Effects of elastic band orthosis (aider) on balance and gait in chronic stroke patients

Daher, Noha,Lee, Seungjun,Yang, You Jin korean Academy of Physical Therapy Rehabilitation 2013 Physical therapy rehabilitation science Vol.2 No.2

Objective: The objective of this study was to investigate the feasibility and effects of balance training using a newly developed elastic band orthosis (aider) for improvement of mobility and balance in chronic stroke patients. Design: Cross-sectional study. Methods: Ten patients with chronic hemiplegia participated in this study. There were six males and four females; two patients had right hemiplegia and eight had left hemiplegia. This study investigated the effect of the elastic band orthosis on balance and gait ability compared with bare foot condition. Gait parameters were measured using the opto-gait system for analysis of the spatial and temporal parameters of walking in stroke patients. In addition, balance ability in stroke patients was evaluated using the Timed Up and Go (TUG) and Berg Balance Scale (BBS). Results: This study investigated the effect of the elastic band orthosis on balance compared with bare foot condition. The TUG and BBS showed significant improvement with use of the elastic band orthosis (p<0.05). Use of the Elastic band orthosis resulted in significantly improved velocity, cadence, less-affected step length, less-affected stride length, and less-affected single limb support in stroke patients (p<0.05). Conclusions: We demonstrated a significant improvement in dynamic balance and gait ability in chronic stroke patients using the elastic band orthosis. This orthosis may aid in prevention of spastic foot drop, leading to improvement of walking ability.

InSpace Balloon for the Management of Massive Irreparable Rotator Cuff Tears: A Systematic Review and Meta-Analysis

Mohammad Daher,Adam Pearl,Zalaquett Ziad,Bassem T. Elhassan,Joseph A. Abboud,Mohamad Y. Fares,Khaled J. Saleh 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.5

Background: The best course of action for massive irreparable rotator cuff tears (MIRCTs) is not universally agreed upon. Numerous surgical techniques have been discussed. The implantation of a biodegradable spacer into the subacromial area has been documented since 2012 by several authors. The implantation method is touted as being simpler, repeatable, and less invasive than other solutions that are now available. The purpose of this systematic review and meta-analysis, being the first of its kind, was to evaluate the literature to see the efficacy of InSpace balloon (ISB) implantation in the management of MIRCTs. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and with 2 researchers assessing and analyzing each study separately, an extensive electronic search of the literature was conducted in the PubMed database from 1961 until July 27, 2022. Results: Fourteen studies were included in this systematic review and three in the meta-analysis. Eleven out of fourteen studies favored ISB use for MIRCTs, while only three were against its use. All spacers were arthroscopically implanted in the subacromial space. Three studies were included in the meta-analysis. The differences in the compared outcomes were statistically insignificant. Conclusions: A controversy about the use of ISB remains in patients with MIRCTs. Both good and bad outcomes were reported. However, the majority of patients had good clinical outcomes across several grading scales, radiographic evidence of improved impingement, and self-report that they would redo the procedure in hindsight. To draw more solid conclusions and have statistically significant results in the meta-analysis, more randomized controlled trials and comparative studies comparing this device to other treatments are needed.

Management of Extra-articular Scapular Fractures: A Narrative Review and Proposal of a Treatment Algorithm

Mohammad Daher,Sami Abi Farraj,Bassem El Hassan 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.5

The management of scapular fractures can be either conservative or operative, but it is still unclear how to choose the treatment option. Scapular fractures can be classified anatomically into four types: scapular spine, scapular body, and scapular neck where the treatment is conservative most of the time except for certain indications that are specific to each one, and inferior angle of the scapula where the operative treatment yields the best results but conservative treatment can be contemplated in some cases.

Non-alcoholic fatty liver disease-related hepatocellular carcinoma

Darine Daher,Karim Seif El Dahan,Amit G. Singal 대한간암학회 2023 대한간암학회지 Vol.23 No.1

Non-alcoholic fatty liver disease (NAFLD), one of the most common causes of liver disease, is an increasingly common cause of hepatocellular carcinoma (HCC). Several demographic, clinical, and genetic factors contribute to HCC risk in NAFLD patients, which may inform risk stratification scores. Proven efficacious approaches to primary prevention approach in patients with non-viral liver disease remain an area of need. Semi-annual surveillance is associated with improved early tumor detection and reduced HCC-related mortality; however, patients with NAFLD have several challenges to effective surveillance, including under-recognition of at-risk patients, low surveillance utilization in clinical practice, and lower sensitivity of current tools for early-stage HCC detection. Treatment decisions are best made in a multidisciplinary fashion and are informed by several factors including tumor burden, liver dysfunction, performance status, and patient preferences. Although patients with NAFLD often have larger tumor burden and increased comorbidities compared to counterparts, they can achieve similar post-treatment survival with careful patient selection. Therefore, surgical therapies continue to provide a curative treatment option for patients diagnosed at an early stage. Although there has been debate about the efficacy of immune checkpoint inhibitors in patients with NAFLD, current data are insufficient to change treatment selection based on liver disease etiology.

Original Article : Effects of elastic band orthosis (aider) on balance and gait in chronic stroke patients

( Noha Daher ),( Seung Jun Lee ),( You Jin Yang ) 물리치료재활과학회 2013 Physical therapy rehabilitation science Vol.2 No.2

Objective: The objective of this study was to investigate the feasibility and effects of balance training using a newly developed elastic band orthosis (aider) for improvement of mobility and balance in chronic stroke patients. Design: Cross-sectional study. Methods: Ten patients with chronic hemiplegia participated in this study. There were six males and four females; two patients had right hemiplegia and eight had left hemiplegia. This study investigated the effect of the elastic band orthosis on balance and gait ability compared with bare foot condition. Gait parameters were measured using the opto-gait system for analysis of the spatial and temporal parameters of walking in stroke patients. In addition, balance ability in stroke patients was evaluated using the Timed Up and Go (TUG) and Berg Balance Scale (BBS). Results: This study investigated the effect of the elastic band orthosis on balance compared with bare foot condition. The TUG and BBS showed significant improvement with use of the elastic band orthosis (p<0.05). Use of the Elastic band orthosis resulted in significantly improved velocity, cadence, less-affected step length, less-affected stride length, and less-affected single limb support in stroke patients (p<0.05). Conclusions: We demonstrated a significant improvement in dynamic balance and gait ability in chronic stroke patients using the elastic band orthosis. This orthosis may aid in prevention of spastic foot drop, leading to improvement of walking ability.

Blood level of adipokines and nutritional status variables in adolescent pregnancy

Mirela Douradinho Fernandes,Silvia Daher,Luciana Moraes de Sousa,Indiomara Baratto,Thalita Frutuoso Lobo,Edward Araujo Júnior,Cristina Aparecida Falbo Guazzelli 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.6

ObjectiveTo evaluate the serum levels of adiponectin and leptin and their relationship with nutritional variables duringpregnancy in adolescents. MethodsThis prospective cohort study evaluated eutrophic pregnant adolescents (body mass index [BMI], 18.5–24.9 kg/m2) during the 3 gestational trimesters (first, 10–14 weeks; second, 24–28 weeks; and third, 30–34 weeks). Serumadiponectin and leptin concentrations were measured using the enzyme-linked immunosorbent assay method. Therelationship of these adipokines with the pre-gestational BMI, gestational weight gain, weight at the time of samplecollection, and newborn weight were evaluated. Analysis of variance and the Kruskal-Wallis test were used forstatistical analysis. ResultsThe study group comprised 62 pregnant adolescents. The serum concentration of adiponectin showed a significantdifference between the first and third trimesters (P=0.003), which decreased during pregnancy, but unrelated tonutritional variables. Serum leptin levels increased throughout the pregnancy (P<0.0001) and showed a positivecorrelation with pre-gestational BMI, total weight gain, pregnancy weight at the time of sample collection, andnewborns’ weight. ConclusionSerum levels of adiponectin and leptin vary inversely throughout pregnancy. This pattern in adolescents is similar tothat observed in adults. Moreover, leptin concentrations increased throughout pregnancy, and they were positivelycorrelated with all variables evaluated.

The Impact of Modifying Empirical Antibiotic Therapy Based on Intestinal Colonization Status on Clinical Outcomes of Febrile Neutropenic Patients

Alrstom Ali,Alsuliman Tamim,Daher Nizar,Abouharb Raed 대한감염학회 2021 Infection and Chemotherapy Vol.53 No.1

Background: This paper aimed to inspect factors affecting febrile neutropenia patients with hematologic malignancies. The intestinal colonization rate of extended-spectrum betalactamase-producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE) was assessed. The rate of subsequent ESBL-E and CRE bacteremia correlated with corresponding bacterial colonization was evaluated. Further, the risk factors for ESBL-E and CRE intestinal colonization were examined. Finally, the impact of rectal swab screening combined with adapted empirical antibiotic therapy on the mortality rate of patients with febrile neutropenia was assessed. Materials and Methods: Febrile neutropenia patients underwent rectal swabs and collection of blood culture specimens upon admission. Empirical treatment was subsequently modified according to rectal swab results if necessary. Bacteremia patients were treated according to blood culture results. Explorative forward-stepwise logistic regression analyses were used to identify risk factors for ESBL-E and CRE fecal carriage and mortality. Results: In total, 201 rectal swabs and 402 blood samples were collected from 163 patients during 201 febrile neutropenia episodes. Of these episodes, 38 (18.90%) were colonized with ESBL-E and 30 (14.92%) with CRE. Bloodstream infections developed in 29/201 (14.42%) episodes. Only bacteremia episodes caused by Gram-negative bacilli were included in our analysis. The development of Gram-negative-rod bacteremia was observed in eight out of 38 (21.05%) ESBL-E colonized episodes and four out of 30 (13.33%) CRE-colonized episodes. A BSI developed in three out of 38 (7.89%) ESBL-E colonized episodes, and two out of 30 (6.66%) CRE-colonized episodes developed BSI with the respective organism. Multivariate analysis identified previous quinolone use as the only independent risk factor for fecal colonization of multi-drug-resistant (MDR) Enterobacteriaceae (ESBL-E and CRE) (odds ratio, 17.09; 95% confidence interval, 5.29 - 55.18; P <0.0001). No significant association was observed between ESBL-E and CRE carriage and increased risk of developing subsequent bacteremia. No significant differences were detected between groups receiving modified and non-modified treatments in duration of hospitalization or antibiotic therapy (univariate analysis) and 28-day mortality rate (logistic regression). Conclusion: Quinolone exposure was a major risk factor for ESBL-E and CRE fecal carriage. Performing rectal swab screening for MDR Enterobacteriaceae and modifying empirical antibiotic therapy accordingly did not improve clinical outcomes of febrile neutropenia patients.

Outcome of Breast Cancer Screening: A Lebanese Single Institution Experience

Kourie, Hampig Raphael,Daher, Alain,Matar, Dany,Antoun, Joelle,Salloum, Lony,Kattan, Joseph Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.21

Background: Since 2002, from October till December of each year, the Lebanese Ministry of Public Health conducts a mammogram based breast cancer screening campaign in the whole country for women over 40 years of age. These mammograms are performed free of charge in governmental hospitals or for reduced fees in private hospitals. The aim of this study is to analyze the direct impact of this campaign on cancer detection and subsequent treatment. Materials and Methods: Radiologic records of women screened with a mammogram during the campaign period from October till December 2012 at Saint Joseph Hospital, Baouchrieh, Beirut, were reviewed. Results of mammograms were reported using the ACR score. Women with ACR score ${\geq}4$ were tracked and investigated. Results: 900 screening mammograms were performed; median age was 55.2 years (range:31-81 years). Some 826 (91.8%) had an ACR score of ${\leq}2$; 66 (7.3%) an ACR =3 and only 8 (0.89%) an ACR=4. Thus, less than 1% (8/900) of all screened women were considered at high risk and needed a close follow-up. Among these 8 women, 4 underwent surgery for an early breast cancer, one had synchronous metastatic breast cancer and two were lost to follow-up. Conclusions: To coclude, Among 900-screened women for BC, less than 1 % (8 out of 900) were at high risk of hiding a BC (ACR=4), half of them benefited from early therapy (4 women out of 900) and one was a false positive. Larger studies on national level should be accomplished to have a complete data on breast cancer screening in Lebanon. The results of these studies can affect the Lebanese health policy regarding BC.

Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes

Mohamad Y. Fares,Peter Boufadel,Mohammad Daher,Jonathan Koa,Akshay Khanna,Joseph A. Abboud 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.4

The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.

The effect of repeated surface treatment of zirconia on its bond strength to resin cement

Lucas Campagnaro Maciel,Marina Amaral,Daher Antonio Queiroz,Kusai Baroudi,Laís Regiane Silva-Concílio 대한치과보철학회 2020 The Journal of Advanced Prosthodontics Vol.12 No.5

PURPOSE. The aim of this study is to evaluate the influence of repeated surface treatments on wettability and surface roughness for zirconia surface and bond strength of zirconia-based ceramics to resin cement. MATERIALS AND METHODS. Seventy blocks (10 × 10 × 3 mm) of zirconia-based ceramics were fabricated and divided into two groups according to the surface treatments: (A) 110 μm Al2O3 airborne-particle abrasion and (R) 110 μm silica modified Al2O3 airborne-particle abrasion. At stage 2, each group was subdivided into 5 groups according to the surface retreatments: (a) 110 μm Al2O3 airborne-particle abrasion, (r) 110 μm silica modified Al2O3 airborne-particle abrasion, (D) diamond bur, (Da) diamond bur + 110 μm Al2O3 airborne-particle abrasion, and (Dr) diamond bur + 110 μm silica modified Al2O3 airborne-particle abrasion. Cylinders of self-adhesive resin cement were cemented onto each treated ceramic surface and subjected to micro-shear bond strength test. Additional specimens were prepared for roughness and wettability analyses. The data were subjected to t-test and One-way ANOVA followed by Tukey’s post hoc test (α=.05). RESULTS. At stage 1, group R presented higher bond strength values than group A (P=.000). There was a statistically significant increase of bond strength at stage 2 for group A (P=.003). The diamond bur influenced the surface roughness, increasing the values (P=.023). Group R provided better wettability. Regardless of the applied surface treatment, most of failures were adhesive. CONCLUSION. The combination of application and reapplication of Rocatec Plus showed the best results of bond strength. Surface retreatment and recementation might be an indicated clinical strategy.