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Almhanni G, Sen I, Vang S, Marczak S, Herzog K, Twesme M, Ryba M, Krueger G, Jack R, Beckermann J, Carmody T, Tallarita T. Midterm outcomes of endoscopic-assisted brachial-basilic arteriovenous fistula creation. J Vasc Surg Cases Innov Tech 2024; 10:101382. [PMID: 38313381 PMCID: PMC10835459 DOI: 10.1016/j.jvscit.2023.101382] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/08/2023] [Indexed: 02/06/2024] Open
Abstract
Endoscopic vein harvest remains underused in single-stage brachial-basilic arteriovenous fistula creation. We analyzed our results with the use of this technique in a cohort of predominantly obese (body mass index ≥30 kg/m2) patients. Demographics, intraoperative details, and outcomes for all consecutive patients who underwent single-stage endoscopic-assisted brachial-basilic arteriovenous fistula creation between 2020 and 2022 at a single institute were analyzed retrospectively. The primary outcomes were technical success, fistula maturation, and primary assisted and secondary patency rates. Of the 11 patients (7 men; mean age, 62 ± 11.6 years), 7 (64%) already required dialysis at referral. The mean body mass index was 34 ± 7 kg/m2, 64% were obese, and an additional 27% were overweight. The medical comorbidities included hypertension in 11 patients (100%), diabetes in 7 (64%), and smoking in 8 (73%). Technical success was 100%, with no intraoperative complications. The median procedural length was 231 minutes (range, 183-302 minutes). Early complications in two patients (18%) included bleeding of the venous side branch requiring ligation and the loss of thrill requiring division of a tethering bridge of a large tributary. The maturation rate was 100%, and the brachial-basilic arteriovenous fistula was successfully accessed in all patients who required dialysis. At 12 months, the primary assisted and secondary patency rates were 90% ± 10% and 100%, respectively. Reintervention in seven patients (64%) included successful angioplasty in four, thrombectomy in two, and aneurysm resection with an interposition graft in one patient. Endoscopic vein harvest can be used for single-stage brachial-basilic arteriovenous fistula creation with good technical success and favorable maturation and patency rates, even for obese patients.
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Affiliation(s)
- Ghaith Almhanni
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Indrani Sen
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Sai Vang
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Shaun Marczak
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Kirk Herzog
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Mark Twesme
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Matthew Ryba
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Gloria Krueger
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Rachel Jack
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Jason Beckermann
- Department of General Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Thomas Carmody
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Tiziano Tallarita
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
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Dvir M, Almhanni G, Qaisar H, Calvin A, Tallarita T. When Occipital Artery Biopsy is Preferred to Temporal Biopsy for Giant Cell Arteritis: A Step-By-Step Description of the Surgical Technique. Mayo Clin Proc Innov Qual Outcomes 2024; 8:53-57. [PMID: 38283098 PMCID: PMC10818155 DOI: 10.1016/j.mayocpiqo.2023.12.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
Giant cell arteritis is an autoimmune disease that affects large and medium blood vessels of the head and neck. Its prompt treatment is mandatory to avoid severe and permanent complications, such as blindness. Temporal artery biopsy is an important part of the diagnostic work-up, especially in those patients with cranial symptoms or in the elderly with a fever of unknown origin. Most patients have signs and symptoms matching the distribution of their arterial involvement. In the case scenario of occipital headache or nuchal pain, a biopsy of the occipital artery may be preferred to a temporal artery biopsy. This article provides important anatomical details of the course of the occipital artery and explains, in a stepwise fashion, how to perform an occipital artery biopsy.
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Affiliation(s)
- May Dvir
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
- University Cattolica del Sacro Cuore, Rome, Italy
| | - Ghaith Almhanni
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
| | - Huzaif Qaisar
- Department of Rheumatology, Mayo Clinic Health System, LaCrosse, WI
| | - Andrew Calvin
- Department of Cardiology, Mayo Clinic Health System, Eau Claire WI
| | - Tiziano Tallarita
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI
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Kouli M, Al Houri HN, Jomaa S, Issa A, Arrouk DMN, Alhouri A, Almhanni G, Alhouri AN, Wardeh R, Kouli M. Epidemiology of poisoning in Syria (1999 through 2020). Clin Toxicol (Phila) 2023; 61:116-122. [PMID: 36524826 DOI: 10.1080/15563650.2022.2156882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/23/2022]
Abstract
INTRODUCTION Acute poisoning is a significant international public health issue and one of the leading causes of death in the emergency department (ED). In the absence of any previous reports describing the poisoning profile in Syria, we present this study to assess the epidemiological and clinical characteristics of poisoning over 21 years. METHODS We collected the data retrospectively from the Syrian Poisons Information Centre (SPIC) from January 1999 until December 2020. The data included patients who had accidental or non-accidental exposure to poisons, either by drugs, medicaments, and biological substances or substances chiefly nonmedicinal sources such as soaps and detergents, corrosive substances, pesticides, and other miscellaneous products. RESULTS We collected the data of 120,972 poisoned patients, of whom 52.6% were females, and 47.4% were males. Aleppo governorate reported the highest number of poisoned cases (28.6%), followed by Damascus governorate (19.9%). The highest poisoning rates were recorded in 2020, 2014, and 2010. Pharmaceutical (37.0%) and animal (33.8%) sources were the most common causative agents. The oral route was the route of poisoning in 58.3% of patients, and 33.4% through the skin. The most common poison was scorpion stings 19.5% while the most common cause of death was organophosphates 15.7%. DISCUSSION The differences in socioeconomic status, cultural habits, and agricultural and industrial activities between countries have led to a state of fluctuation regarding the most common poisoning agents. CONCLUSION Damascus and Aleppo, the two major governorates in Syria, had the highest poisoning cases. Oral administration of pharmaceutical agents was responsible for most of the poisoning cases. The most common individual poison was the scorpion poison, while the top killer was organophosphates.
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Affiliation(s)
- Moudar Kouli
- Doctor of Medicine M.D, Syrian Arab Republic Ministry of Health, Damascus, Syria
| | - Hasan Nabil Al Houri
- Internal Medicine Department, Damascus University, Al Assad University Hospital and Al Mouwasat University Hospital, Damascus, Syria
- Internal Medicine Department, Al-Sham Private University, Damascus, Syria
| | - Sami Jomaa
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Abdulmoez Issa
- Department of Radiology, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Abdullah Alhouri
- Division of Gastroenterology, Department of Medicine, Royal Berkshire Hospital, Reading, United Kingdom
| | - Ghaith Almhanni
- Department of Radiology, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Rahaf Wardeh
- Department of pediatrics, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Maher Kouli
- Head of Syrian Poison Information Center, Ministry of Health, Damascus, Syria
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Hamzeh A, Almhanni G, Aljaber Y, Alhasan R, Alhasan R, Alsamman MI, Alhalabi N, Haddeh Y. Awareness of diabetes and diabetic retinopathy among a group of diabetic patients in main public hospitals in Damascus, Syria during the Syrian crisis. BMC Health Serv Res 2019; 19:549. [PMID: 31382956 PMCID: PMC6683401 DOI: 10.1186/s12913-019-4375-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/28/2019] [Indexed: 12/03/2022] Open
Abstract
Background The awareness of diabetes mellitus (DM) and its complications, especially diabetic retinopathy (DR), is the key to reducing their burden. This study aimed to assess both the awareness of diabetic outpatients and their action towards periodic eye exam, and to determine the causes of non-compliance amongst patients who were aware. Because the Syrian Crisis affected all aspects of Syrians’ life, the study aimed to determine the crisis’ effects on patients’ care-seeking behavior. Our study was the first step in paving the way of prevention strategies. Methods This observational cross-section study was conducted on 260 patients with DM who were visiting the four main hospitals in the Syrian capital, Damascus between August and November 2017. Results The mean (±SD) age of participants was 54.3(±12.8) years. Females were more than half (56.2%). The majority were from areas outside Damascus (72.3%). The mean (±SD) DM duration was 10.6 (±7.1) years. Almost all patients (93.8%) thought that DM could affect the eye. 67.3% believed that it could cause blindness. 86.9% of the patients conceived that DM patients should visit an ophthalmologist regularly. 37% did not visit any ophthalmologists at all, while 63% reported they had visited their ophthalmologists. Only 21.5% had a regular eye exam. Gender, educational level, economic status, province, and family history of DM had statistically an insignificant relation with an ophthalmologist visit. The preponderance of the patients who haven’t visited regularly did not appreciate the necessity of regular eye exam. Diabetic neuropathy was the most common complication of DM that patients were aware of (92%) and suffered from (56.5%). Meanwhile, regarding the effects of the Syrian Crisis: 41.2% of diabetic patients had stopped their medications for at least one month, mainly because the drugs were unavailable (74.7% of them), as some drug companies had been destroyed. Half of the patients had struggled to reach a medical care center. Half of the patients had been displaced, two-third of them were from outside Damascus. Conclusion A screening program for DR should be initiated. Also, awareness about DM and its complications, especially DR, should be raised through doctors and media. Electronic supplementary material The online version of this article (10.1186/s12913-019-4375-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ammar Hamzeh
- Department of Ophthalmology, Al-Mouwassat University Hospital, Damascus, Syria. .,Faculty of Medicine, Damascus University, Damascus, Syria.
| | | | - Yazen Aljaber
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rana Alhasan
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Raneem Alhasan
- Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Nawras Alhalabi
- Department of Ophthalmology, Al-Mouwassat University Hospital, Damascus, Syria.,Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Yousra Haddeh
- Department of Ophthalmology, Al-Mouwassat University Hospital, Damascus, Syria.,Faculty of Medicine, Damascus University, Damascus, Syria
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