization, expenditures, and enrollments across millions of inpatient, outpatient, and prescription drug services. Propensity-score matching (PSM) was employed to match the patient cohorts across demographic characteristics, comorbidities, and treatments.Results: Of 110,911 patients, 65,151 (58.7%) received BC implants while 45,760 (41.3%) received SA implants. Patients who underwent BC surgeries had slightly higher reoperation rates within 1 year after the index ACDF procedure (3.3% vs. 3.0%, <i>p</i>=0.004), higher postoperative complication rates (4.9% vs. 4.6%, <i>p</i>=0.022), and higher 90-day readmission rates (4.9% vs. 4.4%, <i>p</i> =0.001). After PSM, the postoperative complication rates did not vary between the two cohorts (4.8% vs. 4.6%, <i>p</i>=0.369), although dysphagia (2.2% vs. 1.8%, <i>p</i><0.001) and infection (0.3% vs. 0.2%, <i>p</i>=0.007) rates remained higher for the BC group. Other outcome differences, including readmission and reoperation, decreased. Physician’s fees remained high for BC implantation procedures.Conclusions: We found marginal differences in clinical outcomes between BC and SA ACDF interventions in the largest published database cohort of adult ACDF surgeries. After adjusting for group-level differences in comorbidity burden and demographic characteristics, BC and SA ACDF surgeries showed similar clinical outcomes. Physician’s fees, however, were higher for BC implantation procedures.

The Impact of Preoperative Myelopathy on Postoperative Outcomes among Anterior Cervical Discectomy and Fusion Procedures in the Nonelderly Adult Population: A Propensity-Score Matched Study

Rodrigues Adrian John,Schonfeld Ethan,Varshneya Kunal,Stienen Martin Nikolaus,Veeravagu Anand 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.4

Study Design: Retrospective cohort study.Purpose: Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for patients diagnosed with cervical degenerative diseases with or without myelopathy. A thorough understanding of outcomes in patients with and without myelopathy undergoing ACDF is required because of the widespread utilization of ACDF for these indications.Overview of Literature: Non-ACDF approaches achieved inferior outcomes in certain myelopathic cases. Studies have compared patient outcomes across procedures, but few have compared outcomes concerning myelopathic versus nonmyelopathic cohorts.Methods: The MarketScan database was queried from 2007 to 2016 to identify adult patients who were ≤65 years old, and underwent ACDF using the international classification of diseases 9th version and current procedural terminology codes. Nearest neighbor propensity-score matching was employed to balance patient demographics and operative characteristics between myelopathic and nonmyelopathic cohorts.Results: Of 107,480 patients who met the inclusion criteria, 29,152 (27.1%) were diagnosed with myelopathy. At baseline, the median age of patients with myelopathy was higher (52 years vs. 50 years, p <0.001), and they had a higher comorbidity burden (mean Charlson comorbidity index, 1.92 vs. 1.58; p <0.001) than patients without myelopathy. Patients with myelopathy were more likely to undergo surgical revision at 2 years (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.54–1.73) or are readmitted within 90 days (OR, 1.27; 95% CI, 1.20–1.34). After patient cohorts were matched, patients with myelopathy remained at elevated risk for reoperation at 2 years (OR, 1.55; 95% CI, 1.44–1.67) and postoperative dysphagia (2.78% vs. 1.68%, p <0.001) compared to patients without myelopathy.Conclusions: We found inferior postoperative outcomes at baseline for patients with myelopathy undergoing ACDF compared to patients without myelopathy. Patients with myelopathy remained at significantly greater risk for reoperation and readmission after balancing potential confounding variables across cohorts, and these differences in outcomes were largely driven by patients with myelopathy undergoing 1–2 level fusions.

Poster Session : PS 0419 ; Infectious Disease ; Participation of Patients and Family Members as a Strategy for Improving Adherence to Hand Hygiene in a University Hospital

( Roberto Monreal Robles ),( Adrian Camacho Ortiz ),( Laura Baena Trejo ),( Martin Almaguer Leyva ),( Jose Luis Ramos Martinez ),( Dionicio Galaza Delgado ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Health care worker (HCW) hand hygiene (HH) is the single most important strategy to prevent health care associated infections (HAI). Patient participation has been proven to increase HCW hand hygiene compliance. Methods: We conducted a comparative study evaluating the adherence of HH and the rate of HAI among HCW in a 60-bed internal medicine unit pre and post-intervention. Intervention: family members were instructed to show a 10 x 7 cm card with the following printed sentence, “Please, protect my patient, wash your hands” to the HCW every time they intended to touch or perform a medical procedure to their patients. Results: During the study 640 HH opportunities were recorded. Pre-intervention we had a 66% adherence to HH among HCW. After intervention our fi ndings show an overall increase in HH adherence to 84% (18% increased; P= 0.02). Pre-intervention we fi nd that among HCW, physicians had the lowest rate of adherence to HH with a 36% compared with nurses` staff, 84 %. However, after our approach we got high percentage of compliance in both physicians and nurses (76% vs 93%) reducing the rate adherence-gap between them. Pre-intervention we reported a rate of 2.6 HAI per 100 discharges. After our approach we got a rate of 0.8 HAI per 100 discharges. Conclusions: The active participation of patients and family members as a permanent educational feedback was a successful strategy to achieve a higher rate of HH adherence among HCW´s and a lower rate of hospital associated-infections.

Vision-based Autonomous Disinfection of High-touch Surfaces in Indoor Environments

Sean Roelofs,Benoit Landry,Myra Kurosu Jalil,Adrian Martin,Saisneha Koppaka,Sindy K.Y. Tang,Marco Pavone 제어로봇시스템학회 2021 제어로봇시스템학회 국제학술대회 논문집 Vol.2021 No.10

Autonomous systems have played an important role in response to the Covid-19 pandemic. Notably, there have been multiple attempts to leverage Unmanned Aerial Vehicles (UAVs) to disinfect surfaces. Although recent research suggests that surface transmission is less significant than airborne transmission in the spread of Covid-19, surfaces and fomites can play, and have played, critical roles in the transmission of Covid-19 and many other viruses, especially in settings such as child daycares, schools, offices, and hospitals. Employing UAVs for mass spray disinfection offers several potential advantages, including high-throughput application of disinfectant, large scale deployment, and the minimization of health risks to sanitation workers. Despite these potential benefits and preliminary usage of UAVs for disinfection, there has been little research into their design and effectiveness. In this work, we present an autonomous UAV capable of effectively disinfecting indoor surfaces. We identify relevant parameters such as disinfectant type and concentration, and application time and distance required of the UAV to disinfect high-touch surfaces such as door handles. Finally, we develop a robotic system that enables the fully autonomous disinfection of door handles in an unstructured and previously unknown environment. To our knowledge, this is the smallest untethered UAV ever built with both full autonomy and spraying capabilities, allowing it to operate in confined indoor settings, and the first autonomous UAV to specifically target high-touch surfaces on an individual basis with spray disinfectant, resulting in more efficient use of disinfectant.

Poster Session : PS 0153 ; Diabetes : Basal-Bolus Insulin Regimens and a Discharge-Strategy in Hospitalized Patients with Type 2 Diabetes Can Improve and Maintaining Control Glucemic During Several Years

( Pedro Reales Figueroa ),( Yasser Hessein Abdou ),( Maria Martin Toledano Lucas ),( Ibrahim Hamad ),( Adrian Ruiz Fernandez ),( Juan Velasco Franco ),( Marta Salas Cabanas ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Aims: Current guidelines recommend the use of a basal-bolus insulin regimen in hospitalized patients with hyperglycemia or type 2 DM. In addition a simple strategy facilitating the reconciliation of medication on discharge can improve glycemic control post-discharge. With our study we want to test whether this better glycemic control is maintained over time. Methods: Our study is a prospective and observational study during routine clinical practice. It has been held in an Department of Internal Medicine during hospitalization, with follow-up visit at 3 months after discharge and followed up for 3 years. Study patients (30) were treated with a regimen of basal-bolus insulin during hospitalization and an adjustment of their antidiabetic treatment at discharge. As a control group we included patients(30) hospitalized with similar characteristics, treated with other regimen of insulin or oral antidiabetic agents and to which either no treatment adjustment is recommended at discharge. A follow-up to all patients at 3 months after discharge and again after 3 years I realize. Results: Comparing the study group with the control group we found no differences in baseline HbA1c (8,52%±0,81 vs 8,61%±0.72; p:0,652), age (67,7±3,76 vs 67,8±3,71; p:0,86), sex (16 male vs 17 mal) and BMI (30,33±1,62 Kg/m2 vs 30,41±1,63 Kg/m2). Compared with baseline, the HbA1c at 3 months after discharge is lowe r(7,51%±0.81 vs 8,52%±0,81;p:0,001) and 3 years after discharge also remains lower(7,81%±0,81vs8,52%±0,81; p:0,013). Compared with control subjects, patients included in study have lower HbA1c at 3 months after discharge (7,51%±0,81 vs 8,71% ± 0,81:p:0,004) and lower HbA1c at 3 years after discharge (7,81%±0,81 vs 8,91%±0,81; p:0,002). Conclusion: This study confi rm that protocols to manage hyperglycemia with basal-bolus insulin regimens are also feasible and effective in routine clinical practice, and demonstrate that a simple strategy facilitating the reconciliation of medication on discharge can improve glycemic control post-discharge, that remains after 3 years or follow.

Behavioral, Oxidative, and Biochemical Effects of Omega-3 on an Ovariectomized Rat Model of Menopause

( Renata Vinholes Oliveira Da Rocha ),( Maria Isabel Morgan Martins ),( Flavia Tasmim Techera Antunes ),( Marcia Gerhardt Martins ),( Adriane Belló Klein ),( Dione Silva Corrêa ),( Alessandra Hubner D 대한폐경학회 2021 대한폐경학회지 Vol.27 No.3

Objectives: Menopause induces changes in neuronal transmission, leading to anxiety and depression. Changes in the brain’s glutamate levels cause psychological behavior in postmenopausal women. Omega-3 has been studied to improve some of these behaviors. Methods: Twenty-four female Wistar rats were divided into four groups: sham-operated treated with water (SO-W), sham-operated treated with omega-3 (SO-O), ovariectomized (OVX) treated with water (OVX-W), and bilateral OVX treated with omega-3 (OVX-O). These treatments were performed for 20 days via gavage, before and after surgery, totaling 40 days. Results: In the forced swimming, elevated plus-maze, and open field tests to assess behaviors, such as depression and anxiety, omega-3 improved these behaviors in both treated groups. The levels of thiobarbituric acid reactive substances (TBARS) in the brain were not different between the groups; however, there was a significant decrease in the catalase activity in the SO-O group compared with the SO-W group (P < 0.05). The glutamate level in the cerebrospinal fluid (CSF) was elevated in the SO-O group (P < 0.001) but not in the OVX-W or OVX-O groups. Conclusions: These results bring novel data when related to the glutamatergic system in the SO-O group. This has suggested that the action mechanism of omega-3 was not dependent on glutamate levels in the CSF of the OVX group, but it played a regulatory role in the sham-operated animals. To confirm this, more studies are needed to explore this field when relating to the estrogen and glutamate receptor changes in specific brain regions.

Do changes in inflammatory markers predict hepatocellular carcinoma recurrence and survival after liver transplantation?

Lucas Jose Caram,Francisco Calderon,Esteban Masino,Victoria Ardiles,Ezequiel Mauro,Leila Haddad,Juan Pekolj,Jimena Vicens,Adrian Gadano,Eduardo de Santibanes,Martin de Santibanes 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.1

Backgrounds/Aims: The role of inflammation in malignant cell proliferation has been well described. High values of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) as markers of systemic inflammation have shown associations with unfavorable long-term outcomes. The purpose of this study was to determine values of NLR and PLR evaluated prior to and after surgery and their associations with mortality and recurrence rates of liver transplant patients with hepatocellular carcinoma (HCC). Methods: A total of 105 patients with HCC who underwent orthotopic liver transplantation (OLT) were retrospectively reviewed. NLR and PLR values were obtained from complete blood counts prior to and after surgery. Overall survival (OS) and recurrence-free survival (RFS) in relation with delta NLR and PLR were estimated. Results: Serum alpha-fetoprotein levels > 100 ng/mL (p = 0.014) and lymphovascular emboli in the specimen (p = 0.048) were identified to be significant predictors of RFS. Child-Pugh score (p = 0.016) was found to be an independent factor associated with poorer OS. An increasing delta PLR was associated with worse RFS, although it showed no significant association with OS. Conclusions: The analysis of PLR as a continuous variable may predict recurrence outcomes in patients undergoing OLT for HCC. It is more representative than isolated values.