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Intraventricular Antimicrobial Therapy for Intractable Ventriculitis: Two Case Reports

  • Lee, Ji Weon;Yoon, Yoonsun;Kim, Sang-Dae;Kim, Yun-Kyung
    • Pediatric Infection and Vaccine
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    • v.29 no.1
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    • pp.46-53
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    • 2022
  • It is challenging to treat ventriculitis with parenteral treatment alone in some cases because of the difficulty involved in maintaining an appropriate level of antibiotics in cerebrospinal fluid (CSF). We report two cases of ventriculitis who did not respond to intravenous (IV) antibiotics but were successfully treated with intraventricular antibiotics using IV agents. The first case was a four-month-old male patient with X-linked hydrocephalus. He showed ventriculitis due to Klebsiella pneumoniae not producing extended-spectrum β-lactamase and susceptible to third-generation cephalosporins and gentamicin, following ventriculoperitoneal (VP) shunt. His condition did not improve during the 47 days of treatment with IV cefotaxime and meropenem. We achieved improvement in clinical presentation and CSF profile after three times of intraventricular gentamicin injection. The patient was discharged from the hospital with antiepileptic drugs. The second case was a six-month-old female patient with a history of neonatal meningitis complicated with hydrocephalus at one month of age, VP shunt at two months of age, followed by a methicillin-resistant coagulase-negative staphylococci (CoNS) shunt infection with ventriculitis after the shunt operation. CoNS ventriculitis recurred four weeks later. We failed to treat intractable methicillin-resistant CoNS ventriculitis with IV vancomycin for ten days, and thus intraventricular antimicrobial treatment was considered. Five times of intraventricular vancomycin administration led to improvement in clinical parameters. There were only neurological sequelae of delayed language development but no other major complications. Patients in these two cases responded well to intraventricular antibiotics, with negative CSF culture results, and were successfully treated for ventriculitis without serious complications.

Incidence and management of mandibular fractures in a low-resource health facility in Ghana

  • Frimpong, Paul;Nguyen, Truc Thi Hoang;Sodnom-Ish, Buyanbileg;Nimatu, Edinam Salia;Dampare, Nana Yaa Asantewaa;Rockson, Roberta;Awuah, Samuel Baffour;Amponsah, Emmanuel Kofi;Newton, Cardinal;Kim, Soung Min
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.47 no.6
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    • pp.432-437
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    • 2021
  • Objectives: The mandible and other parts of the maxillofacial region suffer significant morbid injuries following road traffic accidents. Our study gives epidemiological description of mandibular fractures in Ghana and also evaluates the relevance of closed reduction and indirect fixation for managing mandibular fractures in low-resource health facilities in low-income countries like Ghana. Patients and Methods: This is a retrospective study involving 268 patients who reported to the Department of Oral and Maxillofacial Surgery of the Sunyani Regional Hospital with mandibular fractures from January 2010 to December 2019. Patient medical records were assessed for information on age, sex, fracture etiology, anatomic location of fracture, time of day of road traffic accident, and other associated injuries. Results: A total of 268 patients were included in this study (males, 216 [80.6%]; females, 52 [19.4%]). Motor vehicular accident (MVA) was the leading cause of mandibular fractures (202 injuries, 75.4%). Other etiologies included assault (39, 14.6%), gunshot (13, 4.9%), falls (12, 4.5%), and industrial accidents (2, 0.7%). Of the 161 male cases caused by MVA, 121 (75.2%) occurred at night and in the evening while the remaining 40 (24.8%) occurred in the morning and afternoon. Among all managed 222 patients, 212 (79.1%) were treated with closed reduction and indirect fixation technique while 10 (3.7%) were treated with open reduction and direct fixation. Conclusion: Closed reduction with indirect fixation could successfully be used to manage mandibular fractures in low resourced health facilities, especially in low-income countries. The poor lightening system on roads in Ghana is a major contributory factor to motor vehicular accidents.

2020 KSC/KATRD Guideline for the Diagnosis and Treatment of Pulmonary Hypertension: Executive Summary

  • Park, Jae-Hyeong;Na, Jin Oh;Lee, Jae Seung;Kim, Yee Hyung;Chang, Hyuk-Jae;Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the Korean Society of Cardiology (KSC) and the Korean Academy of Tuberculosis and Respiratory Diseases (KATRD),
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.1
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    • pp.1-10
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    • 2022
  • Pulmonary hypertension (PH) is a condition of increased blood pressure in the pulmonary arteries and is diagnosed with an increased a mean pulmonary artery pressure ≥25 mm Hg. This condition may be associated with multiple clinical situations. Based on pathophysiological mechanisms, clinical presentation, hemodynamic profiles, and treatment strategies, the patients were classified into five clinical groups. Although there have been major advances in the management of PH, it is still associated with significant morbidity and mortality. The diagnosis and treatment of PH have been performed mainly by following European guidelines, even in Korea because the country lacks localized PH guidelines. European treatment guidelines do not reflect the actual status of Korea. Therefore, the European diagnosis and treatment of PH have not been tailored well to suit the needs of Korean patients with PH. To address this issue, we developed this guideline to facilitate the diagnosis and treatment of PH appropriately in Korea, a country where the consensus for the diagnosis and treatment of PH remains insufficient. This is the first edition of the guidelines for the diagnosis and treatment of PH in Korea, and it is primarily based on the '2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.' with the acceptance and adaptation of recent publications of PH.

The Core Concepts of Mathematics for AI and An Analysis of Mathematical Contents in the Textbook (수학과 인공지능(AI) 핵심 개념과 <인공지능 수학> 내용 체계 분석)

  • Kim, Changil;Jeon, Youngju
    • Journal of the Korean School Mathematics Society
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    • v.24 no.4
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    • pp.391-405
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    • 2021
  • In this study, 'data collection', 'data expression', 'data analysis, and 'optimization and decision-making' were selected as the core AI concepts to be dealt with in the mathematics for AI education. Based on this, the degree of reflection of AI core concepts was investigated and analyzed compared to the mathematical core concepts and content of each area of the elective course. In addition, the appropriateness of the content of was examined with a focus on core concepts and related learning contents. The results provided some suggestions for answering the following four critical questions. First, How to set the learning path for ? Second, is it necessary to discuss the redefinition of the nature of ? Third, is it appropriate to select core concepts and terms for ? Last, is it appropriate to present the relevant learning contents of the content system of ?

Genetic parameter analysis of reproductive traits in Large White pigs

  • Yu, Guanghui;Wang, Chuduan;Wang, Yuan
    • Animal Bioscience
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    • v.35 no.11
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    • pp.1649-1655
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    • 2022
  • Objective: The primary objective of this study was to determine the genetic parameters for reproductive traits among Large White pigs, including the following traits: total number born (TNB), number born alive (NBA), litter birth weight (LBW), average birth weight (ABW), gestation length (GL), age at first service (AFS) and age at first farrowing (AFF). Methods: The dataset consisted of 19,036 reproductive records from 4,986 sows, and a multi-trait animal model was used to estimate genetic variance components of seven reproductive traits. Results: The heritability estimates for these reproductive traits ranged from 0.09 to 0.26, with the highest heritability for GL and AFF, and the lowest heritability for NBA. The repeatabilities for TNB, NBA, LWB, ABW, and GL were ranged from 0.16 to 0.34. Genetic and phenotypic correlations ranged from -0.41 to 0.99, and -0.34 to 0.98, respectively. In particular, the correlations between TNB, NBA and LBW, between AFS and AFF, exhibited a strong positive correlation. Furthermore, for TNB, NBA, LBW, ABW, and GL, genetic correlations of the same trait between different parities were moderately to strongly correlated (0.32 to 0.97), and the correlations of adjacent parities were higher than those of nonadjacent parities. Conclusion: All the results in the present study can be used as a basis for the genetic assessment of the target population. In the formulation of dam line selection index, AFS or AFF can be considered to combine with TNB in a multiple trait swine breeding value estimation system. Moreover, breeders are encouraged to increase the proportion of sows at parity 3-5 and reinforce the management of sows at parity 1 and parity ≥8.

Decision-Making and Principle of Management in Periprosthetic Femoral Fracture after Total Hip Arthroplasty (고관절 치환술 후 삽입물의 안정성 판단과 대퇴 삽입물 주위 골절의 치료 원칙)

  • Kim, Beom-Soo;Lee, Kyung-Jae;Min, Byung-Woo
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.3
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    • pp.200-207
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    • 2021
  • Periprosthetic femoral fractures remain as one of the most challenging complications following total hip arthroplasty. A thorough clinical and radiographic evaluation, precise classification, and understanding of modern management principles are essential to obtain optimal results for these fractures. The Vancouver classification system is a simple, effective, and reproducible method for the planning treatments of these injuries. The fractures associated with a stable femoral stem can be treated effectively with osteosynthesis, but periprosthetic femoral fractures associated with a loose stem require revision arthroplasty. This paper describes the principle of the treatment of patients with periprosthetic femoral fractures and how to assess the stability of the femoral stem.

Cortical Deafness Due to Ischaemic Strokes in Both Temporal Lobes

  • Lachowska, Magdalena;Pastuszka, Agnieszka;Sokolowski, Jacek;Szczudlik, Piotr;Niemczyk, Kazimierz
    • Journal of Audiology & Otology
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    • v.25 no.3
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    • pp.163-170
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    • 2021
  • Cortical deafness is a clinical rarity whereby a patient is unresponsive to all types of sounds despite the preserved integrity of the peripheral hearing organs. In this study, we present a patient who suddenly lost his hearing following ischaemic infarcts in both temporal lobes with no other neurological deficits. The CT confirmed damage to the primary auditory cortex (Heschl's gyrus) of both hemispheres. Initially, the patient was unresponsive to all sounds, however, he regained some of the auditory abilities during 10 months follow up. Pure tone threshold improvement from complete deafness to the level of moderate hearing loss in the right ear and severe in the left was observed in pure tone audiometry. Otoacoustic emissions, auditory brainstem responses, and acoustic reflex findings showed normal results. The middle and late latency potential results confirmed objectively the improvement of the patient's hearing, however, after 10 months still, they were somewhat compromised on both sides. In speech audiometry, there was no comprehension of spoken words neither at 3 nor at 10 months. The absent mismatch negativity confirmed above mentioned comprehension deficit. The extensive auditory electrophysiological testing presented in this study contributes to the understanding of the neural and functional changes in cortical deafness. It presents the evolution of changes after ischaemic cerebrovascular event expressed as auditory evoked potentials starting from short through middle and long latency and ending with event-related potentials and supported by neuroimaging.

Gaps-In-Noise Test Performance in Children with Speech Sound Disorder and Cognitive Difficulty

  • Jung, Yu Kyung;Lee, Jae Hee
    • Journal of Audiology & Otology
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    • v.24 no.3
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    • pp.133-139
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    • 2020
  • Background and Objectives: The Gaps-In-Noise (GIN) test is a clinically effective measure of the integrity of the central auditory nervous system. The GIN procedure can be applied to a pediatric population above 7 years of age. The present study conducted the GIN test to compare the abilities of auditory temporal resolution among typically developing children, children with speech sound disorder (SSD), and children with cognitive difficulty (CD). Subjects and Methods: Children aged 8 to 11 years-(total n=30) participated in this study. There were 10 children in each of the following three groups: typically developing children, children with SSD, and children with CD. The Urimal Test of Articulation and Phonology was conducted as a clinical assessment of the children's articulation and phonology. The Korean version of the Wechsler Intelligence Scale for Children-III (K-WISC-III) was administered as a screening test for general cognitive function. According to the procedure of Musiek, the pre-recorded stimuli of the GIN test were presented at 50 dB SL. The results were scored by the approximated threshold and the overall percent correct score (%). Results: All the typically developing children had normal auditory temporal resolution based on the clinical cutoff criteria of the GIN test. The children with SSD or CD had significantly reduced gap detection performance compared to age-matched typically developing children. The children's intelligence score measured by the K-WISC-III test explained 37% of the variance in the percent-correct score. Conclusions: Children with SSD or CD exhibited poorer ability to resolve rapid temporal acoustic cues over time compared to the age-matched typically developing children. The ability to detect a brief temporal gap embedded in a stimulus may be related to the general cognitive ability or phonological processing.

Deforestation and Islamic Ethics: A Search for the Eco-Religious Links between Islam and Sustainable Development in Indonesia

  • KIM, Yekyoum
    • SUVANNABHUMI
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    • v.13 no.2
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    • pp.109-134
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    • 2021
  • Indonesia has undergone the rapid deforestation largely as a result of practical consequences of human overexploitation of the forest. Between 1950 and 2015, around 43% of the forest area in Indonesia had been lost (68.0 million hectares). The process of deforestation has partly been a response to the rapidly intensifying 'global' and 'domestic' economic demands. Deforestation in Indonesia is also indirectly due to 'materialism-driven' value system and the corresponding weakening of Indonesian ethics. Therefore, given that socio-cultural expressions of modern Indonesian value systems have mostly taken place within a framework of Islam, the aim of the paper is to attempt to find Islamic ethics in general, which can provide the basis of ecological ethics to prevent rapid deforestation in Indonesia. The paper is composed of the followings. First, following the 'Introduction', it outlines the historical process of deforestation in Indonesia and also its corresponding socio-economic contexts. Then it moves on to talk about ecological ethics in general, thereby emphasizing that the phenomenological problem of deforestation needs to be conceived at a philosophical level beyond ecological phenomena. After discussing the ecological ethics, the paper proceeds to examine Islamic ethics as a canonical framework of ecological ethics in Indonesia. In doing so, it attempts to apply the Islamic ethics to the diverse Indonesian society and then considers 'Pancasila' as a potential framework for a pragmatic link between Islam ethics and Indonesian society. Having said that, in conclusion, the paper argues that there is a need for 'concrete' translation of 'Pancasila' into implementation in an Indonesian context, thereby various agents (government, policy-practitioners, concessionaires and also all the Indonesian) may agree in saying 'no' to overexploitation of the forest, to rapid depletion of the forest and to 'unsustainable' development practices.

DALY Estimation Approaches: Understanding and Using the Incidence-based Approach and the Prevalence-based Approach

  • Kim, Young-Eun;Jung, Yoon-Sun;Ock, Minsu;Yoon, Seok-Jun
    • Journal of Preventive Medicine and Public Health
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    • v.55 no.1
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    • pp.10-18
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    • 2022
  • Disability-adjusted life-year (DALY) estimates may vary according to factors such as the standard life expectancy, age weighting, time preference and discount rate, calculation of disability weights, and selection of the estimation method. DALY estimation methods are divided into the following 3 approaches: the incidence-based approach, the pure prevalence-based approach, and the hybrid approach. These 3 DALY estimation approaches each reflect different perspectives on the burden of disease using unique characteristics, based on which the selection of a suitable approach may vary by the purpose of the study. The Global Burden of Disease studies, which previously estimated DALYs using the incidence-based approach, switched to using the hybrid approach in 2010, while the National Burden of Disease studies in Korea still mainly apply the incidence-based approach. In order to increase comparability with other international burden of disease studies, more DALY studies using the prevalence-based approach need to be conducted in Korea. However, with the limitations of the hybrid approach in mind, it is necessary to conduct more research using a disease classification system suitable for Korea. Furthermore, more detailed and valid data sources should be established before conducting studies using a broader variety of DALY estimation approaches. This review study will help researchers on burden of disease use an appropriate DALY estimation approach and will contribute to enhancing researchers' ability to critically interpret burden of disease studies.