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Zouki J, Sidhom D, Bindon R, Sidhu T, Chan E, Lyon M. Choledocholithiasis: A Review of Management and Outcomes in a Regional Setting. Cureus 2023; 15:e50223. [PMID: 38192960 PMCID: PMC10773468 DOI: 10.7759/cureus.50223] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
Background Choledocholithiasis is a common surgical presentation with an incidence of 8% to 16% in symptomatic cholelithiasis. Treatment often requires a multi-stage approach via endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC), which can prolong the length of stay (LoS) and expose patients to unnecessary risks. A single-stage procedure, such as LC with common bile duct exploration (CBDE), is a safe and effective option that may decrease LoS. This study compares patient outcomes and management in a regional center and aims to identify factors that predict the presence of confirmed choledocholithiasis. Methods A retrospective cross-sectional analysis was performed on all patients admitted to Toowoomba Hospital for management of diagnosed or suspected choledocholithiasis from January 2021 to March 2023. Patient demographics, ERCP findings, and operative data were collated. Results A total of 195 patients were identified, including 136 patients undergoing multi-stage management, 34 patients who had an ERCP alone, and 25 patients who underwent single-stage management. Single-stage procedures had an 80% success rate with an average LoS of 3.6 days. Multi-stage procedures had an average LoS of 8.1 days and an ERCP success rate of 93%. Complication rates between ERCP (11.7%) and LC with CBDE (9.7%) were comparable. Time to index ERCP and serum bilirubin level were found to be significantly lower in those with positive index ERCP findings compared to those without. Conclusion Single-stage procedures are a safe way to manage choledocholithiasis and are associated with a reduced LoS when compared to multi-stage management, with comparable efficacy and morbidity rates.
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Affiliation(s)
- Jason Zouki
- General Surgery, Toowoomba Hospital, Toowoomba, AUS
| | - David Sidhom
- General Surgery, Toowoomba Hospital, Toowoomba, AUS
| | | | | | - Erick Chan
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
| | - Matthew Lyon
- General Surgery, Toowoomba Hospital, Toowoomba, AUS
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2
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Lee JH, Arora A, Bergman R, Gomez-Rexrode A, Sidhom D, Reddy RM. Increased Variation in Esophageal Cancer Treatment and Geographic Healthcare Disparity in Michigan. J Am Coll Surg 2023; 237:779-785. [PMID: 37581370 DOI: 10.1097/xcs.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Regional variation in complex healthcare is shown to negatively impact health outcomes. We sought to characterize geographic variance in esophageal cancer operation in Michigan. STUDY DESIGN Data for patients with locoregional esophageal cancer from the Michigan Cancer Surveillance Program from 2000 to 2013 was analyzed. We reviewed the incidence of esophageal cancer by county and region, and those with locoregional disease receiving an esophagectomy. Counties were aggregated into existing state-level "urban vs rural" designations, regions were aggregated using the Michigan Economic Recovery Council designations, and data was analyzed with ANOVA, F-test, and chi-square test. RESULTS Of the 8,664 patients with locoregional disease, 2,370 (27.4%) were treated with operation. Men were significantly more likely to receive esophagectomy than women (p < 0.001). Likewise, White, insured, and rural patients were more likely than non-White (p < 0.001), non-insured (p = 0.004), and urban patients (p < 0.001), respectively. There were 8 regions and 83 counties, with 61 considered rural and 22 urban. Region 1 (Detroit metro area, southeast) comprises the largest urban and suburban populations; with 4 major hospital systems it was considered the baseline standard for access to care. Regions 2 (west; p = 0.011), 3 (southwest; p = 0.024), 4 (east central; p = 0.012), 6 (northern Lower Peninsula; p = 0.008), and 8 (Upper Peninsula; p < 0.001) all had statistically significant greater variance in annual rates of operation compared with region 1. Region 8 had the largest variance and was the most rural and furthest from region 1. The variance in operation rate between urban and rural differed significantly (p = 0.005). CONCLUSIONS A significant increase in variation of care was found in rural vs urban counties, as well as in regions distant to larger hospital systems. Those of male sex, White race, rural residence, and those with health insurance were significantly more likely to receive operation.
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Affiliation(s)
- John H Lee
- From the University of Michigan Medical School, Ann Arbor, MI (Lee, Arora, Gomez-Rexrode, Sidhom, Reddy)
| | - Akul Arora
- From the University of Michigan Medical School, Ann Arbor, MI (Lee, Arora, Gomez-Rexrode, Sidhom, Reddy)
| | - Rachel Bergman
- the Department of Orthopedic Surgery, Northwestern Medicine, Chicago, IL (Bergman)
| | - Amalia Gomez-Rexrode
- From the University of Michigan Medical School, Ann Arbor, MI (Lee, Arora, Gomez-Rexrode, Sidhom, Reddy)
| | - David Sidhom
- From the University of Michigan Medical School, Ann Arbor, MI (Lee, Arora, Gomez-Rexrode, Sidhom, Reddy)
| | - Rishindra M Reddy
- From the University of Michigan Medical School, Ann Arbor, MI (Lee, Arora, Gomez-Rexrode, Sidhom, Reddy)
- Department of Surgery, Section of Thoracic, University of Michigan, Ann Arbor, MI (Reddy)
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Sidhom D, Aboul-Hassan D, Clauw DJ, Cofield C, Bergmans R. Chronic pain management in sickle cell disease: A systematic scoping review of controlled trials. Crit Rev Oncol Hematol 2023; 190:104087. [PMID: 37541536 DOI: 10.1016/j.critrevonc.2023.104087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/12/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/06/2023] Open
Abstract
Existing treatment for chronic pain in sickle cell disease (SCD) is opioid-dependent, which is ineffective and carries risks. We conducted a scoping literature review to assess the size and scope of available literature about controlled trials of therapies for SCD chronic pain and identify research gaps. The search strategy in PubMed and EMBASE utilized keywords for chronic pain and sickle cell and identified seven original articles that met inclusion criteria. Six of the studies recruited from clinics while one recruited from community sources. Cannabis and behavioral modification were associated with improvements in pain scores. However, existing evidence does not represent best practices for assessing chronic pain, and this along with small sample sizes prevents translation to clinical care. The limited evidence concerning treatment for SCD chronic pain highlights the need for larger trials of opioid alternatives and the utilization of chronic pain measures that capture nociplastic pain in SCD.
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Affiliation(s)
- David Sidhom
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Deena Aboul-Hassan
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Cherie Cofield
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Bergmans
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
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Elam AR, Sidhom D, Ugoh P, Andrews CA, De Lott LB, Woodward MA, Lee PP, Newman-Casey PA. Disparities in Eye Care Utilization During the COVID-19 Pandemic. Am J Ophthalmol 2022; 233:163-170. [PMID: 34324852 PMCID: PMC8312151 DOI: 10.1016/j.ajo.2021.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the relationship between telemedicine utilization and sociodemographic factors among patients seeking eye care. DESIGN Comparative utilization analysis. METHODS We reviewed the eye care utilization patterns of a stratified random sample of 1720 patients who were seen at the University of Michigan Kellogg Eye Center during the height of the COVID-19 pandemic (April 30 to May 25, 2020) and their odds of having a video, phone, or in-person visit compared with having a deferred visit. Associations between independent variables and visit type were determined using a multinomial logistic regression model. RESULTS Older patients had lower odds of having a video visit (P = .007) and higher odds of having an in-person visit (P = .023) compared with being deferred, and in the nonretina clinic sample, older patients still had lower odds of a video visit (P = .02). Non-White patients had lower odds of having an in-person visit (P < .02) in the overall sample compared with being deferred, with a similar trend seen in the retina clinic. The mean neighborhood median household income was $76,200 (±$33,500) and varied significantly (P < .0001) by race with Blacks having the lowest estimated mean income. CONCLUSION Disparities exist in how patients accessed eye care during the COVID-19 pandemic with older patients-those for whom COVID-19 posed a higher risk of mortality-being more likely to be seen for in-person care. In our affluent participant sample, there was a trend toward non-White patients being less likely to access care. Reimbursing telemedicine solely through broadband internet connection may further exacerbate disparities in eye care.
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Affiliation(s)
- Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - David Sidhom
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School
| | | | - Chris A Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Paul P Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC.
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Xue H, Maksemous N, Sidhom D, Ma L, Chen S, Wu J, Feng Y, M Haupt L, R Griffiths L. Novel compound heterozygous missense mutations in GDAP1 cause Charcot-Marie-Tooth type 4A. J Genet 2021; 100:58. [PMID: 34470922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Homozygous or compound heterozygous mutations in the GDAP1 gene cause Charcot-Marie-Tooth (CMT4A) that are consistent with an autosomal recessive mode of inheritance. The case reported in this study is clinically and genetically diagnosed with recessive CMT4A that is caused by a compound novel heterozygous GDAP1 mutation. The genomic DNA of the proband with the clinical diagnosis of CMT was screened for GDAP1 mutations using a targeted next-generation sequencing (NGS) gene-panel that comprised of 27 CMT genes. Two novel compound heterozygous amino acid changing variants were identified in the GDAP1 gene, c.246C>G p.His82Gln in exon 2 and c.614T>G p.Leu205Trp in exon 5. The two amino acid changing variants were not previously reported in the 1000 Genome, Mutation Taster and gnomAD. Our findings expand the phenotypic characterization of the two novel heterozygous mutations associated with CMT4A (AR-CMT1A) and add to the repertoire of GDAP1 mutations related to autosomal recessive CMT in Chinese populations.
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Affiliation(s)
- Huiqin Xue
- Children's Hospital of Shanxi, Women Health Center of Shanxi, Affiliated Hospital of Shanxi Medical University, Taiyuan 030013, Shanxi, People's Republic of China
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Yu J, Clark DA, Sidhom D, Edmundson A, Solomon M. Anastomotic leak does not affect long-term and longitudinal functional outcomes after ileal pouch surgery for ulcerative colitis when managed aggressively. Tech Coloproctol 2020; 24:1285-1292. [PMID: 32856185 DOI: 10.1007/s10151-020-02331-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ileal pouch-anal anastomosis (IPAA) is an effective surgical alternative to a permanent ileostomy following proctocolectomy in patients with ulcerative colitis (UC). Anastomotic leakage (AL) is a serious postoperative complication of an intestinal anastomosis that is associated with increased morbidity and mortality. The aim of this study was to evaluate the longitudinal long-term functional outcomes of patients who had IPAA that was complicated by AL. METHODS A retrospective longitudinal cohort study was performed of patients who had an IPAA procedure at a tertiary referral centre and a metropolitan private centre in Australia, over a 14-year period (October 2003-October 2017). The long-term functional outcome was assessed using objective clinical measures such as the number of bowel motions during the day and overnight, ability to defer defaecation and the presence of faecal incontinence, and repeated at annual intervals. RESULTS A total of 138 patients [mean age 38.5 (± 16.9) years, 72 males] satisfied the inclusion criteria. AL was diagnosed in 14 (10%) patients [mean age 38.8 (± 17) years, 10 males], 11 (79%) of which were managed with surgery. The median bowel motion frequency during the day and overnight remained stable over a median of 62 (28-91) months follow-up, with no significant difference between those who had AL or not (p = 0.6, p = 0.1 respectively). The incidence of faecal incontinence remained low, and the majority of patients in both groups were able to defer defaecation for more than 60 min. Six patients (4.3%) had their pouch excised. CONCLUSIONS There is no statistical difference in longitudinal function between patients who experienced AL after IPAA surgery for UC compared with those who did not. Therefore, an acute AL does not negatively impact long-term functional outcomes in IPAA patients.
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Affiliation(s)
- J Yu
- Royal Brisbane and Women's Hospital, Herston Road, Brisbane, QLD, 4066, Australia.,University of Qld, St Lucia, Brisbane, QLD, 4072, Australia
| | - D A Clark
- Royal Brisbane and Women's Hospital, Herston Road, Brisbane, QLD, 4066, Australia. .,Faculty of Medicine and Health, Surgical Outcomes Research Centre (SOuRCe), University of Sydney, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia. .,University of Qld, St Lucia, Brisbane, QLD, 4072, Australia. .,St Vincent's Private Hospital Northside, 627 Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
| | - D Sidhom
- Royal Brisbane and Women's Hospital, Herston Road, Brisbane, QLD, 4066, Australia
| | - A Edmundson
- Royal Brisbane and Women's Hospital, Herston Road, Brisbane, QLD, 4066, Australia.,University of Qld, St Lucia, Brisbane, QLD, 4072, Australia
| | - M Solomon
- Faculty of Medicine and Health, Surgical Outcomes Research Centre (SOuRCe), University of Sydney, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
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7
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Zheng T, Finn C, Parrett CJ, Dhume K, Hwang JH, Sidhom D, Strutt TM, Li Sip YY, McKinstry KK, Huo Q. A Rapid Blood Test To Determine the Active Status and Duration of Acute Viral Infection. ACS Infect Dis 2017; 3:866-873. [PMID: 28918638 DOI: 10.1021/acsinfecdis.7b00137] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The ability to rapidly detect and diagnose acute viral infections is crucial for infectious disease control and management. Serology testing for the presence of virus-elicited antibodies in blood is one of the methods used commonly for clinical diagnosis of viral infections. However, standard serology-based tests have a significant limitation: they cannot easily distinguish active from past, historical infections. As a result, it is difficult to determine whether a patient is currently infected with a virus or not, and on an optimal course of action, based off of positive serology testing responses. Here, we report a nanoparticle-enabled blood test that can help overcome this major challenge. The new test is based on the analysis of virus-elicited immunoglobulin G (IgG) antibody present in the protein corona of a gold nanoparticle surface upon mixing the gold nanoparticles with blood sera. Studies conducted on mouse models of influenza A virus infection show that the test gives positive responses only in the presence of a recent acute viral infection, approximately between day 14 and day 21 following the infection, and becomes negative thereafter. When used together with the traditional serology testing, the nanoparticle test can determine clearly whether a positive serology response is due to a recent or historical viral infection. This new blood test can provide critical clinical information needed to optimize further treatment and/or to determine if further quarantining should be continued.
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Affiliation(s)
- Tianyu Zheng
- Department
of Chemistry and NanoScience Technology Center, University of Central Florida, 12424 Research Parkway Suite 400, Orlando, Florida 32826, United States
| | - Caroline Finn
- Burnett
School of Biomedical Science, Division of Immunity and Pathogenesis,
College of Medicine, University of Central Florida, 6900 Lake Nona
Blvd., Orlando, Florida 32827, United States
| | - Christopher J. Parrett
- Burnett
School of Biomedical Science, Division of Immunity and Pathogenesis,
College of Medicine, University of Central Florida, 6900 Lake Nona
Blvd., Orlando, Florida 32827, United States
| | - Kunal Dhume
- Burnett
School of Biomedical Science, Division of Immunity and Pathogenesis,
College of Medicine, University of Central Florida, 6900 Lake Nona
Blvd., Orlando, Florida 32827, United States
| | - Ji Hae Hwang
- Burnett
School of Biomedical Science, Division of Immunity and Pathogenesis,
College of Medicine, University of Central Florida, 6900 Lake Nona
Blvd., Orlando, Florida 32827, United States
| | - David Sidhom
- Burnett
School of Biomedical Science, Division of Immunity and Pathogenesis,
College of Medicine, University of Central Florida, 6900 Lake Nona
Blvd., Orlando, Florida 32827, United States
| | - Tara M. Strutt
- Burnett
School of Biomedical Science, Division of Immunity and Pathogenesis,
College of Medicine, University of Central Florida, 6900 Lake Nona
Blvd., Orlando, Florida 32827, United States
| | - Yuen Yee Li Sip
- Burnett
School of Biomedical Science, Division of Immunity and Pathogenesis,
College of Medicine, University of Central Florida, 6900 Lake Nona
Blvd., Orlando, Florida 32827, United States
| | - Karl K. McKinstry
- Burnett
School of Biomedical Science, Division of Immunity and Pathogenesis,
College of Medicine, University of Central Florida, 6900 Lake Nona
Blvd., Orlando, Florida 32827, United States
| | - Qun Huo
- Department
of Chemistry and NanoScience Technology Center, University of Central Florida, 12424 Research Parkway Suite 400, Orlando, Florida 32826, United States
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Sidhom D, Scalia G. The Role of ePLAR in Determining Patient Suitability and Response to Vasodilator Therapy in Pulmonary Hypertension. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.050] [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: 10/21/2022]
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