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- 저자 : ( Jacob George ) (검색결과 10 건)
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Vignesh Vudatha,Yahya Alwatari,George Ibrahim,Tayler Jacobs,Kyle Alexander,Carlos Puig-Gilbert,Walker Julliard,Rachit Dilip Shah 대한심장혈관흉부외과학회 2023 Journal of Chest Surgery (J Chest Surg) Vol.56 No.5
Background: A significant proportion of cardiac surgery intensive care unit (CSICU) patients require long-term ventilation, necessitating tracheostomy placement. The goal of this study was to evaluate the long-term postoperative outcomes and complications associated with percutaneous dilatational tracheostomy (PDT) in CSICU patients. Methods: All patients undergoing PDT after cardiac, thoracic, or vascular operations in the CSICU between January 1, 2013 and January 1, 2021 were identified. They were evaluated for mortality, decannulation time, and complications including bleeding, infection, and need for surgical intervention. Multivariable regression models were used to identify predictors of early decannulation and the complication rate. Results: Ninety-three patients were identified for this study (70 [75.3%] male and 23 [24.7%] female). Furthermore, 18.3% of patients had chronic obstructive pulmonary disease (COPD), 21.5% had history of stroke, 7.5% had end-stage renal disease, 33.3% had diabetes, and 59.1% were current smokers. The mean time from PDT to decannulation was 39 days. Roughly one-fifth (20.4%) of patients were on dual antiplatelet therapy and 81.7% had anticoagulation restarted 8 hours post-tracheostomy. Eight complications were noted, including 5 instances of bleeding requiring packing and 1 case of mediastinitis. There were no significant predictors of decannulation prior to discharge. Only COPD was identified as a negative predictor of decannulation at any point in time (hazard ratio, 0.28; 95% confidence interval, 0.08–0.95; p=0.04). Conclusion: Percutaneous tracheostomy is a safe and viable alternative to surgical tracheostomy in cardiac surgery ICU patients. Patients who undergo PDT have a relatively short duration of tracheostomy and do not have major post-procedural complications.
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MAFLD: How is it different from NAFLD?
Cameron Gofton,Yadhavan Upendran,Ming-Hua Zheng,Jacob George 대한간학회 2023 Clinical and Molecular Hepatology(대한간학회지) Vol.29 No.-
“Metabolic dysfunction-associated fatty liver disease (MAFLD)” is the term suggested in 2020 to refer to fatty liver disease related to systemic metabolic dysregulation. The name change from nonalcoholic fatty liver disease (NAFLD) to MAFLD comes with a simple set of criteria to enable easy diagnosis at the bedside for the general medical community, including primary care physicians. Since the introduction of the term, there have been key areas in which the superiority of MAFLD over the traditional NAFLD terminology has been demonstrated, including for the risk of liver and extrahepatic mortality, disease associations, and for identifying high-risk individuals. Additionally, MAFLD has been adopted by a number of leading pan-national and national societies due to its concise diagnostic criterion, removal of the requirement to exclude concomitant liver diseases, and reduction in the stigma associated with this condition. The current article explores the differences between MAFLD and NAFLD diagnosis, areas of benefit, some potential limitations, and how the MAFLD terminology has opened up new fields of research.
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Acute hepatitis A, B and C but not D is still prevalent in Mongolia: a time trend analysis
( Oidov Baatarkhuu ),( Hye Won Lee ),( Jacob George ),( Dashchirev Munkh-orshikh ),( Baasankhuu Enkhtuvshin ),( Sosorbaram Ariunaa ),( Mohammed Eslam ),( Sang Hoon Ahn ),( Kwang-hyub Han ),( Do Young 대한간학회 2017 Clinical and Molecular Hepatology(대한간학회지) Vol.23 No.2
Background/Aims: Mongolia has one of the highest hepatitis A, C, B and D infection incidences worldwide. We sought to investigate changes in the proportion of acute viral hepatitis types in Mongolia over the last decade. Methods: The cohort comprised 546 consecutive patients clinically diagnosed with acute viral hepatitis from January 2012 to December 2014 in Ulaanbaatar Hospital, Mongolia. A time trend analysis investigating the change in proportion of acute hepatitis A virus, hepatitis C virus (HCV), hepatitis B virus (HBV) and hepatitis delta virus (HDV) infection among the cohort with respect to a previous published study was undertaken. Results: Acute hepatitis A, B and C was diagnosed in 50.9%, 26.2% and 6.0% of the cohort. Notably, 16.8% of the cohort had a dual infection. The etiologies of acute viral hepatitis were varied by age groups. The most common cause of acute viral hepatitis among 2-19 year olds was hepatitis A, HBV and superinfection with HDV among 20-40 year olds, and HCV among 40-49 year olds. Patients with more than one hepatitis virus infection were significantly older, more likely to be male and had a higher prevalence of all risk factors for disease acquisition. These patients also had more severe liver disease at presentation compared to those with mono-infection. Conclusions: Acute viral hepatitis is still prevalent in Mongolia. Thus, the need for proper infection control is increasing in this country. (Clin Mol Hepatol 2017;23:147-153)
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Degenerated lumbricals in the feet of adult human cadavers: case series
Hare Krishna,Rati Tandon,Tony George Jacob 대한해부학회 2023 Anatomy & Cell Biology Vol.56 No.2
In the foot, the lumbricals flex the metatarsophalangeal joints and extend the interphalangeal joints. Thelumbricals are known to be affected in neuropathies. It is not known whether they may degenerate in normal individuals. Here, we report our findings of isolated degenerated lumbricals in seemingly normal feet of two cadavers. We explored lumbricals in 20 male and 8 female cadavers that were 60–80 years of age at the time of death. As part of routine dissection, we exposed the tendons of the flexor digitorum longus and the lumbricals. From the degenerated lumbricals, we took some tissue for paraffin-embedding, sectioning, and staining by hematoxylin and eosin, and Masson’s trichrome technique. Of the 224 lumbricals studied, we found four apparently degenerated lumbricals in two male cadavers. In the first, the 2nd and 4th lumbricals in the left foot and the 2nd in the right foot were degenerated. In the second, the right 4th lumbrical was degenerated. Microscopically, the degenerated tissue was made of bundles of collagen. The lumbricals may have degenerated due to compression of their nerve supply. We cannot comment on whether the functionality of the feet were affected by these isolated degeneration of the lumbricals.
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MAFLD enhances clinical practice for liver disease in the Asia-Pacific region
Takumi Kawaguchi,Tsubasa Tsutsumi,Dan Nakano,Mohammed Eslam,Jacob George,Takuji Torimura 대한간학회 2022 Clinical and Molecular Hepatology(대한간학회지) Vol.28 No.2
Fatty liver is now a major cause of liver disease in the Asia-Pacific region. Liver diseases in this region have distinctive characteristics. First, fatty liver is frequently observed in lean/normal-weight individuals. However, there is no standard definition of this unique phenotype. Second, fatty liver is often observed in patients with concomitant viral hepatitis. The exclusion of viral hepatitis from non-alcoholic fatty liver disease limits its value and detracts from the investigation and holistic management of coexisting fatty liver in patients with viral hepatitis. Third, fatty liver-associated hepatocellular carcinoma (HCC) is generally categorized as non-B non-C HCC. Fourth, the population is aging rapidly, and it is imperative to develop a practicable, low-intensity exercise program for elderly patients. Fifth, most patients and nonspecialized healthcare professionals still lack an awareness of the significance of fatty liver both in terms of intrahepatic and extrahepatic disease and cancer. Recently, an international expert panel proposed a new definition of fatty liver: metabolic dysfunction-associated fatty liver disease (MAFLD). One feature of MAFLD is that metabolic dysfunction is a prerequisite for diagnosis. Pertinent to regional issues, MAFLD also provides its diagnostic criteria in lean/normal-weight individuals. Furthermore, MAFLD is independent of any concomitant liver disease, including viral hepatitis. Therefore, MAFLD may be a more suitable definition for fatty liver in the Asia-Pacific region. In this review, we introduce the regional characteristics of fatty liver and discuss the advantages of MAFLD for improving clinical practice for liver disease in the region.
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Anu Mary Oommen,Vinod Joseph Abraham,Vinod Joseph Abraham,V. Jacob Jose,Kuryan George 대한당뇨병학회 2017 Diabetes and Metabolism Journal Vol.41 No.5
Background: The Achutha Menon Centre Diabetes Risk Score (AMCDRS), which was developed in rural Kerala State, South India, had not previously been externally validated. We examined the performance of the AMCDRS in urban and rural areas in the district of Vellore in the South Indian state of Tamil Nadu, and compared it with other diabetes risk scores developed from India. Methods: We used the data from 4,896 participants (30 to 64 years) of a cross-sectional study conducted in Vellore (2010 to 2012), to calculate the AMCDRS scores using age, family history, and waist circumference. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV), and the area under the receiver operating characteristic curve (AROC) were calculated for undiagnosed and total diabetes. Results: Of the 4,896 individuals surveyed, 274 (5.6%) had undiagnosed diabetes and 759 (15.5%) had total diabetes. The AMCDRS, with an optimum cut-point of ≥4, identified 45.0% for further testing with 59.5% sensitivity, 60.5% specificity, 9.1% PPV, 95.8% NPV, and an AROC of 0.639 (95% confidence interval [CI], 0.608 to 0.670) for undiagnosed diabetes. The corresponding figures for total diabetes were 75.1%, 60.5%, 25.9%, 93.0%, and 0.731 (95% CI, 0.713 to 0.750), respectively. The AROC for the AMCDRS was not significantly different from that of the Indian Diabetes Risk Score, the Ramachandran or the Chaturvedi risk scores for total diabetes, but was significantly lower than the AROC of the Chaturvedi score for undiagnosed diabetes. Conclusion: The AMCDRS is a simple diabetes risk score that can be used to screen for undiagnosed and total diabetes in lowresource primary care settings in India. However, it probably requires recalibration to improve its performance for undiagnosed diabetes.
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( Do Young Kim ),( Won Young Tak ),( Stefan Zeuzem ),( Lawrence Serfaty ),( John M. Vierling ),( Wendy Cheng ),( Jacob George ),( Jan Sperl ),( Simone I. Strasser ),( Hiromitsu Kumada ),( Peggy Hwang 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: GT1b is the most common HCV genotype globally, accounting for the largest proportion of infections in Europe, Latin America, Russia, Turkey, and East Asia. We report the efficacy of 12 weeks of once-daily elbasvir/grazoprevir (50 mg/100 mg) (NS5A inhibitor/ NS3/4 protease inhibitor) in HCV GT1b-infected patients enrolled in the clinical development program. Methods: This analysis of treatment-naïve and treatment-experienced GT1b-infected patients used data pooled from 11 trials involving 30 countries and included 1070 patients with/without cirrhosis, chronic kidney disease (CKD), and HIV co-infection. Cirrhosis (F4, compensated) was confirmed by either liver biopsy or noninvasive tests. Patients with Stage 4 or Stage 5 CKD on hemodialysis were included. HIV/HCV co-infected patients were required to be on a stable antiretroviral regimen (ARV) (tenofovir or abacavir, emtricitabine or lamivudine, and either raltegrevir, dolutegravir, or rilpivirine) with CD4 >200/μL and HIV viral load undetectable, or if not on ARVs, have CD4 >500/μL and viral load < 50,000 IU/mL. The primary endpoint was the proportion of patients with HCV RNA below the lower limit of quantitation 12 weeks after treatment (SVR12). Efficacy data are presented for the full analysis set (FAS), which includes all patients who received at least one dose of study medication, and for the per-protocol (PP) population, which excludes nonvirologic failures. Results: A total of 1,070 patients were included in the analysis. Mean patient age was 53.7 years (range, 19-80); 50% were male; 47% were white, 43% were Asian, and 9% were black or African American; 20% were treatment-experienced; 39% had a baseline viral load >2,000,000 IU/mL; and 18% had evidence of cirrhosis. SVR12 was 97% (1040/1070) in the FAS; 15 patients (1.4%) were categorized as virologic failures and 15 (1.4%) were categorized as nonvirologic failures (lost-to-follow-up or withdrawal). Excluding the nonvirologic failures, SVR12 was 99% (1040/1055) in the PP analysis. There were no notable differences in subgroup analyses: SVR12 was 97% in both treatment-naïve and treatment-experienced patients; 99% in cirrhotics and 97% in noncirrhotics; 98% in patients with a baseline viral load < 2,000,000 IU/mL and 97% in patients with a baseline viral >2,000,000 IU/mL; 94% in HIV/HCV co-infected patients; and 100% and 95% in patients with Stage 4 or 5 CKD, respectively. Conclusions: High efficacy was achieved in the GT1b-infected population treated with elbasvir/grazoprevir for 12 weeks, with comparable efficacy across subgroups, including those with cirrhosis, high baseline viral load, and prior treatment failures.
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