Carlos Buitrago - Profile on Academia.edu (original) (raw)
Papers by Carlos Buitrago
Metformin Use Is Inversely Associated with Prevalent, but Not Incident Colorectal Adenomas
Digestive Diseases and Sciences
Chemoprevention for colorectal neoplasia has attracted growing interest, with multiple medication... more Chemoprevention for colorectal neoplasia has attracted growing interest, with multiple medications investigated. Metformin may decrease the overall incidence of cancer in patients with diabetes and may decrease the incidence of colorectal cancer. We aimed to determine the impact of metformin use on the behavior of colorectal adenomas in a US veteran population. All patients with at least two high-quality colonoscopies between January 1997 and December 2013 at Veterans Affairs New York Harbor Healthcare System were identified. Outpatient prescription records were used to determine metformin exposure, and colonoscopy findings were recorded. Multivariable logistic regression was used to determine factors associated with adenoma detection on baseline and interval colonoscopy. In total, 1869 patients with two successive colonoscopies (median 4.5 years) were included. Four hundred and sixty patients had metformin exposure prior to baseline and/or interval colonoscopy. Overall adenoma detection rate was 59.7% at baseline and 45.9% at interval colonoscopy. On multivariable analysis, metformin use was associated with decreased adenoma prevalence at baseline (OR 0.68; 95% CI 0.51–0.92; p = 0.015). Metformin did not impact adenoma incidence at interval colonoscopy whether prescribed before baseline (OR 1.26; 95% CI 0.60–2.67), after baseline (OR 1.25; 95% CI 0.91–1.72), or before and after baseline (OR 1.14; 95% CI 0.82–1.58). In this retrospective analysis of an average-risk cohort, metformin use was associated with a decreased prevalence of colorectal adenomas at baseline colonoscopy. This inverse association did not persist on interval colonoscopy. Prospective studies are needed to evaluate potential chemoprotective effects of metformin over time.
Comprehensive meta-analysis of randomized controlled trials of Lactated Ringer’s versus Normal Saline for acute pancreatitis
Pancreatology
INTRODUCTION Fluid resuscitation is the keystone of treatment for acute pancreatitis. Though clin... more INTRODUCTION Fluid resuscitation is the keystone of treatment for acute pancreatitis. Though clinical guidelines and expert opinions agree on large volume resuscitation, debate remains on the optimal fluid type. The most commonly used fluids are Lactated Ringer's (LR) and Normal Saline (NS), but the studies published to date comparing LR vs NS yield conflicting results. We aimed to identify and quantitatively synthesize existing high quality data of the topic of fluid type or acute pancreatitis resuscitation. METHODS In collaboration with the study team, an information specialist performed a comprehensive literature review to identify reports addressing type of fluid resuscitation. Studies were screened using the Covidence system by two independent reviewers in order to identify Randomized controlled trials comparing LR versus NS. The main outcome was the development of moderately severe or severe pancreatitis and additional outcomes included local complications, ICU admission, and length of stay. Pooled odds ratios were estimated using the random effects model and standardized mean difference to compare continuous variables. RESULTS We reviewed 7964 abstracts and 57 full text documents. Four randomized controlled trials were identified and included in our meta-analyses. There were a total of 122 patients resuscitated with LR versus 126 with NS. Patients resuscitated with LR were less likely to develop moderately severe/severe pancreatitis (OR 0.49; 95 % CI 0.25-0.97). There was no difference in development of SIRS at 24 or 48 h or development of organ failure between the two groups. Patients resuscitated with LR were less likely to require ICU admission (OR 0.33; 95 % CI 0.13-0.81) and local complications (OR 0.42; 95 % CI 0.2-0.88). While there was a trend towards shorter hospitalizations for LR (SMD -0.18, 99 % CI -0.44-0.07), it was not statistically significant. CONCLUSION Resuscitation with LR reduces the development of moderately severe-severe pancreatitis relative to NS. Nevertheless, no difference in SIRS development or organ failure underscores the need for further studies to verify this finding and define its mechanism.
Gastrointestinal Endoscopy
This document was reviewed and approved by the Governing Board of the American Society for Gastro... more This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy. Cholangitis is a GI emergency requiring prompt recognition and treatment. The purpose of this document from the American Society for Gastrointestinal Endoscopy's (ASGE) Standards of Practice Committee is to provide an evidencebased approach for management of cholangitis. This document addresses the modality of drainage (endoscopic vs percutaneous), timing of intervention (<48 hours vs >48 hours), and extent of initial intervention (comprehensive therapy vs decompression alone). Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to formulate recommendations on these topics. The ASGE suggests endoscopic rather than percutaneous drainage and biliary decompression within 48 hours. Additionally, the panel suggests that sphincterotomy and stone removal be combined with drainage rather than decompression alone, unless patients are too unstable to tolerate more extensive endoscopic treatment. (Gastrointest Endosc 2021;94:207-21.) (footnotes appear on last page of article) 1. For patients with cholangitis, we suggest ERCP over percutaneous transhepatic biliary drainage. Conditional Very low 2. For patients with cholangitis, we suggest the performance of ERCP in 48 h compared with 48 h. Conditional Very low 3. For patients with cholangitis, we suggest that biliary drainage should be combined with other maneuvers such as sphincterotomy and stone removal versus stent alone. Conditional Low ASGE guideline on the management of cholangitis 208 GASTROINTESTINAL ENDOSCOPY Volume 94, No. 2 : 2021 www.giejournal.org OR, Odds ratio; d, insufficient data available. * Low number of events. y High I 2 . z National studies.
Gastroenterology, 2021
The standard method to train the Higher Order Neural Networks (HONN) is the well-known Backpropag... more The standard method to train the Higher Order Neural Networks (HONN) is the well-known Backpropagation (BP) algorithm. Yet, the current BP algorithm has several limitations including easily stuck into local minima, particularly when dealing with highly non-linear problems and utilise computationally intensive training algorithms. The current BP algorithm is also relying heavily on the initial weight values and other parameters picked. Therefore, in an attempt to overcome the BP drawbacks, we investigate a method called Modified Cuckoo Search-Markov chain Monté Carlo for optimising the weights in HONN and boost the learning process. This method, which lies in the Swarm Intelligence area, is notably successful in optimisation task. We compared the performance with several HONN-based network models and standard Multilayer Perceptron on four (4) time series datasets: Temperature, Ozone, Gold Close Price and Bitcoin Closing Price from various repositories. Simulation results indicate that this swarm-based algorithm outperformed or at least at par with the network models with current BP algorithm in terms of lower error rate.
S0091 Admission Outcomes and Risk Factors for Patients Presenting With Acute Pancreatitis and Concomitant Diabetic Ketoacidosis
American Journal of Gastroenterology, 2020
S0928 ERCP for Gallstone Pancreatitis in Fluid Sensitive Patients Is Associated With Increased Rates of Volume Overload Without Increased Rates of Post-ERCP Pancreatitis
American Journal of Gastroenterology, 2020
Su1250 – Feasibility of Gastric Intestinal Metaplasia Surveillance in a High Risk American Cohort
Gastroenterology, 2019
Gastrointestinal Endoscopy, 2020
Su1474 INFLUENCE OF PRE-EXISTING DIABETES MELLITUS ON ACUTE PANCREATITIS OUTCOMES
Gastroenterology, 2020
Sa1362 INCREASED FLUID RATE HASTENS RECOVERY OF ACUTE KIDNEY INJURY IN ACUTE PANCREATITIS
Gastroenterology, 2020
Gastroenterology, 2020
BACKGROUND & AIMS: Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-... more BACKGROUND & AIMS: Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly expanded; however, clinical trials excluded patients taking immunosuppressive medications such as those with inflammatory bowel disease (IBD). Therefore, we explored real-world effectiveness of coronavirus disease 2019 (COVID-19) vaccination on subsequent infection in patients with IBD with diverse exposure to immunosuppressive medications. METHODS: This was a retrospective cohort study of patients in the Veterans Health Administration with IBD diagnosed before December 18, 2020, the start date of the Veterans Health Administration patient vaccination program. IBD medication exposures included mesalamine, thiopurines, anti-tumor necrosis factor biologic agents, vedolizumab, ustekinumab, tofacitinib, methotrexate, and corticosteroid use. We used inverse probability weighting and Cox's regression with vaccination status as a time-updating exposure and computed vaccine effectiveness from incidence rates. RESULTS: The cohort comprised 14,697 patients, 7321 of whom received at least 1 vaccine dose (45.2% Pfizer, 54.8% Moderna). The cohort had median age 68 years, 92.2% were men, 80.4% were White, and 61.8% had ulcerative colitis. In follow-up data through April 20, 2021, unvaccinated individuals had the highest raw proportion of SARS-CoV-2 infection (197 [1.34%] vs 7 [0.11%] fully vaccinated). Full vaccination status, but not partial vaccination status, was associated with a 69% reduced hazard of infection relative to an unvaccinated status (hazard ratio, 0.31, 95% confidence interval, 0.17-0.56; P < .001), corresponding to an 80.4% effectiveness. CONCLUSIONS: Full vaccination (> 7 days after the second dose) against SARS-CoV-2 infection has an w80.4% effectiveness in a broad IBD cohort with diverse exposure to immunosuppressive medications. These results may serve to increase patient and provider willingness to pursue vaccination in these settings.
Meta-Analysis and Systematic Review of Initial Endoscopic Therapy for Cholangitis
American Journal of Gastroenterology, 2019
Assessing the Impact of Metformin Use on Colonic Polyp Behavior
American Journal of Gastroenterology, 2018
Conversion of a surgically arthrodesed knee to a total knee arthroplasty - Is it worth it? A Systematic Review
The Journal of Arthroplasty, 2016
Conversion of a surgically arthrodesed knee to total knee arthroplasty (TKA) is an option for a s... more Conversion of a surgically arthrodesed knee to total knee arthroplasty (TKA) is an option for a select group of patients who are not satisfied with their results. However, there is a paucity of literature on this topic. A systematic review of literature was performed to (1) describe the overall demographic characteristics; (2) evaluate the clinical outcomes; (3) determine the overall rate of complications; and (4) evaluate the overall satisfaction of patients who underwent conversion of an arthrodesed knee to TKA. A comprehensive literature search was systematically performed to evaluate all studies included in the literature until July 2015. The specific search terms used were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;fusion knee&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;arthrodesis knee,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; which revealed a total of 2206 studies. A review and selection of these abstracts were then performed based on inclusion and/or exclusion criteria; a total of 10 articles were used for final review. There were a total of 98 surgically arthrodesed knees that subsequently underwent TKA. Patients had a mean age of 55 years and were followed up for a mean of 5 years. Using a random effects model, there was an overall complication rate of 47%, an overall revision rate of 25%, and an overall failure rate of 11%. However, most patients were overall satisfied with the procedure. Fusion takedown is a challenging procedure that should only be performed by experienced surgeons after extensive discussion with the patients. The clinical outcomes are good with overall patient satisfaction, but complication rates are high including risk of repeat fusion or amputation.
Synthetic dendrimeric peptide active against biofilm and persister cells of Pseudomonas aeruginosa
Applied microbiology and biotechnology, Jan 27, 2015
Antimicrobial dendrimeric peptides (AMDP) are a relatively new class of agents displaying repetit... more Antimicrobial dendrimeric peptides (AMDP) are a relatively new class of agents displaying repetitive functional groups on a branched core. Previously, we have investigated the length requirement for antimicrobial activity of peptides consisting of repeated arginine (R) and tryptophan (W) side chains and found that even short linear RW repeats are active, providing a starting point for a de novo design of multivalent structures. In this study, we synthesized and tested a new synthetic dendrimer, 2D-24, for its antimicrobial activity against Pseudomonas aeruginosa, including the wild-type PAO1 and its mucoid mutant PDO300. This synthetic AMDP was found to kill planktonic cells of both PAO1 and PDO300 in a dose-dependent manner, with nearly complete killing of both strains observed when treated with 50 μM of this agent. In addition to planktonic cells, 2D-24 was also found to kill biofilm cells of both strains in a dose-dependent manner. For example, treatment with 30 μM 2D-24 led to 9...
Conversion of a surgically arthrodesed knee to a total knee arthroplasty - Is it worth it? A Systematic Review
The Journal of Arthroplasty, 2016
Conversion of a surgically arthrodesed knee to total knee arthroplasty (TKA) is an option for a s... more Conversion of a surgically arthrodesed knee to total knee arthroplasty (TKA) is an option for a select group of patients who are not satisfied with their results. However, there is a paucity of literature on this topic. A systematic review of literature was performed to (1) describe the overall demographic characteristics; (2) evaluate the clinical outcomes; (3) determine the overall rate of complications; and (4) evaluate the overall satisfaction of patients who underwent conversion of an arthrodesed knee to TKA. A comprehensive literature search was systematically performed to evaluate all studies included in the literature until July 2015. The specific search terms used were &amp;amp;amp;amp;amp;quot;fusion knee&amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;quot;arthrodesis knee,&amp;amp;amp;amp;amp;quot; which revealed a total of 2206 studies. A review and selection of these abstracts were then performed based on inclusion and/or exclusion criteria; a total of 10 articles were used for final review. There were a total of 98 surgically arthrodesed knees that subsequently underwent TKA. Patients had a mean age of 55 years and were followed up for a mean of 5 years. Using a random effects model, there was an overall complication rate of 47%, an overall revision rate of 25%, and an overall failure rate of 11%. However, most patients were overall satisfied with the procedure. Fusion takedown is a challenging procedure that should only be performed by experienced surgeons after extensive discussion with the patients. The clinical outcomes are good with overall patient satisfaction, but complication rates are high including risk of repeat fusion or amputation.
Metformin Use Is Inversely Associated with Prevalent, but Not Incident Colorectal Adenomas
Digestive Diseases and Sciences
Chemoprevention for colorectal neoplasia has attracted growing interest, with multiple medication... more Chemoprevention for colorectal neoplasia has attracted growing interest, with multiple medications investigated. Metformin may decrease the overall incidence of cancer in patients with diabetes and may decrease the incidence of colorectal cancer. We aimed to determine the impact of metformin use on the behavior of colorectal adenomas in a US veteran population. All patients with at least two high-quality colonoscopies between January 1997 and December 2013 at Veterans Affairs New York Harbor Healthcare System were identified. Outpatient prescription records were used to determine metformin exposure, and colonoscopy findings were recorded. Multivariable logistic regression was used to determine factors associated with adenoma detection on baseline and interval colonoscopy. In total, 1869 patients with two successive colonoscopies (median 4.5 years) were included. Four hundred and sixty patients had metformin exposure prior to baseline and/or interval colonoscopy. Overall adenoma detection rate was 59.7% at baseline and 45.9% at interval colonoscopy. On multivariable analysis, metformin use was associated with decreased adenoma prevalence at baseline (OR 0.68; 95% CI 0.51–0.92; p = 0.015). Metformin did not impact adenoma incidence at interval colonoscopy whether prescribed before baseline (OR 1.26; 95% CI 0.60–2.67), after baseline (OR 1.25; 95% CI 0.91–1.72), or before and after baseline (OR 1.14; 95% CI 0.82–1.58). In this retrospective analysis of an average-risk cohort, metformin use was associated with a decreased prevalence of colorectal adenomas at baseline colonoscopy. This inverse association did not persist on interval colonoscopy. Prospective studies are needed to evaluate potential chemoprotective effects of metformin over time.
Comprehensive meta-analysis of randomized controlled trials of Lactated Ringer’s versus Normal Saline for acute pancreatitis
Pancreatology
INTRODUCTION Fluid resuscitation is the keystone of treatment for acute pancreatitis. Though clin... more INTRODUCTION Fluid resuscitation is the keystone of treatment for acute pancreatitis. Though clinical guidelines and expert opinions agree on large volume resuscitation, debate remains on the optimal fluid type. The most commonly used fluids are Lactated Ringer's (LR) and Normal Saline (NS), but the studies published to date comparing LR vs NS yield conflicting results. We aimed to identify and quantitatively synthesize existing high quality data of the topic of fluid type or acute pancreatitis resuscitation. METHODS In collaboration with the study team, an information specialist performed a comprehensive literature review to identify reports addressing type of fluid resuscitation. Studies were screened using the Covidence system by two independent reviewers in order to identify Randomized controlled trials comparing LR versus NS. The main outcome was the development of moderately severe or severe pancreatitis and additional outcomes included local complications, ICU admission, and length of stay. Pooled odds ratios were estimated using the random effects model and standardized mean difference to compare continuous variables. RESULTS We reviewed 7964 abstracts and 57 full text documents. Four randomized controlled trials were identified and included in our meta-analyses. There were a total of 122 patients resuscitated with LR versus 126 with NS. Patients resuscitated with LR were less likely to develop moderately severe/severe pancreatitis (OR 0.49; 95 % CI 0.25-0.97). There was no difference in development of SIRS at 24 or 48 h or development of organ failure between the two groups. Patients resuscitated with LR were less likely to require ICU admission (OR 0.33; 95 % CI 0.13-0.81) and local complications (OR 0.42; 95 % CI 0.2-0.88). While there was a trend towards shorter hospitalizations for LR (SMD -0.18, 99 % CI -0.44-0.07), it was not statistically significant. CONCLUSION Resuscitation with LR reduces the development of moderately severe-severe pancreatitis relative to NS. Nevertheless, no difference in SIRS development or organ failure underscores the need for further studies to verify this finding and define its mechanism.
Gastrointestinal Endoscopy
This document was reviewed and approved by the Governing Board of the American Society for Gastro... more This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy. Cholangitis is a GI emergency requiring prompt recognition and treatment. The purpose of this document from the American Society for Gastrointestinal Endoscopy's (ASGE) Standards of Practice Committee is to provide an evidencebased approach for management of cholangitis. This document addresses the modality of drainage (endoscopic vs percutaneous), timing of intervention (<48 hours vs >48 hours), and extent of initial intervention (comprehensive therapy vs decompression alone). Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to formulate recommendations on these topics. The ASGE suggests endoscopic rather than percutaneous drainage and biliary decompression within 48 hours. Additionally, the panel suggests that sphincterotomy and stone removal be combined with drainage rather than decompression alone, unless patients are too unstable to tolerate more extensive endoscopic treatment. (Gastrointest Endosc 2021;94:207-21.) (footnotes appear on last page of article) 1. For patients with cholangitis, we suggest ERCP over percutaneous transhepatic biliary drainage. Conditional Very low 2. For patients with cholangitis, we suggest the performance of ERCP in 48 h compared with 48 h. Conditional Very low 3. For patients with cholangitis, we suggest that biliary drainage should be combined with other maneuvers such as sphincterotomy and stone removal versus stent alone. Conditional Low ASGE guideline on the management of cholangitis 208 GASTROINTESTINAL ENDOSCOPY Volume 94, No. 2 : 2021 www.giejournal.org OR, Odds ratio; d, insufficient data available. * Low number of events. y High I 2 . z National studies.
Gastroenterology, 2021
The standard method to train the Higher Order Neural Networks (HONN) is the well-known Backpropag... more The standard method to train the Higher Order Neural Networks (HONN) is the well-known Backpropagation (BP) algorithm. Yet, the current BP algorithm has several limitations including easily stuck into local minima, particularly when dealing with highly non-linear problems and utilise computationally intensive training algorithms. The current BP algorithm is also relying heavily on the initial weight values and other parameters picked. Therefore, in an attempt to overcome the BP drawbacks, we investigate a method called Modified Cuckoo Search-Markov chain Monté Carlo for optimising the weights in HONN and boost the learning process. This method, which lies in the Swarm Intelligence area, is notably successful in optimisation task. We compared the performance with several HONN-based network models and standard Multilayer Perceptron on four (4) time series datasets: Temperature, Ozone, Gold Close Price and Bitcoin Closing Price from various repositories. Simulation results indicate that this swarm-based algorithm outperformed or at least at par with the network models with current BP algorithm in terms of lower error rate.
S0091 Admission Outcomes and Risk Factors for Patients Presenting With Acute Pancreatitis and Concomitant Diabetic Ketoacidosis
American Journal of Gastroenterology, 2020
S0928 ERCP for Gallstone Pancreatitis in Fluid Sensitive Patients Is Associated With Increased Rates of Volume Overload Without Increased Rates of Post-ERCP Pancreatitis
American Journal of Gastroenterology, 2020
Su1250 – Feasibility of Gastric Intestinal Metaplasia Surveillance in a High Risk American Cohort
Gastroenterology, 2019
Gastrointestinal Endoscopy, 2020
Su1474 INFLUENCE OF PRE-EXISTING DIABETES MELLITUS ON ACUTE PANCREATITIS OUTCOMES
Gastroenterology, 2020
Sa1362 INCREASED FLUID RATE HASTENS RECOVERY OF ACUTE KIDNEY INJURY IN ACUTE PANCREATITIS
Gastroenterology, 2020
Gastroenterology, 2020
BACKGROUND & AIMS: Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-... more BACKGROUND & AIMS: Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly expanded; however, clinical trials excluded patients taking immunosuppressive medications such as those with inflammatory bowel disease (IBD). Therefore, we explored real-world effectiveness of coronavirus disease 2019 (COVID-19) vaccination on subsequent infection in patients with IBD with diverse exposure to immunosuppressive medications. METHODS: This was a retrospective cohort study of patients in the Veterans Health Administration with IBD diagnosed before December 18, 2020, the start date of the Veterans Health Administration patient vaccination program. IBD medication exposures included mesalamine, thiopurines, anti-tumor necrosis factor biologic agents, vedolizumab, ustekinumab, tofacitinib, methotrexate, and corticosteroid use. We used inverse probability weighting and Cox's regression with vaccination status as a time-updating exposure and computed vaccine effectiveness from incidence rates. RESULTS: The cohort comprised 14,697 patients, 7321 of whom received at least 1 vaccine dose (45.2% Pfizer, 54.8% Moderna). The cohort had median age 68 years, 92.2% were men, 80.4% were White, and 61.8% had ulcerative colitis. In follow-up data through April 20, 2021, unvaccinated individuals had the highest raw proportion of SARS-CoV-2 infection (197 [1.34%] vs 7 [0.11%] fully vaccinated). Full vaccination status, but not partial vaccination status, was associated with a 69% reduced hazard of infection relative to an unvaccinated status (hazard ratio, 0.31, 95% confidence interval, 0.17-0.56; P < .001), corresponding to an 80.4% effectiveness. CONCLUSIONS: Full vaccination (> 7 days after the second dose) against SARS-CoV-2 infection has an w80.4% effectiveness in a broad IBD cohort with diverse exposure to immunosuppressive medications. These results may serve to increase patient and provider willingness to pursue vaccination in these settings.
Meta-Analysis and Systematic Review of Initial Endoscopic Therapy for Cholangitis
American Journal of Gastroenterology, 2019
Assessing the Impact of Metformin Use on Colonic Polyp Behavior
American Journal of Gastroenterology, 2018
Conversion of a surgically arthrodesed knee to a total knee arthroplasty - Is it worth it? A Systematic Review
The Journal of Arthroplasty, 2016
Conversion of a surgically arthrodesed knee to total knee arthroplasty (TKA) is an option for a s... more Conversion of a surgically arthrodesed knee to total knee arthroplasty (TKA) is an option for a select group of patients who are not satisfied with their results. However, there is a paucity of literature on this topic. A systematic review of literature was performed to (1) describe the overall demographic characteristics; (2) evaluate the clinical outcomes; (3) determine the overall rate of complications; and (4) evaluate the overall satisfaction of patients who underwent conversion of an arthrodesed knee to TKA. A comprehensive literature search was systematically performed to evaluate all studies included in the literature until July 2015. The specific search terms used were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;fusion knee&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;arthrodesis knee,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; which revealed a total of 2206 studies. A review and selection of these abstracts were then performed based on inclusion and/or exclusion criteria; a total of 10 articles were used for final review. There were a total of 98 surgically arthrodesed knees that subsequently underwent TKA. Patients had a mean age of 55 years and were followed up for a mean of 5 years. Using a random effects model, there was an overall complication rate of 47%, an overall revision rate of 25%, and an overall failure rate of 11%. However, most patients were overall satisfied with the procedure. Fusion takedown is a challenging procedure that should only be performed by experienced surgeons after extensive discussion with the patients. The clinical outcomes are good with overall patient satisfaction, but complication rates are high including risk of repeat fusion or amputation.
Synthetic dendrimeric peptide active against biofilm and persister cells of Pseudomonas aeruginosa
Applied microbiology and biotechnology, Jan 27, 2015
Antimicrobial dendrimeric peptides (AMDP) are a relatively new class of agents displaying repetit... more Antimicrobial dendrimeric peptides (AMDP) are a relatively new class of agents displaying repetitive functional groups on a branched core. Previously, we have investigated the length requirement for antimicrobial activity of peptides consisting of repeated arginine (R) and tryptophan (W) side chains and found that even short linear RW repeats are active, providing a starting point for a de novo design of multivalent structures. In this study, we synthesized and tested a new synthetic dendrimer, 2D-24, for its antimicrobial activity against Pseudomonas aeruginosa, including the wild-type PAO1 and its mucoid mutant PDO300. This synthetic AMDP was found to kill planktonic cells of both PAO1 and PDO300 in a dose-dependent manner, with nearly complete killing of both strains observed when treated with 50 μM of this agent. In addition to planktonic cells, 2D-24 was also found to kill biofilm cells of both strains in a dose-dependent manner. For example, treatment with 30 μM 2D-24 led to 9...
Conversion of a surgically arthrodesed knee to a total knee arthroplasty - Is it worth it? A Systematic Review
The Journal of Arthroplasty, 2016
Conversion of a surgically arthrodesed knee to total knee arthroplasty (TKA) is an option for a s... more Conversion of a surgically arthrodesed knee to total knee arthroplasty (TKA) is an option for a select group of patients who are not satisfied with their results. However, there is a paucity of literature on this topic. A systematic review of literature was performed to (1) describe the overall demographic characteristics; (2) evaluate the clinical outcomes; (3) determine the overall rate of complications; and (4) evaluate the overall satisfaction of patients who underwent conversion of an arthrodesed knee to TKA. A comprehensive literature search was systematically performed to evaluate all studies included in the literature until July 2015. The specific search terms used were &amp;amp;amp;amp;amp;quot;fusion knee&amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;quot;arthrodesis knee,&amp;amp;amp;amp;amp;quot; which revealed a total of 2206 studies. A review and selection of these abstracts were then performed based on inclusion and/or exclusion criteria; a total of 10 articles were used for final review. There were a total of 98 surgically arthrodesed knees that subsequently underwent TKA. Patients had a mean age of 55 years and were followed up for a mean of 5 years. Using a random effects model, there was an overall complication rate of 47%, an overall revision rate of 25%, and an overall failure rate of 11%. However, most patients were overall satisfied with the procedure. Fusion takedown is a challenging procedure that should only be performed by experienced surgeons after extensive discussion with the patients. The clinical outcomes are good with overall patient satisfaction, but complication rates are high including risk of repeat fusion or amputation.