GD may be triggered by I. The incidence of the condition is low. Several risk factors were consistently identified; some have shown to raise the risk significantly.I-IGD seems more treatment resistant than iodine-independent GD and the best resolution rates were achieved with uptake-based selected iodine activities.
). AbstractPurpose Antibiotic prophylaxis decreases the rate of surgical site infection in a broad spectrum of surgical procedures. However, in patients undergoing elective hand surgery, there is evidence of lower efficacy, and its use might be related to the development of antimicrobial resistance. The side effects and higher health-related costs must also be taken into consideration. Our aim was to assess the efficacy of antibiotic prophylaxis in these procedures. Material and methods A retrospective study was conducted including all patients who underwent clean, elective hand surgery lasting less than 30 minutes from January 1st 2014 to December 31st 2015 at our hospital. The demographic and surgery-related data were analyzed using the Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY, US) software, version 23.0. Results A total of 346 patients matched the study's inclusion criteria. The infection rate was of 1%, and it was not influenced by gender, age or diabetes mellitus. Antibiotic prophylaxis was administered in 52% of the cases, and it had no effect on the decrease in the infection rate, even in the group of diabetic patients. Conclusions Despite the inherent limitations of any retrospective study, our data analysis supports the fact that prophylactic antibiotic administration does not reduce the incidence of surgical site infection in clean, elective hand surgery that lasts less than 30 minutes, even in patients at risk. ResumenIntroducción La profilaxis antibiótica disminuye la tasa de infección quirúrgica en un amplio espectro de procedimientos. Sin embargo, en los pacientes sometidos a cirugía electiva de la mano, existe evidencia de una menor eficacia, y hay que considerar que su uso podría estar relacionado con el desarrollo de la resistencia a los antimicrobianos, los efectos secundarios y el mayor costo en salud. Nuestro objetivo fue evaluar la eficacia de la profilaxis antibiótica en estos procedimientos. Material y métodos Se realizó un estudio retrospectivo que incluyó a todos los pacientes sometidos a cirugía de mano limpia y programada, con duración inferior a 30 minutos, desde el 1 de enero de 2014 al 31 de diciembre de 2015 en nuestro hospital. Los datos demográficos y quirúrgicos se analizaron mediante el programa Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY, US), versión 23.0.
This article proposes a new generalization of the Multivariate Markov Chains (MMC) model. The future values of a Markov chain commonly depend on only the past values of the chain in an autoregressive fashion. The generalization proposed in this work also considers exogenous variables that can be deterministic or stochastic. Furthermore, the effects of the MMC's past values and the effects of pre-determined or exogenous covariates are considered in our model by considering a non-homogeneous Markov chain. The Monte Carlo simulation study findings showed that our model consistently detected a non-homogeneous Markov chain. Besides, an empirical illustration demonstrated the relevance of this new model by estimating probability transition matrices over the space state of the exogenous variable. An additional and practical contribution of this work is the development of a novel R package with this generalization. Keywords Multivariate Markov chains and Mixture transition distribution Model and High order Markov chains and Multivariate Markov chains with exogenous variables and R
Hand infections represent common medical and surgical challenges that endanger delicate structures with severe consequences if not promptly addressed. Early identification and management are essential to achieve optimal outcomes. To the best of our knowledge this is the first reported case caused by Streptococcus constellatus, in which a severe periungueal infection evolved rapidly with septic thrombosis of digital vessels and culminated in amputation. This microorganism belongs to a group of commensal bacteria, Streptococcus milleri, that causes dental, peritonsillar and sinus abscesses. When bacteriemia outbursts, distant abscesses may form or endocarditis may ensue. A missed diagnosis and treatment can induce important morbidities, often delayed by the difficult isolation of the agent in the laboratory and its complex mechanisms of antibacterial resistance. This article focus on the importance of identifying serious hand infections requiring urgent or emergent treatment, since delayed or inadequate identification and management can lead to important and permanent deficits.
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