| 1. |
- Bravo, L, et al.
(author)
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- 2021
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| 2. |
- Tabiri, S, et al.
(author)
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- 2021
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| 3. |
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| 5. |
- Glasbey, JC, et al.
(author)
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- 2021
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| 6. |
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| 7. |
- Amjad, M., et al.
(author)
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Efficacy of Quinapyramine Sulphate, Isometamedium Chloride and Diminazene Aceturate For Treatment of Surra
- 2022
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In: Journal of Animal and Plant Sciences. - : Pakistan Agricultural Scientists Forum. - 1018-7081. ; 32:3, s. 663-669
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Journal article (peer-reviewed)abstract
- Trypanosomiasis (Surra) is a parasitic and zoonotic disease caused by Trypanosoama evansi, transmitted by insect vectors Tabanus and Stomoxys mechanically. The aim of the present study was to determine the therapeutic efficacy of various trypanosidal drugs against trypanosomiasis in Thoroughbred horses. Horses having clinical signs of trypanosomiasis were diagnosed through blood smear through a microscope were selected for this study. The infected horses were divided into three experimental groups for therapeutic trials. Animals in group A were treated with a single dose of quinapyramine sulphate @ 3000mg/ml per 50/kg body weight; group B was treated with a single dose of isometamedium chloride Hydrochloride@ 0.5 mg/2.5 ml of 1% solution per 50/kg body weight; group C was treated with a single dose of diminazene aceturate@ 2360 mg/15 ml per 100/kg. Results revealed that significant (P<0.0001) de cline in the values of erythrocyte counts (RBC), hemoglobin concentration (Hb), packed cell volume (PCV), platelets (PLT) and a significant (P<0.0001) increase in white blood cells (WBC), granulocytes, and monocytes in infected horses as compared to healthy ones. Therapeutic trials indicated that quinapyramine sulphate that showed 100% efficacy at 21th days had significantly higher than isometamedium chloride and diminazene aceturate (95.83 and 75% efficacy, respectively). The hematological parameters of recovered horses were significantly restored to normal values on day 21 after treatment. It is concluded that quinapyramine sulphate is the drug of choice against trypanosomiasis in Thoroughbred horses.
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| 8. |
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| 9. |
- Ivanics, Tommy, et al.
(author)
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Combined Chylothorax and Chylous Ascites Complicating Liver Transplantation: A Report of a Case and Review of the Literature
- 2019
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In: Case Reports in Transplantation. - : Hindawi Limited. - 2090-6943 .- 2090-6951.
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Journal article (peer-reviewed)abstract
- Chyle leaks may occur as a result of surgical intervention. Chyloperitoneum, or chylous ascites after liver transplantation, is rare and the development of chylothorax after abdominal surgery is even more rare. With increasingly aggressive surgical resections, particularly in the retroperitoneum, the incidence of chyle leaks is expected to increase in the future. Here we present a unique case of a combined chylothorax and chyloperitoneum following liver transplantation successfully managed conservatively. Risk factors for chylous ascites include para-aortic manipulation, extensive retroperitoneal dissection, use of a Ligasure device, and early enteral feeding as well as early enteral feeding. The clinical presentation is typically insidious and may include painless abdominal distension. Diagnosis can be made by noting characteristic milky white drainage which on laboratory examination has a total fluid triglyceride level >110 mg/dl, an ascites/serum triglyceride ratio of >1 and a leukocyte count in fluid >1000/uL with a lymphocyte predominance. Chyle leaks may lead to significant morbidity and mortality. Numerous management options exist, with conservative nonoperative measurements leading to the most consistent and successful outcomes. This includes a step-up approach beginning with dietary modifications to a low-fat or medium chain triglyceride diet followed by nil per os with addition of total parenteral nutrition and somatostatin analogues such as octreotide. Rarely do patients require more invasive treatment. Early recognition and appropriate management are imperative to mitigate this complication.
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| 10. |
- Ivanics, Tommy, et al.
(author)
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Contemporary management of chronic indwelling inferior vena cava filters
- 2021
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In: Journal of Vascular Surgery. - : Elsevier. - 2213-3348. ; 9:1, s. 163-169
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Journal article (peer-reviewed)abstract
- Objective: Despite increasing retrieval rates of the inferior vena cava (IVC) filter, less than one-third are removed within the recommended timeline. Prolonged filter dwell times may increase the technical difficulty of retrieval and filter-related complications. We sought to evaluate the contemporary outcomes of patients with chronic indwelling IVC filters at a tertiary care center.Methods: A retrospective analysis was performed from August 2015 through August 2019 of all patients who were referred for removal of a prolonged IVC filter with a dwell time >1 year. Descriptive analysis was used to evaluate patients' characteristics and procedural outcomes, which were reviewed through electronic medical records. Data were expressed as median with interquartile range (IQR) or number and percentage, as appropriate.Results: A total of 47 patients were identified with a median filter dwell time of 10.0 years (IQR, 6-13 years); 34 patients underwent IVC filter removal, and 13 patients refused retrieval. The median age of patients was 54.9 years (IQR, 42.5-64.0 years); the majority were female (57%) and white (53%). The most common indication for filter placement was high risk despite anticoagulation (49%), followed by venous thromboembolism prophylaxis (21%). The majority of patients were symptomatic (72%). If symptomatic, the most common reason for retrieval was IVC penetration (94%), and the chief complaint was pain (56%). Retrieval success was 97%, with a median length of stay of 0 days. The majority of retrievals were performed through an endovascular approach (97%). There was one postprocedural complication (3%).Conclusions: Despite prolonged dwell times, IVC filter retrieval can be performed safely and effectively in carefully selected patients at a tertiary referral center.
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| 11. |
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| 12. |
- Ivanics, Tommy, et al.
(author)
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Evaluation of a Multidisciplinary Team Approach for Generating Survivorship Care Plan Treatment Summaries in Patients With Breast Cancer
- 2019
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In: J Oncol Pract. - : American Society of Clinical Oncology (ASCO). ; 15:5, s. e467-e474
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Journal article (peer-reviewed)abstract
- The optimal structure for survivorship care plan (SCP) programs and methodology for generating treatment summaries (TSs) has not yet been defined, but the Commission on Cancer and the National Accreditation Program for Breast Centers both mandate that participating oncology programs implement SCP-TS processes for patients that have completed treatment. METHODS: We used the Institute for Healthcare Improvement’s Plan-Do-Study-Act model for conducting a quality improvement project evaluating two different SCP-TS programs implemented at the Henry Ford Health System/Henry Ford Cancer Institute’s Breast Oncology Program in Detroit, Michigan. System I involved TSs drafted by nonspecialist breast clinic staff; System II involved TSs vetted through a multidisciplinary breast specialist conference approach. Accuracy of basic documentation entries related to dates and components of treatment were compared for the two approaches. RESULTS: Seventy-one System I and 93 System II documents were reviewed. Documentation was accurate in at least 90% of documents for both systems regarding delivery of chemotherapy and/or endocrine therapy and for documenting the identity of the various members of the cancer treatment team. Both systems had notable inaccuracies in documenting type of surgery performed, but System II had fewer inaccuracies than System I (33.78% v 51.67%, respectively; P = .05). System II, compared with System I, had fewer inaccuracies in documenting date of diagnosis (9.68% v 25.35%, respectively; P = .01) and had less missing information for dose of radiation delivered (9.33% v 33.9%, respectively; P < .01). CONCLUSION: A multidisciplinary team approach to drafting and reviewing SCP-TS documents improved content accuracy for our program, but ongoing education regarding documentation of various surgical procedures is warranted.
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| 13. |
- Ivanics, Tommy, et al.
(author)
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Prescribing Habits of Providers and Risk Factors for Nonadherence to Opioid Prescribing Guidelines
- 2020
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In: The American surgeon. - : SAGE Publications. - 0003-1348 .- 1555-9823. ; 87:7, s. 1039-1047
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Journal article (peer-reviewed)abstract
- The Michigan Opioid Prescribing Engagement Network introduced guidelines in October 2017 to combat opioid overprescription following various surgical procedures. We sought to evaluate changes in opioid prescribing at our academic center and identify factors associated with nonadherence to recently implemented opioid prescribing guidelines. Methods This retrospective review analyzed opioid prescribing data for appendectomy, cholecystectomy, and hernia repair from January 2015 through September 2017 (pre-guidelines group) and November 2017 through December 2018 (post-guidelines group). October 2017 data were excluded to allow for guideline implementation. Opioid prescribing data were recorded as total morphine equivalents (TMEs). Results Of 1493 cases (903 pre-vs. 590 post-guidelines), the mean TME prescribed significantly decreased post-guidelines (231.9 ± 108.6 vs. 112.7 ± 73.9 mg; P < .01). More providers prescribed within recommended limits post-guidelines (2.8% vs. 44.8%; P < .01). On multivariable analysis, independent risk factors for guideline nonadherence were the American Society of Anesthesiologists class > 2 (adjusted odds ratio [AOR]:1.65, 95% confidence interval[CI] 1.09-2.49; P = .02), general surgery vs. acute care surgery service (AOR 1.89, 95% CI 1.15-3.10; P = .01), oxycodone vs. hydrocodone (AOR:1.90, 95% CI:1.06-3.41; P = .03), and nonphysician provider vs. resident prescriber (AOR:2.10, 95% CI:1.14-3.11; P < .01). Conclusions Opioid prescribing significantly reduced after the adoption of opioid prescribing guidelines at our institution. Numerous factors associated with provider guideline nonadherence may identify actionable targets to minimize opioid overprescribing further.
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| 14. |
- Jabbar, Abdul, et al.
(author)
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Epidemiology and antibiogram of common mastitis-causing bacteria in Beetal goats
- 2020
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In: Veterinary World. - : Veterinary World. - 0972-8988 .- 2231-0916. ; 13:12, s. 2596-2607
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Journal article (peer-reviewed)abstract
- Background and Aim: Mastitis has been identified as the most prevalent and economically imperative disease among dairy animals. Thus, understanding its common bacterial pathogens and risk factors is necessary to improve udder health at herd, region, or country level. However, scientific research on caprine mastitis, especially on Beetal breed, has remained to be insufficient in Pakistan. Therefore, this study aimed to evaluate the epidemiology and antibiogram assay of common mastitis-causing bacterial agents, that is, Staphylococcus, Streptococcus, and Escherichia coli, in dairy goats.Materials and Methods: In total, 500 Beetal goats, irrespective of age and those that were not treated with any kind of antimicrobial agents during the past 120 h, were screened using California Mastitis Test in Pattoki, Kasur District, whereas epidemiological factors were recorded. The milk samples of mastitic goats were then collected and processed using standard methods. Each sample was primarily cultured on nutrient agar. Using a specific medium, each bacterial colony was separated using several streak methods. Six antibiotic disks belonging to different antibiotic groups were used for antibiogram profiling of bacterial isolates. Chi-square test was used to assess the association of baseline characteristics and mastitis occurrence. Meanwhile, multivariable logistic regression (p<0.001) was utilized to determine the risk factors associated with positive and negative dichotomous outcome of mastitis.Results: The results revealed that the overall prevalence of goat mastitis was 309 (61.8%), in which 260 (52%) and 49 (9.8%) cases were positive for subclinical mastitis (SCM) and clinical mastitis (CM), respectively. Streptococcus and E. coli were found to be the predominant isolates causing SCM and CM, respectively (p<0.001). It was observed that amoxicillin+clavulanic acid was highly sensitive to isolates of Staphylococcus and Streptococcus and ceftiofur sodium to isolates of Streptococcus and E. coli, while enrofloxacin was found to be sensitive to isolates of Streptococcus and E. coli. Risk factors such as herd structure, deworming, vaccination, presence of ticks, use of teat dip and mineral supplements, feeding type, age, parity, housing, blood in the milk, milk leakage, milk taste, and milk yield were found to have the strongest association with mastitis occurrence, while ease of milking has moderate association.Conclusion: In the area examined, cases of SCM were found to be higher compared with that of CM, and ceftiofur sodium has been identified as the preferred treatment in both clinical and subclinical forms of caprine mastitis in Beetal goats. Risk factors for mastitis that was identified in this study can form the basis for the creation of an udder health control program specific for dairy goats. We hope our findings could raise awareness of the risk factors and treatment approaches for common mastitis-causing bacterial agents.
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| 15. |
- Leonard-Murali, Shravan, et al.
(author)
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Esophagectomies for Malignancy Among General and Thoracic Surgeons: A Propensity Score Matched National Surgical Quality Improvement Program Analysis Stratified by Surgical Approach
- 2021
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In: The American surgeon. - : SAGE Publications. - 0003-1348 .- 1555-9823.
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Journal article (peer-reviewed)abstract
- Previous studies of esophagectomy outcomes by surgical specialty do not address malignancy or surgical approach. We sought to evaluate these cases using a national database. The National Surgical Quality Improvement Program (NSQIP)–targeted esophagectomy data set was queried for esophagectomies for malignancy and grouped by surgeon specialty: thoracic surgery (TS) or general surgery (GS). 1:1 propensity score matching was performed. Associations of surgical specialty with outcomes of interest (30-day mortality, anastomotic leak, Clavien-Dindo grade ≥ 3, and positive margin rate) were assessed overall and in surgical approach subsets. 1463 patients met inclusion criteria (512 GS and 951 TS). Propensity score matching yielded matched groups of 512, with similar demographics, preoperative stage, and neoadjuvant therapy rates. All outcomes of interest were similar between TS and GS groups, both overall and when stratified by surgical approach. Esophagectomy for malignancy has a similar perioperative safety profile and positive margin rate among general and thoracic surgeons, regardless of surgical approach.
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| 16. |
- Leonard-Murali, Shravan, et al.
(author)
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Intraoperative Nerve Monitoring in Thyroidectomies for Malignancy: Does it Matter?
- 2021
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In: The American surgeon. - : SAGE Publications. - 0003-1348 .- 1555-9823.
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Journal article (peer-reviewed)abstract
- Recurrent laryngeal nerve (RLN) injury and postoperative hypocalcemia are potential complications of thyroidectomy, particularly in malignancy. Intraoperative nerve monitoring (IONM) remains controversial. We sought to evaluate the impact of IONM on these complications using a national data set. Methods The American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-targeted data set was queried for patients who underwent thyroidectomies from 2016 to 2017. Patients were grouped according to IONM use. Logistic regression models were constructed to evaluate associations of variables with 30-day hypocalcemic events (HCEs) and RLN injury. Associations were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). A subgroup analysis was performed of patients with malignancy. Results A total of 9527 patients were identified; 5969 (62.7%) underwent thyroidectomy with IONM and 3558 (37.3%) without. By multivariable analysis, IONM had protective associations with HCE (OR = .81, 95% CI = .68-.96; P = .013) and RLN injury (OR = .83, 95% CI = .69-.98; P = .033). Malignancy increased risk of HCE (OR = 1.21, 95% CI=1.01-1.45; P = .038) and RLN injury (OR = 1.22, 95% CI = 1.02-1.46; P = .034). A large proportion (5943/9527, 62.4%) of patients had malignancy; 3646 (61.3%) underwent thyroidectomy with IONM and 2297 (38.7%) without. In the subgroup analysis, IONM had stronger protective associations with HCE (OR = .73, 95% CI = .60-.90; P = .003) and RLN injury (OR = .76, 95% CI = .62-.94; P = .012). Discussion Malignancy was associated with increased risk of HCE and RLN injury. Intraoperative nerve monitoring had a protective association with HCE and RLN injury, both overall, and in the malignant subgroup. Intraoperative nerve monitoring was correlated with improved thyroidectomy outcomes, especially if the indication was malignancy. This warrants further study to clarify cause and effect.
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| 19. |
- Leonard-Murali, Shravan, et al.
(author)
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Spontaneous hepatic rupture due to primary amyloidosis
- 2019
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In: BMJ Case Reports. - : BMJ Publishing Group Ltd. - 1757-790X. ; 12:10
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Journal article (peer-reviewed)abstract
- Spontaneous hepatic rupture is an uncommon cause of haemorrhagic shock and very rarely happens due to amyloidosis. This report describes one such case in which a middle-aged man presented in extremis. He was managed initially with massive transfusion, interventional radiology embolisation and decompressive laparotomy for abdominal compartment syndrome. Subsequent coagulopathy was treated with activated factor VII due to deficient native activity. Serum protein electrophoresis and liver biopsy during his hospital course yielded a diagnosis of amyloidosis, which was treated palliatively with steroids and bortezomib. Despite supportive care, he died 10 days after presentation. This case illustrates the importance of considering an uncommon pathology when a patient presents with a condition in an uncommon way.
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| 20. |
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| 21. |
- Nasser, Hassan, et al.
(author)
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Clostridium difficileEnteritis after Total Abdominal Colectomy for Ulcerative Colitis
- 2019
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In: Case Reports in Critical Care. - : Hindawi Limited. - 2090-6420 .- 2090-6439. ; 2019, s. 1-4
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Journal article (peer-reviewed)abstract
- Introduction.IsolatedClostridium difficilesmall bowel enteritis is a rare condition with significant morbidity and mortality.Presentation of Case.An 83-year-old female with refractory ulcerative colitis underwent a total proctocolectomy and end ileostomy. Her postoperative course was complicated with return to the operating room for repair of an incarcerated port site hernia. Subsequently, she developed septic shock and multiorgan failure requiring intubation and mechanical ventilation, renal replacement therapy, and high dose vasopressors. Diagnostic workup revealed diffuse small bowel wall thickening on computed tomography scan as well as positive nucleic acid amplification test forC. difficiletoxin B gene. Despite treatment with antibiotics and maximum attempts at resuscitation, the patient expired.Discussion. C. difficileinfection most commonly affects the colon but rarely can involve the small bowel. The pathogenesis ofC. difficileenteritis is unclear but is believed to mirror that of colitis. Surgical patients are susceptible forC. difficileinfection, as they tend to be relatively immunosuppressed in the postoperative period. Radiologic findings of enteritis may mimic those of colitis and this includes small bowel dilation and thickening. Treatment for this condition has not been well established but it is approached similar to colitis.Conclusion.Despite an increase in the number of case reports ofC. difficileenteritis, it continues to be a rare but potentially fatal infection. Clinicians should maintain a high index of suspicion especially in patients with inflammatory bowel disease who undergo colon resections.
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| 28. |
- Nasser, Hassan, et al.
(author)
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Severe phlebitis-like abnormal reaction following great saphenous vein cyanoacrylate closure
- 2019
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In: Journal of Vascular Surgery. - : Elsevier. - 2213-3348. ; 7:4, s. 578-582
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Journal article (peer-reviewed)abstract
- The VenaSeal closure system is a nonthermal, nontumescent technique that was approved by the U.S. Food and Drug Administration in 2015 for the treatment of superficial venous insufficiency. Studies have demonstrated a comparable efficacy and safety profile to thermal ablation procedures. We report a case of a middle-aged woman who developed a severe, prolonged phlebitis-like reaction requiring treatment with steroids and antihistamines after cyanoacrylate adhesive embolization. This adverse reaction is uncommon but usually self-limiting and is believed to be a type IV hypersensitivity reaction to the cyanoacrylate compound. Knowledge of this potential complication and its treatment are key, because the reaction may be severe with significant morbidity.
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| 29. |
- Shetty, Tushar, et al.
(author)
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Is Loop Ileostomy in Patients with Cecal Bascule a Viable Option?
- 2019
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In: Case Reports in Surgery. - : Hindawi Limited. - 2090-6919 .- 2090-6900. ; 2019, s. 1-4
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Journal article (peer-reviewed)abstract
- Background. Cecal bascule, initially described in 1899 by Treves, is the rarest form of cecal volvulus and represents a phenomenon when a redundant and distended cecum folds anteriorly over the ascending colon causing an intestinal obstruction. Patients with cerebral palsy are at increased risk for this condition. Case Presentation. We present a 28-year-old male with cerebral palsy, functionally dependent in all activities of daily living, who had undergone a loop ileostomy for cecal bascule. He then presented to our emergency department with a large loop ileostomy prolapse, which was the result of an inverted prolapsed cecum through the efferent ileostomy limb. He underwent a right hemicolectomy with end ileostomy and transverse mucous fistula creation through the previous ostomy site. He progressed well appropriately postoperatively and was discharged home. Conclusions. While cecal bascule is a rare form of bowel obstruction, patients with cerebral palsy are at an increased risk for this condition. The treatment options are numerous and are primarily surgical. Diverting loop ileostomy alone is not a recommended treatment. A high index of suspicion is warranted in all cases of large bowel obstruction to minimize risk of recurrence, morbidity, and mortality for patients afflicted by this condition.
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