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Shah RS, Bachour S, Joseph A, Xiao H, Lyu R, Syed H, Li T, Pothula S, Vinaithirthan V, Ali AH, Contreras S, Hu JH, Barnes EL, Axelrad JE, Holubar SD, Regueiro M, Cohen BL, Click BH. Real-World Surgical and Endoscopic Recurrence Based on Risk Profiles and Prophylaxis Utilization in Postoperative Crohn's Disease. Clin Gastroenterol Hepatol 2024; 22:847-857.e12. [PMID: 37879523 DOI: 10.1016/j.cgh.2023.10.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND & AIMS Preoperative risk stratification may help guide prophylactic biologic utilization for the prevention of postoperative Crohn's disease (CD) recurrence; however, there are limited data exploring and validating proposed clinical risk factors. We aimed to explore the preoperative clinical risk profiles, quantify individual risk factors, and assess the impact of biologic prophylaxis on postoperative recurrence risk in a real-world cohort. METHODS In this multicenter retrospective analysis, patients with CD who underwent ileocolonic resection (ICR) from 2009 to 2020 were identified. High-risk (active smoking, ≥2 prior surgeries, penetrating disease, and/or perianal disease) and low-risk (nonsmokers and age >50 y) features were used to stratify patients. We assessed the risk of endoscopic (Rutgeert score, ≥i2b) and surgical recurrence by risk strata and biologic prophylaxis (≤90 days postoperatively) with logistic and time-to-event analyses. RESULTS A total of 1404 adult CD patients who underwent ICR were included. Of the high-risk factors, 2 or more ICRs (odds ratio [OR], 1.71; 95% CI, 1.13-2.57), active smoking (OR, 1.73; 95% CI, 1.17-2.53), penetrating disease (OR, 1.41; 95% CI, 1.02-1.94), and history of perianal disease alone (OR, 1.99; 95% CI, 1.42-2.79) were associated with surgical but not endoscopic recurrence. Surgical recurrence was lower in high-risk patients receiving prophylaxis vs not (10.2% vs 16.7%; P = .02), and endoscopic recurrence was lower in those receiving prophylaxis irrespective of risk strata (high-risk, 28.1% vs 37.4%; P = .03; and low-risk, 21.1% vs 38.3%; P = .002). CONCLUSIONS Clinical risk factors accurately illustrate patients at risk for surgical recurrence, but have limited utility in predicting endoscopic recurrence. Biologic prophylaxis may be of benefit irrespective of risk stratification and future studies should assess this.
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Affiliation(s)
- Ravi S Shah
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Salam Bachour
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Abel Joseph
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Huijun Xiao
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Ruishen Lyu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Hareem Syed
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Terry Li
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Shravya Pothula
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Adel Hajj Ali
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sussel Contreras
- Department of Gastroenterology and Hepatology, New York University, New York, New York
| | - Jessica H Hu
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina
| | - Jordan E Axelrad
- Department of Gastroenterology and Hepatology, New York University, New York, New York
| | - Stefan D Holubar
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Benjamin H Click
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Wendt S, Abdullah Z, Barrett S, Daruwalla C, Go JA, Le B, Li E, Livingston C, Miller M, Nakhleh L, Pecha J, Pothula S, Pradhan S, Sathappan V, Shah A, Sonuyi AM, Ugoh P, Wang Q, Weber N, Succar T, Blieden L, Mortensen P, Elkin Z, Sun G, Lee AG. A virtual COVID-19 ophthalmology rotation. Surv Ophthalmol 2021; 66:354-361. [PMID: 33058927 PMCID: PMC7550053 DOI: 10.1016/j.survophthal.2020.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/09/2022]
Abstract
The coronavirus (COVID-19) pandemic temporarily suspended medical student involvement in clinical rotations, resulting in the need to develop virtual clinical experiences. The cancellation of clinical ophthalmology electives and away rotations reduces opportunities for exposure to the field, to network with faculty, conduct research, and prepare for residency applications. We review the literature and discuss the impact and consequences of COVID-19 on undergraduate medical education with an emphasis on ophthalmic undergraduate medical education. We also discuss innovative learning modalities used from medical schools around the world during the COVID-19 pandemic such as virtual didactics, online cases, and telehealth. Finally, we describe a novel, virtual neuro-ophthalmology elective created to educate medical students on neuro-ophthalmology foundational principles, provide research and presentation opportunities, and build relationships with faculty members. These innovative approaches represent a step forward in further improving medical education in ophthalmology during COVID-19 pandemic and beyond.
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Affiliation(s)
| | | | | | | | | | - Brandon Le
- Baylor College of Medicine, Houston, Texas, USA
| | - Elijah Li
- Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | | | | | | | | | - Alay Shah
- Baylor College of Medicine, Houston, Texas, USA
| | | | - Peter Ugoh
- Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Tony Succar
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Save Sight Institute, Discipline of Ophthalmology, The University of Sydney, Sydney, Australia
| | - Lauren Blieden
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Mortensen
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Zachary Elkin
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - Grace Sun
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA; Departments of Neurology, Neurosurgery, and Ophthalmology, Weill Cornell Medicine, New York, New York, USA; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA; Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Ophthalmology, Texas A&M University College of Medicine, Houston, Texas, USA; Baylor College of Medicine and the Center for Space Medicine, Houston, Texas, USA; University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; University of Buffalo, Buffalo, New York, USA.
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Acosta H, Viafara LM, Hanif N, Acosta S, Pagadala M, Acosta B, Pothula S, Peckosh C, Bear J, Alzate S, Ballesteros H, De Las Salas A, Martin T, Doepke M. A Novel and Practical Method of Performing Atrioventricular Nodal Ablation via a Superior Approach in Patients with Refractory Atrial Fibrillation Undergoing Cardiac Resynchronization Device Implantation. J Innov Card Rhythm Manag 2019; 10:3924-3928. [PMID: 32477714 PMCID: PMC7252731 DOI: 10.19102/icrm.2019.101201] [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: 01/11/2019] [Accepted: 05/20/2019] [Indexed: 11/06/2022] Open
Abstract
Atrioventricular node (AVN) ablation is a strategy to manage patients with drug-refractory atrial fibrillation (AF) and heart failure in whom cardiac resynchronization therapy (CRT) device implantation has been prescribed. This study describes a practical method to perform these two procedures using the same surgical site. Twenty-seven patients were indicated for AVN ablation and concurrent CRT device implantation while presenting with AF and rapid ventricular response (RVR) refractory to medical therapy. After placement of the right and left ventricular leads, a third puncture was made in the axillary vein to obtain access to perform the ablation. After hand-injecting contrast media through a RAMP™ (Abbott Laboratories, Chicago, IL, USA) sheath positioned in the right atrial cavity, the anatomical area corresponding to the AVN was identified using fluoroscopy cine runs obtained in the right anterior oblique and left anterior oblique projections. The adequate site for ablation was confirmed by the bipolar recording of a His-bundle deflection at the tip of the ablation catheter. Radiofrequency energy was delivered to achieve complete heart block. Subsequently, device implant was completed. The method was successfully applied in 27 consecutive cases, achieving permanent complete heart block in all patients. The mean radiofrequency time to achieve heart block was 110 seconds ± 43 seconds. The average procedural time including AVN ablation and device implant was 87 minutes ± 21 minutes. The images obtained with the hand-injected contrast media provided adequate information to readily identify the anatomical area corresponding to the AVN with 100% accuracy. This study suggests that ablation of the AVN can be safely and effectively accomplished via a superior approach in patients undergoing a CRT device implant.
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Affiliation(s)
- Helbert Acosta
- Trinity Medical Center, Rock Island, IL, USA.,Cardiovascular Medicine, P.C., Moline, IL, USA
| | | | | | | | | | | | | | | | - Julie Bear
- Trinity Medical Center, Rock Island, IL, USA
| | | | | | | | - Toni Martin
- Trinity Medical Center, Rock Island, IL, USA
| | - Matthew Doepke
- Trinity Medical Center, Rock Island, IL, USA.,Abbott Laboratories, Chicago, IL, USA
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Acosta H, Viafara LM, Izquierdo D, Pothula VR, Bear J, Pothula S, Antonio-Drabeck C, Lee K. Atrial lead placement at the lower atrial septum: a potential strategy to reduce unnecessary right ventricular pacing. Europace 2012; 14:1311-6. [DOI: 10.1093/europace/eus043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pothula S, Sanchala VT, Inchiosa MA, Pack E, Kamaly A. COMPARISON OF STANDARD COAGULATION TESTS WITH ASSESSMENT OF CLOTTING BY LEE-WHITE COAGULATION TIME. Anesth Analg 1995. [DOI: 10.1213/00000539-199504001-00137] [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: 11/05/2022]
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Ediale KR, Pothula S, Kumar V, Inchiosa MA. CHANGES IN RADIAL-AORTIC PRESSURE GRADIENTS, SYSTEMIC VASCULAR RESISTANCE AND CARDIAC INDEX FOLLOWING CARDIO-PULMONARY BYPASS. Anesth Analg 1995. [DOI: 10.1213/00000539-199504001-00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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