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Pordal A, Guerra JD, Morin D, Oppat W, Jacobs MJ, Patil S. Temporal and institutional trends in robotic surgery. J Robot Surg 2024; 18:191. [PMID: 38693330 DOI: 10.1007/s11701-024-01914-w] [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: 02/07/2023] [Accepted: 05/21/2023] [Indexed: 05/03/2024]
Abstract
Robotic surgery has become increasingly prevalent in general surgery practice. While previous studies have shown the safety and efficacy of robotic assistance in laparoscopic general surgery procedures, few studies have evaluated the temporal and regional trends in implementation. In our retrospective population-based study, we aim to evaluate the national trends in robotic surgery. National Inpatient Database (NIS 2009-2014) was used to identify adults who underwent robotic assisted surgery (ICD 9 codes 17.41 to 17.49). Robotic procedures related to seven abdominal organ systems were compared against the trends of Urology, Gynaecologic, and Orthopedic robotic procedures. Discharge weights were applied to calculate National temporal trends separated by hospital size, teaching status and US geographic region. 894,163 patients received a robotic assisted procedure between 2009 and 2014 with 64% increase in utilization. The largest percent change was witnessed in biliary robotic procedures with 2984% change in utilization, followed by hernia (1376%). Lowest percent change was witnessed in esophageal procedures with 114% increase. Medium sized hospitals had the largest change in robotic utilization (41%), with large institutions seeing 18% decrease. Gastric procedures were the most common robotic procedure performed at small institutions (7917 total cases; 316%). Large institutions saw an overall decrease in gastric (- 47%), esophageal (- 17%), small and large intestinal (-16%), and hepatic (- 7%) robotic procedures. Rural non-teaching hospitals saw the largest increase in robotic surgery (274%). Urban non-teaching hospitals saw a decrease of 29%. While urban teaching institutions saw a 20% and 6% increase in gynecological and urological procedures, an overall decrease was seen in esophageal (- 10%), gastric (- 12%), intestinal (- 11%), hepatic (- 17%), biliary (- 10%), pancreatic (- 11%) and hernia procedures (- 14%). Biliary procedures saw the largest increase in rural institutions (740 cases; 392%), followed by hernia (144% increase). South region of the nation had the largest increase in robotic procedures (23%). No change was seen in the use of robotic surgery in the northeast region with the midwest and west seeing an overall decrease (- 4% and - 22%, respectively). Our study highlights the increase in use of robotics for both general and specialty surgery, with an increase in utilization over time. Increased incidence of robotic surgery in smaller, rural institutions with overall decrease in larger, urban teaching hospitals suggests increasing comfort in robotic surgery in the community setting. Further studies are necessary to evaluate the factors associated with increased utilization in smaller institutions.
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Affiliation(s)
- A Pordal
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA
| | - J D Guerra
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA
| | - D Morin
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA
| | - W Oppat
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA
| | - M J Jacobs
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA
| | - S Patil
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA.
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Refaeian A, Vest EL, Schmidt M, Guerra JD, Refaei MN, Refaeian M, Floresca RA, Refaeian M. Ciprofloxacin-Induced Peripheral Neuropathy: A Case Report. HCA Healthc J Med 2023; 4:383-387. [PMID: 37969850 PMCID: PMC10635701 DOI: 10.36518/2689-0216.1400] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Introduction Fluoroquinolones, a class of antibiotics, are commonly employed in the treatment of a wide array of bacterial infections. Recognized for their effectiveness against a broad spectrum of pathogens, fluoroquinolones have played a pivotal role in managing conditions like urinary tract infections and respiratory diseases. Nevertheless, their usage is not without contention due to their association with a variety of adverse effects, including tendon rupture and the less frequently reported issue of peripheral neuropathy. Case Presentation We present the case of a 42-year-old male who developed peripheral neuropathy several days after completing a 10-day course of ciprofloxacin for gastroenteritis. The patient's presenting complaint was bilateral upper and lower extremity weakness for which inpatient treatment was initiated and workup for other causes was negative. Nerve conduction studies (NCS) and electromyography (EMG) demonstrated peripheral neuropathy. The patient was treated with intravenous immunoglobulin (IVIG), steroids, and physical therapy. Followup NCS and EMG showed continued neuropathy but with significant improvement. Conclusion The case aligns with existing research, demonstrating that fluoroquinolone use is linked to peripheral neuropathy, particularly axonal polyneuropathy, and emphasizes the importance of investigating the underlying mechanism for improved therapeutic strategies. The potential combination of intravenous immunoglobulin and physical therapy has exhibited promising results.
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Affiliation(s)
| | - Eric L Vest
- Texas Tech University Health Sciences Center El Paso, TX
| | | | - Jorge D Guerra
- Texas Tech University Health Sciences Center El Paso, TX
| | - Mohd N Refaei
- Eastside Rehabilitation Medicine and Pain Clinic, El Paso, TX
| | | | | | - Manouchehr Refaeian
- Texas Tech University Health Sciences Center El Paso, TX
- Las Palmas Medical Center, El Paso, TX
- Eastside Rehabilitation Medicine and Pain Clinic, El Paso, TX
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Guerra JD, De Santiago AB, Reed S, Hammonds KP, Shaver C, Widmer RJ, Scholz BA. Cardiology co-management of rheumatoid arthritis patients with coronary artery disease as an intervention reduces hospitalization rates and adverse event occurrence. Clin Rheumatol 2022; 41:3715-3724. [PMID: 35974225 PMCID: PMC9381150 DOI: 10.1007/s10067-022-06335-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/21/2022] [Accepted: 08/09/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a systemic autoimmune disease with important cardiovascular (CV) implications. CV disease represents over half of RA patient deaths and causes significant morbidity. CV manifestations in RA can be complex, raising concerns for adequate patient management and provider-dependent roles. METHODS This is a retrospective study of patients diagnosed with RA and coronary artery disease (CAD). Patients were identified and filtered via EPIC Database search engine. Parameters were set from January 1, 2014, to December 31, 2020. Inclusion criteria consisted of patients who met diagnostic criteria for both RA and CAD. A total of 399 patients met criteria. RESULTS Of the 399 identified patients, 272 were female (68.2%) and 127 were male (31.8%) with a median age of 73 (range 26-98). The population was further divided into two groups: those with established cardiology care versus those without. Patients without cardiology follow-up experienced significantly more hospitalizations (RR 1.63 95% CI 1.12, 2.38), higher rates of adverse events including myocardial infarction (MI) (RR 4.82 95% CI 1.94, 11.98), heart failure (HF) (OR 15.81 95% CI 3.54, 70.52), and stroke (RR 2.55 95% CI 1.29, 5.03). Patients not followed by cardiology also had numerical increases in CV death (4 deaths compared to none in those with cardiology follow) and all-cause mortality (HR 1.03 95% CI 0.63, 1.67). CONCLUSION Patients with regular cardiology follow-up demonstrated fewer cardiac-related adverse events. This suggests that co-management may have a role in adverse cardiac event risk reduction and should therefore be an early consideration. Key Points • Rheumatoid arthritis patients demonstrate higher rates of coronary disease compared to the general population. Traditional cardiac risk factors may not be entirely responsible for this phenomenon • Hospitalization rates and adverse event occurrence are significantly higher in patients with single-provider care (rheumatology only) compared to dual provider care (rheumatology and cardiology) • Cardiology co-management should be an early consideration in the management of RA patients • Early screening, risk stratification of coronary disease, and utilization of appropriate treatment algorithms are important to decrease morbidity and mortality.
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Affiliation(s)
- Jorge D Guerra
- Department of Internal Medicine, Baylor Scott & White Medical Center, Texas A&M University College of Medicine, St, MS 01 161B, Temple, TX, 2401 S 3176508, USA.
| | - Andres Belmont De Santiago
- Department of Internal Medicine, Baylor Scott & White Medical Center, Texas A&M University College of Medicine, St, MS 01 161B, Temple, TX, 2401 S 3176508, USA
| | - Shirley Reed
- Department of Internal Medicine, Baylor Scott & White Medical Center, Texas A&M University College of Medicine, St, MS 01 161B, Temple, TX, 2401 S 3176508, USA
| | - Kendall P Hammonds
- Baylor Scott & White Research Institute, Baylor Scott & White Medical Center, Texas A&M University College of Medicine, Temple, TX, USA
| | - Courtney Shaver
- Baylor Scott & White Research Institute, Baylor Scott & White Medical Center, Texas A&M University College of Medicine, Temple, TX, USA
| | - Robert J Widmer
- Department of Cardiovascular Disease, Baylor Scott & White Medical Center, Texas A&M University College of Medicine, Temple, TX, USA
| | - Beth A Scholz
- Department of Rheumatology, Baylor Scott & White Medical Center, Texas A&M University College of Medicine, Temple, TX, USA
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Luu QH, Guerra JD, Castañeda CM, Martinez MA, Saunders J, Garcia BA, Gonzales BV, Aidunuthula AR, Mito S. Ultrasound assisted one-pot synthesis of benzo-fused indole-4, 9-dinones from 1,4-naphthoquinone and α-aminoacetals. Tetrahedron Lett 2016; 57:2253-2256. [PMID: 34054151 DOI: 10.1016/j.tetlet.2016.04.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/16/2022]
Abstract
A one-pot synthesis of benzo[f]indole-4,9-diones from 1,4-naphthoquinone with α-aminoacetals has been developed. This method provides a straightforward synthesis of benzo[f]indole-4,9-diones via intramolecular nucleophilic attack of aminoquinones to aldehydes under mild reaction conditions. The detailed mechanism was also investigated.
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Affiliation(s)
- Quang H Luu
- Department of Chemistry, The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Jorge D Guerra
- Department of Chemistry, The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Cecilio M Castañeda
- Department of Chemistry, The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Manuel A Martinez
- Department of Chemistry, The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Jong Saunders
- Department of Chemistry, The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Benjamin A Garcia
- Department of Chemistry, The University of Texas Rio Grande Valley, Edinburg, TX 78539, USA
| | - Brenda V Gonzales
- Department of Chemistry, The University of Texas Rio Grande Valley, Edinburg, TX 78539, USA
| | | | - Shizue Mito
- Department of Chemistry, The University of Texas at El Paso, El Paso, TX 79968, USA.,Department of Chemistry, The University of Texas Rio Grande Valley, Edinburg, TX 78539, USA
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