1
|
Hussein NL, Stevenson AP, Lawton CF, Elmayan A, Hillis EE, Burton JH, Fuhrman G. An Analysis of the Timing for Closure of a Diverting Loop Ileostomy. Am Surg 2023; 89:3870-3872. [PMID: 37144471 DOI: 10.1177/00031348231173971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A diverting loop ileostomy (DLI) is used to protect a distal gastrointestinal anastomosis at risk of leakage. While patients typically prefer early DLI closure, surgeons vary in opinion regarding optimal timing. This study evaluated whether the timing of DLI closure impacts outcomes.A retrospective review was performed on patients who underwent DLI creation within one health care system between 2012 and 2020. Patient characteristics and postoperative outcomes were compared across ileostomies closed in ≤2 months, 2-4 months, and >4 months. Outcomes examined included anastomotic leak, other complications, reintervention, and death within 30 days.A total of 500 DLIs were analyzed for the study, 455 of which were closed. The three closure groups were similar in patient characteristics and comorbidities. None of the outcome variables analyzed in this study demonstrated a statistically significant difference between groups, suggesting that in patients otherwise fit for surgery, DLI closure can be safely performed within 2 months of creation.
Collapse
Affiliation(s)
- Nadia L Hussein
- Department of Surgery, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Autumn P Stevenson
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA, USA
| | - Catherine F Lawton
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA, USA
| | - Ardem Elmayan
- Center for Outcomes and Health Services Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Emma E Hillis
- Center for Outcomes and Health Services Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Jeffrey H Burton
- Center for Outcomes and Health Services Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - George Fuhrman
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| |
Collapse
|
2
|
Mussarat N, Biggio J, Martin J, Morgan J, Tivis R, Elmayan A, Williams FB. Masked pregnancy-associated hypertension as a predictor of adverse outcomes. Am J Obstet Gynecol MFM 2023; 5:100976. [PMID: 37098390 DOI: 10.1016/j.ajogmf.2023.100976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Masked hypertension has been described in nonpregnant populations as elevated blood pressure in the home setting that is not reproduced on clinical assessment. Patients with masked hypertension have a greater risk of cardiovascular morbidity than patients who have blood pressures within normal range or those with white coat hypertension. OBJECTIVE This study aimed to determine whether masked pregnancy-associated hypertension detected on Connected Maternity Online Monitoring, a remote home blood pressure monitoring system, is associated with higher rates of hypertensive disorders of pregnancy during delivery admission and maternal and neonatal morbidities. STUDY DESIGN This was a retrospective cohort study of all patients on Connected Maternity Online Monitoring who delivered at 6 hospitals in a single healthcare system between October 2016 and December 2020. Patients were classified as having either normal blood pressure or masked pregnancy-associated hypertension. Masked pregnancy-associated hypertension was defined as remotely detected systolic blood pressure of ≥140 mm Hg or diastolic blood pressure of ≥90 mm Hg after 20 weeks of gestation on 2 occasions before diagnosis in a clinical setting. The chi-square test and Student t test were used for demographic and outcomes comparisons. Logistic regression was used to adjust outcomes by race, insurance, and body mass index. RESULTS A total of 2430 deliveries were included in our analysis, including 165 deliveries that met the criteria for masked pregnancy-associated hypertension. Clinically established pregnancy-associated hypertension, defined at the time of delivery, was more common in the masked pregnancy-associated hypertension group than in the normotensive group (66% vs 10%; adjusted odds ratio, 17.2; 95% confidence interval, 11.91-24.81). Patients with masked pregnancy-associated hypertension had higher rates of preeclampsia with severe features on delivery admission than normotensive patients (28% vs 2%; adjusted odds ratio, 23.35; 95% confidence interval, 14.25-38.26). Preterm delivery (16% vs 7%; adjusted odds ratio, 2.47; 95% confidence interval, 1.55-3.94), cesarean delivery(38% vs 26%; adjusted odds ratio, 1.58; 95% confidence interval, 1.13-2.23), small for gestational age (11% vs 5%; adjusted odds ratio, 2.27; 95% confidence interval, 1.31-3.94), and neonatal intensive care unit admission (8% vs 4%; adjusted odds ratio, 2.20; 95% confidence interval, 1.18-4.09) were more common among patients with masked pregnancy-associated hypertension than among normotensive patients. CONCLUSION With more outcomes research, remote blood pressure monitoring may prove to be an important tool in identifying pregnancies at risk of complications related to masked hypertension.
Collapse
Affiliation(s)
- Naiha Mussarat
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA.
| | - Joseph Biggio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Jane Martin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - John Morgan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Rick Tivis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Ardem Elmayan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Frank B Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| |
Collapse
|
3
|
Mussarat N, Biggio JR, Gastanaduy M, Chawla H, Scott M, Martinez C, Elmayan A, Williams FW. In mild chronic hypertension, remotely detected masked elevated blood pressure is associated with perinatal death. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
4
|
Mussarat N, Biggio JR, Gastanaduy M, Elmayan A, Williams FW. Expanded classification of gestational hypertension as a marker for adverse outcomes. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
5
|
Tijani A, Coons EM, Mizuki B, Dermady M, Stanilova K, Casey AL, Alqudsi M, Gastanaduy M, Elmayan A, Bamnolker A, Velez JCQ. Direct Oral Anticoagulants Versus Warfarin for Venous Thromboembolism Prophylaxis in Patients With Nephrotic Syndrome: A Retrospective Cohort Study. Ann Pharmacother 2022:10600280221129348. [DOI: 10.1177/10600280221129348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Evidence supporting venous thromboembolism (VTE) prophylaxis with direct oral anticoagulants (DOACs) in patients with nephrotic syndrome (NS) is limited to case reports. Objective: The purpose of this study was to compare bleeding and thromboembolic events in this population. Methods: A retrospective cohort study was conducted in adults with NS initiated on a DOAC or warfarin for VTE prophylaxis between January 2013 and July 2021 within the Ochsner Health System. Patients with study drug exposure within the preceding 7 days, acute VTE within the preceding 6 months, or ≤7 days of study drug exposure were excluded. The primary outcome was the composite rate of major bleeding and clinically relevant nonmajor bleeding. Secondary outcomes included time to major bleeding and rate of new thromboembolic events. This study was approved by the Ochsner Health System Institutional Review Board. Results: Twenty-five DOAC and 19 warfarin patients were included. The primary outcome occurred in 8% vs 26.3% ( P = 0.21) of patients treated with a DOAC or warfarin, respectively, and was driven by major bleeding (4% vs 21%, P = 0.25). Other secondary outcomes were similar between cohorts. The study was limited by a small sample size. Conclusion and Relevance: Use of DOACs for VTE prophylaxis resulted in a nonstatistically significant, but clinically relevant lower rate of major bleeding compared to warfarin. This study provides comparative data showing safe and effective use of DOACs in patients with NS. Prospective, randomized studies are needed to confirm results.
Collapse
Affiliation(s)
- Aminat Tijani
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | - Eric M. Coons
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | - Britta Mizuki
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | - Miranda Dermady
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | | | - Ashley L. Casey
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | | | | | - Ardem Elmayan
- Ochsner Center for Outcomes Research, Ochsner Health, New Orleans, LA, USA
| | - Adi Bamnolker
- Department of Hospital Medicine, Ochsner Health, New Orleans, LA, USA
| | | |
Collapse
|
6
|
Abstract
OBJECTIVE The objective of this study was to describe the safety profile and demographic data for a cohort of pregnant individuals who received an mRNA coronavirus disease 2019 (COVID-19) vaccine. STUDY DESIGN Prospective cohort study (with exposure matching) of individuals with active pregnancy who underwent immunization with a novel mRNA COVID-19 vaccine matched 1:2 with vaccinated age-matched female nonregnant controls was carried out. The primary outcome was defined as any vaccine-related complaints as defined in the original safety data. Secondary outcomes included specific complaints, COVID-19 screening test, and positive COVID-19 test. RESULTS Eighty-three vaccinated pregnant persons were age-matched with 166 female controls, all of whom were vaccinated between December 2020 and January, 2021. There was no difference in race or ethnicity between the groups. The mean body mass index of pregnant patients was lower than that of controls (26.1 vs. 29.2, p = 0.002). The frequency of complaints following vaccine administration was not different between pregnant and nonpregnant patients (18.1 vs. 16.9%, p = 0.201). Pregnant individuals were more likely to report fever (4.8 vs. 0.6%, p = 0.044) and gastrointestinal symptoms (4.8 vs. 0%, p = 0.012). CONCLUSIONS Side effect profiles of COVID-19 vaccine administration at our institution were relatively similar between pregnant and nonpregnant individuals and no serious complications occurred in either group. As COVID-19 infection in pregnancy can have significant morbidity, our data support the continued use of the vaccine for pregnant patients. KEY POINTS · Pregnant and nonpregnant women had a similar frequency of complaints.. · No serious adverse outcomes were observed in either group.. · Pregnant women were more likely to report fever and gastrointestinal side effects which may reflect gestationally mediated physiological responses to immunization..
Collapse
Affiliation(s)
- Angela Nakahara
- Ochsner Health, Department of Women's Services, New Orleans, Louisiana
| | - Joseph R Biggio
- Ochsner Health, Department of Women's Services, New Orleans, Louisiana
| | - Ardem Elmayan
- Ochsner Health, Department of Women's Services, New Orleans, Louisiana
| | - Frank B Williams
- Ochsner Health, Department of Women's Services, New Orleans, Louisiana
| |
Collapse
|
7
|
Nakahara A, Long M, Elmayan A, Biggio JR, Williams F. Expanded fetal growth restriction definition identifies high proportion of umbilical artery doppler anomalies. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
8
|
Mussarat N, Biggio JR, Rick Tivis, Elmayan A, Williams F. Connected MOM: A Remote Blood Pressure Monitoring System for Early Detection of Pregnancy Associated Hypertension. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Mussarat N, Biggio JR, Tivis R, Elmayan A, Williams F. Masked Pregnancy Associated Hypertension as a Predictor of Adverse Outcomes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
10
|
Long M, Nakahara A, Elmayan A, Tivis R, Biggio J, Williams F. Fetal growth restriction defined by abdominal circumference alone predicts perinatal mortality. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Ghersi BM, Peterson AC, Gibson NL, Dash A, Elmayan A, Schwartzenburg H, Tu W, Riegel C, Herrera C, Blum MJ. In the heart of the city: Trypanosoma cruzi infection prevalence in rodents across New Orleans. Parasit Vectors 2020; 13:577. [PMID: 33189151 PMCID: PMC7666460 DOI: 10.1186/s13071-020-04446-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/30/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Trypanosoma cruzi - the causative agent of Chagas disease - is known to circulate in commensal pests, but its occurrence in urban environments is not well understood. We addressed this deficit by determining the distribution and prevalence of T. cruzi infection in urban populations of commensal and wild rodents across New Orleans (Louisiana, USA). We assessed whether T. cruzi prevalence varies according to host species identity and species co-occurrences, and whether T. cruzi prevalence varies across mosaics of abandonment that shape urban rodent demography and assemblage structure in the city. METHODS Leveraging city-wide population and assemblage surveys, we tested 1428 rodents comprising 5 species (cotton rats, house mice, Norway rats, rice rats and roof rats) captured at 98 trapping sites in 11 study areas across New Orleans including nine residential neighborhoods and a natural area in Orleans Parish and a neighborhood in St. Bernard Parish. We also assayed Norway rats at one site in Baton Rouge (Louisiana, USA). We used chi-square tests to determine whether infection prevalence differed among host species, among study areas, and among trapping sites according to the number of host species present. We used generalized linear mixed models to identify predictors of T. cruzi infection for all rodents and each host species, respectively. RESULTS We detected T. cruzi in all host species in all study areas in New Orleans, but not in Baton Rouge. Though overall infection prevalence was 11%, it varied by study area and trapping site. There was no difference in prevalence by species, but roof rats exhibited the broadest geographical distribution of infection across the city. Infected rodents were trapped in densely populated neighborhoods like the French Quarter. Infection prevalence seasonally varied with abandonment, increasing with greater abandonment during the summer and declining with greater abandonment during the winter. CONCLUSIONS Our findings illustrate that T. cruzi can be widespread in urban landscapes, suggesting that transmission and disease risk is greater than is currently recognized. Our findings also suggest that there is disproportionate risk of transmission in historically underserved communities, which could reinforce long-standing socioecological disparities in New Orleans and elsewhere.
Collapse
Affiliation(s)
- Bruno M. Ghersi
- Department of Ecology & Evolutionary Biology, University of Tennessee, Knoxville, TN USA
| | - Anna C. Peterson
- Department of Ecology & Evolutionary Biology, University of Tennessee, Knoxville, TN USA
| | - Nathaniel L. Gibson
- Department of Ecology & Evolutionary Biology, University of Tennessee, Knoxville, TN USA
| | - Asha Dash
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Ardem Elmayan
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Hannah Schwartzenburg
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Weihong Tu
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Claudia Riegel
- City of New Orleans Mosquito, Termite, Rodent Control Board, New Orleans, LA USA
| | - Claudia Herrera
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Michael J. Blum
- Department of Ecology & Evolutionary Biology, University of Tennessee, Knoxville, TN USA
| |
Collapse
|
12
|
Zhao C, Wang L, Yakirevich E, Resnick M, Lombardo K, Elmayan A, Lu S. TCTE3 is a Novel Marker for Pancreatobiliary Tumors. Am J Clin Pathol 2016. [DOI: 10.1093/ajcp/aqw159.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
13
|
Clark PA, Bhattacharya S, Elmayan A, Darjatmoko SR, Thuro BA, Yan MB, van Ginkel PR, Polans AS, Kuo JS. Resveratrol targeting of AKT and p53 in glioblastoma and glioblastoma stem-like cells to suppress growth and infiltration. J Neurosurg 2016; 126:1448-1460. [PMID: 27419830 DOI: 10.3171/2016.1.jns152077] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Glioblastoma multiforme (GBM) is an aggressive brain cancer with median survival of less than 2 years with current treatment. Glioblastomas exhibit extensive intratumoral and interpatient heterogeneity, suggesting that successful therapies should produce broad anticancer activities. Therefore, the natural nontoxic pleiotropic agent, resveratrol, was studied for antitumorigenic effects against GBM. METHODS Resveratrol's effects on cell proliferation, sphere-forming ability, and invasion were tested using multiple patient-derived GBM stem-like cell (GSC) lines and established U87 glioma cells, and changes in oncogenic AKT and tumor suppressive p53 were analyzed. Resveratrol was also tested in vivo against U87 glioma flank xenografts in mice by using multiple delivery methods, including direct tumor injection. Finally, resveratrol was delivered directly to brain tissue to determine toxicity and achievable drug concentrations in the brain parenchyma. RESULTS Resveratrol significantly inhibited proliferation in U87 glioma and multiple patient-derived GSC lines, demonstrating similar inhibitory concentrations across these phenotypically heterogeneous lines. Resveratrol also inhibited the sphere-forming ability suggesting anti-stem cell effects. Additionally, resveratrol blocked U87 glioma and GSC invasion in an in vitro Matrigel Transwell assay at doses similar to those mediating antiproliferative effects. In U87 glioma cells and GSCs, resveratrol reduced AKT phosphorylation and induced p53 expression and activation that led to transcription of downstream p53 target genes. Resveratrol administration via oral gavage or ad libitum in the water supply significantly suppressed GBM xenograft growth; intratumoral or peritumoral resveratrol injection further suppressed growth and approximated tumor regression. Intracranial resveratrol injection resulted in 100-fold higher local drug concentration compared with intravenous delivery, and with no apparent toxicity. CONCLUSIONS Resveratrol potently inhibited GBM and GSC growth and infiltration, acting partially via AKT deactivation and p53 induction, and suppressed glioblastoma growth in vivo. The ability of resveratrol to modulate AKT and p53, as well as reportedly many other antitumorigenic pathways, is attractive for therapy against a genetically heterogeneous tumor such as GBM. Although resveratrol exhibits low bioavailability when administered orally or intravenously, novel delivery methods such as direct injection (i.e., convection-enhanced delivery) could potentially be used to achieve and maintain therapeutic doses in the brain. Resveratrol's nontoxic nature and broad anti-GBM effects make it a compelling candidate to supplement current GBM therapies.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Arthur S Polans
- Ophthalmology and Visual Sciences, and.,Carbone Cancer Center, and
| | - John S Kuo
- Departments of 1 Neurological Surgery and.,Carbone Cancer Center, and.,Department of Surgery, National University of Singapore
| |
Collapse
|
14
|
Abstract
Dr. Clinton Woolsey was a leading 20th-century neuroscientist for almost 4 decades. His most significant achievements were the novel use and refinement of evoked potential techniques to functionally map mammalian brains, the discovery of secondary cortical areas, and a wide repertoire of comparative neurofunctional studies across many species. The authors discuss his life and work through a historical context with contemporaries, highlight the primitive state of brain mapping before Woolsey, and review his involvement in advancing its rapid development through work at both Johns Hopkins University and University of Wisconsin in Madison. Dr. Woolsey's lasting impact on basic and clinical neuroscience, neurosurgery, and neurology and his important roles as a scientific mentor and leader are also described.
Collapse
Affiliation(s)
- Will Lyon
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | | | | | | | | |
Collapse
|