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Rudy HL, Shamamian P, Grande J, Wang F, Lu YH, Ricci JA. Hemostatic Agents Do Not Significantly Affect Seroma Formation in Abdominal Body Contouring. Aesthetic Plast Surg 2024; 48:1395-1402. [PMID: 37949979 DOI: 10.1007/s00266-023-03748-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Objective: Seroma formation is plaguing complication in abdominal body contouring surgery (ABCS) that has been loosely associated with the use of intraoperative hemostatic agents. The aim of this study was to investigate the association between hemostatic agent usage and seroma development following ABCS. METHODS A retrospective review of patients undergoing ABCS between 2010 and 2020 was completed. Cases who received hemostatic agents were matched to controls (1:2) based on potential confounders including age, BMI, and ASA score. Demographic data, operative details, and postoperative complications including development of seroma, hematoma, venous thromboembolism, wound dehiscence, and delayed wound healing were collected. RESULTS Seven hundred and seven patients were included in the study. Sixty-five patients (9.2%) received at least one hemostatic agent. The most used agents were topical thrombin (n = 33, 50.1%), dry matrices including oxidized cellulose, microporous polysaccharides, and absorbable gelatin matrices (n = 15, 23.1%) followed by combination fibrin sealant/thrombin preparations (n = 9, 14.0%). No significant differences with respect to demographic data or medical comorbidities between the cases and controls were identified. Bivariate analysis demonstrated no significant differences in the rate of development of seroma (OR: 0.83, 95% confidence interval [CI] = 0.23-1.99, p = 0.781), hematoma (OR: 3.72, 95% confidence interval [CI] = 0.95-14.65, p = 0.060), venous thromboembolism (OR: 0.40, 95% confidence interval [CI] = 0.44-3.81, p = 0.433). CONCLUSION Hemostatic agent use, regardless of type, does not significantly affect the risk of seroma, hematoma, and venous thromboembolism development, nor does it influence the rates of delayed wound healing or wound dehiscence. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Hayeem L Rudy
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter Shamamian
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Julia Grande
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fei Wang
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yi-Hsueh Lu
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joseph A Ricci
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Surgery, Northwell Health, 600 Northern Blvd, Suite 309, Great Neck, NY, 11021, USA.
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Salari N, Fatahi B, Bartina Y, Kazeminia M, Heydari M, Mohammadi M, Hemmati M, Shohaimi S. The Global Prevalence of Seroma After Abdominoplasty: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021; 45:2821-2836. [PMID: 34080041 DOI: 10.1007/s00266-021-02365-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abdominoplasty is one of the most common cosmetic surgeries performed worldwide. Seroma is also the most common local complication associated with abdominoplasty, which increases care costs, reduces patient satisfaction, and has serious complications for patients. Results of previous studies report different levels of seroma prevalence after abdominoplasty. The aim of this study is to standardize the statistics of the prevalence of seroma after abdominoplasty using meta-analysis. METHODS In this systematic review and meta-analysis study, data from studies conducted on the global prevalence of seroma after abdominoplasty was extracted using the keywords "Prevalence, Epidemiology, Complications, Abdominoplasty, Seroma, and Lipo abdominoplasty" in the databases of Science, Scientific Information Database, MagIran, Embase, Scopus, PubMed, Web of Science, and Google Scholar search engine without time limit until October 2020. The random-effects model was used to analyze the eligible studies, and the heterogeneity of the studies was investigated with the I2 index. Data analysis was performed using Comprehensive Meta-Analysis software (Version 2). RESULTS In reviewing 143 studies (five studies related to Asia, 55 studies related to Europe, three studies related to Africa, and 80 studies related to the Americas) with a total sample size of 27834 individuals, the global prevalence of seroma after abdominoplasty was obtained as 10.9% (95% CI: 9.3-3.6.6%) and the highest prevalence of seroma was related to the Europe continent with 12.8% (95% CI: 10.15-3.9%). The results from meta-regression showed a declining trend in the global prevalence of seroma after abdominoplasty with an increase in the sample size, age of study participants, and the year of study (p < 0.05). CONCLUSIONS This study shows that the prevalence of seroma after abdominoplasty is high globally. Therefore, physicians and specialists must consider its importance and take the controlling and treatment measures seriously. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behnaz Fatahi
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yalda Bartina
- Department of Translation Studies, Faculty of Literature, Istanbul University, Istanbul, Turkey
| | - Mohsen Kazeminia
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Heydari
- Department of General Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mahvan Hemmati
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
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Wigbers FM, Woitalla-Bruning J, Bruning G. Therapie postoperativer Serome nach inguinaler Crossektomie durch offene Revision in Kombination mit einem 2-Schicht-Verband. J Dtsch Dermatol Ges 2021; 19:1367-1370. [PMID: 34541799 DOI: 10.1111/ddg.14529_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Guido Bruning
- Zentrum für Venen- und Dermatochirurgie, Krankenhaus Tabea GmbH & Co. KG, Hamburg
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Local Triamcinolone Treatment Affects Inflammatory Response in Seroma Exudate of Abdominoplasty Patients: A Randomized Controlled Trial. Plast Reconstr Surg 2021; 147:345-354. [PMID: 33565825 DOI: 10.1097/prs.0000000000007523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As the leading complication of abdominoplasty, seroma formation might represent an inflammatory process in response to surgical trauma. This prospective randomized trial investigated whether local administration of the antiinflammatory agent triamcinolone could prevent seroma accumulation. METHODS Weekly and cumulative seroma volumes were compared between the study groups A, B, and C over a 4-week follow-up (group A, with drain, without triamcinolone; group B, without drain, without triamcinolone; group C, without drain, with triamcinolone). Aspirated seroma samples were analyzed by enzyme-linked immunosorbent assay for selective inflammatory mediators. RESULTS Triamcinolone significantly reduced cumulative seroma volume (n = 60; mA 845 ± SDA 578 ml, mC 236 ± SDC 381 ml, p = 0.001). The most accentuated suppressive effect of triamcinolone was observed shortly after the treatment (week 1) (mA1 616 ± SDA1 457 ml, mB1 153 ± SDB1 161 ml, mC1 22 ± SDC1 44 ml, pA1/C1 < 0.001, pB1/C1 = 0.014). Local triamcinolone administration resulted in a differential concentration of interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9 (week 1) in seroma exudate as measured by enzyme-linked immunosorbent assay (mIL-6A1 1239 ± SDA1 59 pg/ml, mIL-6C1 848 ± SDC1 80 pg/ml, p < 0.001; mMMP-9A1 2343 ± SDA1 484 pg/ml, mMMP-9C1 376 ± SDC1 120 pg/ml, p = 0.001). CONCLUSIONS Local administration of 80 mg of triamcinolone reduced postabdominoplasty seroma accumulation significantly. Under triamcinolone treatment, suppressed levels of IL-6 and MMP-9 in seroma fluid were observed. Notably, inflammatory marker suppression correlated clinically with a decrease in seroma accumulation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Wigbers FM, Woitalla-Bruning J, Bruning G. Open revision in combination with a 2-layer dressing for therapy of postoperative seroma after inguinal crossectomy. J Dtsch Dermatol Ges 2021; 19:1367-1369. [PMID: 34164918 DOI: 10.1111/ddg.14529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Guido Bruning
- Zentrum für Venen- und Dermatochirurgie, Krankenhaus Tabea GmbH & Co. KG, Hamburg
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Janis JE, Jefferson RC, Kraft CT. Panniculectomy: Practical Pearls and Pitfalls. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3029. [PMID: 32983784 PMCID: PMC7489615 DOI: 10.1097/gox.0000000000003029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/08/2020] [Indexed: 02/03/2023]
Abstract
Panniculectomy is an increasingly common operation, given the current obesity epidemic and the increasing prevalence of bariatric surgery. At first glance, it could be considered a technically simple operation; however, this procedure can be fraught with complications, given the patient population and high demands placed on compromised abdominal tissue. Sufficient attention must be given to the nuances of patient optimization and surgical planning to maximize safe and ideal outcomes. We highlight our practical tips when performing standard or massive panniculectomy for preoperative optimization, intraoperative techniques, and postoperative management to reduce complication and maximize outcomes of this procedure from a surgeon's and a patient's perspective.
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Affiliation(s)
- Jeffrey E. Janis
- From the Ohio State University Wexner Medical Center, Department of Plastic Surgery, Columbus, Ohio
| | - Ryan C. Jefferson
- From the Ohio State University Wexner Medical Center, Department of Plastic Surgery, Columbus, Ohio
| | - Casey T. Kraft
- From the Ohio State University Wexner Medical Center, Department of Plastic Surgery, Columbus, Ohio
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Degovtsov EN, Kolyadko PV, Kolyadko VP. Using local hemostatic to prevent seromas in patients with large incisional hernias randomized controlled trial. Hernia 2020; 25:441-448. [PMID: 32556730 DOI: 10.1007/s10029-020-02251-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/12/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study is to compare the results of single-blind a randomized controlled trial on the use of the local hemostatic agent Haemoblock and ultrasound monitoring of postoperative wounds in patients after the large incisional hernias repair. METHODS The study represented a single-blind randomized controlled trial. The total number of patients was 66. Group with Haemoblock (A) and the Group without Haemoblock (B) included 33 patients each. Operation-sublay retromuscular repair with mesh prolene implant. We applied Haemoblock 15 ml retromuscularly and 15 ml subcutaneousely in group A. Wounds were drained by vacuum suction drainage. Postoperatively - ultrasound monitoring of postoperative wounds. RESULTS Median of follow-up was 33 days. Significant differences were obtained in the duration of wound draining, 2.6 ± 0.6 days in group A versus 4.1 ± 0.9 days in group B (p = 0.002). In group A, the levels of C-reactive protein and albumin were less in the separated discharge, as well as its total amount. During the first 12 days, a significantly lower volume of fluid collections was detected in patients of group A than in patients of group B. We noted a more rapid subsidence of exudative processes in postoperative wounds in patients from group A. The number of punctures was significantly higher in group B (0.8 ± 1.0 vs. 0.2 ± 0.4, respectively, p = 0.003). The total number of puncture interventions in group A was six in six patients, versus 27 in 14 patients in group B (p = 0.000). CONCLUSION The use of the local hemostatic agent Haemoblock can reduce the duration of the postoperative wound draining, shorten the period of inflammatory exudative processes in the postoperative wound, significantly reduce the number of puncture interventions for the postoperative wound, reduce the risk of the seromas formation and surgical site infections (SSI) associated with seroma, reduce the severity of pain and the need for analgesics.
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Affiliation(s)
- E N Degovtsov
- Head of the Department of Hospital Surgery Named After N.S. Makokhi, Russian Federation, Omsk State Medical University of the Ministry of Health of Russia, Lenin's st. 12., Omsk, 644099, Russia
| | - P V Kolyadko
- Head of the Department of Hospital Surgery Named After N.S. Makokhi, Russian Federation, Omsk State Medical University of the Ministry of Health of Russia, Lenin's st. 12., Omsk, 644099, Russia.
- Russian Federation, Nizhnevartovsk County Clinical Hospital, Lenin's st. 18, Khanty-Mansi Autonomous Area, Nizhnevartovsk, 628614, Russia.
| | - V P Kolyadko
- Russian Federation, Nizhnevartovsk County Clinical Hospital, Lenin's st. 18, Khanty-Mansi Autonomous Area, Nizhnevartovsk, 628614, Russia
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Giordano S, Kangas R, Veräjänkorva E, Koskivuo I. Ligasure impact™might reduce blood loss, complications, and re-operation occurrence after abdominoplasty in massive-weight-loss patients: A Comparative Study. Scand J Surg 2019; 109:151-158. [DOI: 10.1177/1457496919828237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims:The most effective dissection technique for raising the flap in abdominoplasty is still controversial, particularly in high-risk massive-weight-loss patients. LigaSure Impact™vessel-sealing system (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and implement outcomes. The aim of this study was to investigate the effectiveness of LigaSure Impact in abdominoplasty compared with the conventional techniques, diathermia.Material and Methods:Patients underwent primary abdominoplasty after massive weight loss at a single center from 1 January 2008 to 31 May 2015 and were retrospectively reviewed. A total of 94 patients eligible for the study were divided into two groups on basis of the dissection technique: LigaSure Impact group (29 patients) and the conventional technique group (65 patients). Total intraoperative blood loss was the primary endpoint. Duration of the operation, perioperative complications and re-operation were recorded as secondary endpoints.Results:Baseline characteristics were well balanced between the groups. Significant differences were found in intraoperative blood loss favoring LigaSure Impact group (259.6 ± 198.8 mL vs 377.9 ± 190.0 mL, p = 0.004) and blood transfusion rates (13.8% vs 35.4%, p = 0.047). In contrast, operative time was significantly longer in LigaSure Impact group (168.6 ± 121.2 vs 179.7 ± 57.6 min, p = 0.005), while a tendency to shorter hospital stay was found in LigaSure Impact group (3.6 ± 1.1 days vs 4.6 ± 3.2 days, p = 0.081). Overall complications occurrence, Clavien–Dindo grade II (24.1% vs 55.4%) and grade III (13.8% vs 30.8%) complications were significantly lower in LigaSure Impact group (respectively, p = 0.005, p = 0.007, p = 0.016). Late (>30 days) re-operation rate was significantly lower in the LigaSure Impact group (6.9% vs 27.70%, p = 0.0028). Specific wound complications showed no significant difference.Conclusion:LigaSure Impact vessel-sealing system may be beneficial in improving abdominoplasty outcomes in massive-weight-loss patients because it might reduce blood loss, need for transfusions, complications, and re-operations.
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Affiliation(s)
- S. Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
- The University of Turku, Turku, Finland
| | - R. Kangas
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- The University of Turku, Turku, Finland
| | - E. Veräjänkorva
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- The University of Turku, Turku, Finland
| | - I. Koskivuo
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- The University of Turku, Turku, Finland
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The use of adjuncts to reduce seroma in open incisional hernia repair: a systematic review. Hernia 2017; 22:273-283. [PMID: 29071497 DOI: 10.1007/s10029-017-1690-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/19/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Seroma formation remains a common complication after an incisional hernia repair. The use of surgical drains is widespread, but evidence for their use and other adjuncts is limited. Our aim was to perform a systematic review of the literature on techniques used to reduce the incidence of post-operative seroma formation. METHODS A systematic search of PubMed and Embase databases was conducted using terms including "incisional hernia" and "seroma". All studies on adults undergoing open incisional hernia repair with at least one intervention designed to reduce seroma formation were included. RESULTS Of the 1093 studies identified, 9 met the inclusion criteria. Medical talc: one cohort study of 74 patients undergoing talc application following pre-peritoneal mesh placement found a significantly decreased rate of seroma formation of 20.8 versus 2.7% (p < 0.001), but a retrospective study including 21 patients with onlay mesh found an increased rate of 76% seroma formation from 9.5% (p = 0.001). Fibrin glue: one comparative study including 60 patients found a reduction in seroma formation from 53 to 10% (p = 0.003), whereas a retrospective study of 250 patients found no difference (11 vs. 4.9% p = 0.07). Negative pressure wound therapy: four retrospective studies including a total of 358 patients found no difference in seroma outcome. Others: one randomised study of 42 patients undergoing either suction drainage or "quilting" sutures found no difference in seroma formation. CONCLUSIONS There is currently insufficient quality evidence to recommend any of the investigated methods, some of which incur significant additional cost.
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Sucupira E, Matta R, Zuker P, Matta J, Uebel CO. Inguinal Fold as a Closed-Suction Drain Exit Site in Abdominoplasty. Aesthetic Plast Surg 2015; 39:1022-4. [PMID: 26487656 DOI: 10.1007/s00266-015-0572-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Eduardo Sucupira
- General and Plastic Surgery Department, Santa Casa da Misericórdia Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renato Matta
- Plastic Surgery Department, São Lucas Hospital of PUC-RS, Porto Alegre, Brazil.
| | - Patrícia Zuker
- General and Plastic Surgery Department, Santa Casa da Misericórdia Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Matta
- Plastic Surgery Resident, Materno Infantil Perinatal Institute, Recife, Brazil
| | - Carlos O Uebel
- Plastic Surgery Department, São Lucas Hospital of PUC-RS, Porto Alegre, Brazil
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Poudel DR, Giri S, Pathak R, Morsey M, Alsafwah S. Late onset seroma post-thymectomy presenting as cardiac tamponade. J Community Hosp Intern Med Perspect 2015; 5:27459. [PMID: 26091658 PMCID: PMC4475261 DOI: 10.3402/jchimp.v5.27459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/17/2015] [Accepted: 04/21/2015] [Indexed: 11/14/2022] Open
Abstract
Late onset seroma is a rare post-operative complication occurring after various surgeries including thymectomy. Most cases are asymptomatic; however, seromas occurring in the mediastinal cavity may cause compression symptoms including airway compression or cardiac tamponade. We present a 62-year-old male with a history of thymectomy for myasthenia gravis who presented with cardiac tamponade several years ago. Further evaluation revealed a late onset seroma anteriorly compressing the cardiac chambers resulting in tamponade physiology.
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Affiliation(s)
- Dilli Ram Poudel
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Smith Giri
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA;
| | - Ranjan Pathak
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Mohamed Morsey
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shadwan Alsafwah
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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