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  1. Article ; Online: Should I start an SGLT-2 inhibitor in my patient with heart failure and chronic kidney disease?

    Sekerak, Richard / Lerner, Johanna Ben-Ami / Prasad, Pooja / Prasad, Megha

    Cleveland Clinic journal of medicine

    2023  Volume 90, Issue 10, Page(s) 607–609

    MeSH term(s) Humans ; Sodium-Glucose Transporter 2 Inhibitors/adverse effects ; Heart Failure/drug therapy ; Hypoglycemic Agents/pharmacology ; Renal Insufficiency, Chronic/complications ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy
    Chemical Substances Sodium-Glucose Transporter 2 Inhibitors ; Hypoglycemic Agents
    Language English
    Publishing date 2023-10-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639116-3
    ISSN 1939-2869 ; 0891-1150
    ISSN (online) 1939-2869
    ISSN 0891-1150
    DOI 10.3949/ccjm.90a.23004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Ua VI Zs.212: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  2. Article: Comparative outcome analysis of spinal anesthesia versus general anesthesia in lumbar fusion surgery.

    Sekerak, Richard / Mostafa, Evan / Morris, Matthew T / Nessim, Adam / Vira, Anjali / Sharan, Alok

    Journal of clinical orthopaedics and trauma

    2020  Volume 13, Page(s) 122–126

    Abstract: Introduction: Spinal anesthesia (SA) has been shown in several studies to be a viable alternative to general anesthesia (GA) in laminectomies, discectomies, and microdiscectomies. However, the use of SA in spinal fusion surgery has been very scarcely ... ...

    Abstract Introduction: Spinal anesthesia (SA) has been shown in several studies to be a viable alternative to general anesthesia (GA) in laminectomies, discectomies, and microdiscectomies. However, the use of SA in spinal fusion surgery has been very scarcely documented in the current literature. Here we present a comparison of SA to GA in lumbar fusion surgery in terms of perioperative outcomes and cost.
    Methods: The authors retrospectively reviewed the charts of all patients who underwent 1- or 2-level minimally invasive transforaminal lumbar interbody fusion (TLIF) surgery by a single surgeon, at a single institution, from 2015 to 2018. Data collected included demographics, operative and recovery times, nausea/vomiting, postoperative pain, and opioid requirement. Costs were included in the analysis if they were: 1) non-fixed; 2) incurred in the operating room (OR); and 3) directly related to patient care. All cost data represents net costs and was obtained from the hospital revenue cycle team. Patients were grouped for statistical analysis based on anesthetic modality.
    Results: A total of 29 patients received SA and 46 received GA. Both groups were similar in terms of age, gender, BMI, number of levels operated upon, preoperative diagnosis, and medical comorbidities. The SA group spent less time in the OR (163.86 ± 9.02 vs. 195.63 ± 11.27 min, p < 0.05), PACU (82.00 ± 7.17 vs. 102.98 ± 8.46 min, p < 0.05), and under anesthesia (175.03 ± 9.31 vs. 204.98 ± 10.15 min, p < 0.05) than the GA group. Post-surgery OR time was significantly less with SA than with GA (6.00 ± 1.09 vs. 17.26 ± 3.05 min, p < 0.05); however, pre-surgery OR time was similar between groups (50.17 ± 3.08 vs. 56.17 ± 5.34 min, p = 0.061). The SA group also experienced less maximum postoperative pain (3.31 ± 1.41 out of 10 vs. 5.96 ± 0.84/10, p < 0.05) and required less opioid analgesics (2.38 ± 1.37 vs. 5.39 ± 0.84 doses, p < 0.05). Both groups experienced similar nausea or vomiting rates and adverse events postoperatively. Net operative cost was found to be $812.31 (5.6%) less with SA than with GA, although this difference was not significant (p = 0.225).
    Discussion/conclusion: To our knowledge, SA is almost never used in lumbar fusion, and a cost-effectiveness comparison with GA has not been recorded. In this retrospective study, we demonstrate that the use of SA in lumbar fusion surgery leads to significantly shorter operative and recovery times, less postoperative pain and opioid usage, and slight cost savings over GA. Thus, we conclude that this anesthetic modality represents a safe and cost-effective alternative to GA in lumbar fusion.
    Language English
    Publishing date 2020-11-27
    Publishing country India
    Document type Journal Article
    ZDB-ID 2596956-0
    ISSN 2213-3445 ; 0976-5662
    ISSN (online) 2213-3445
    ISSN 0976-5662
    DOI 10.1016/j.jcot.2020.11.017
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Infra-adjacent Segment Disease After Lumbar Fusion: An Analysis of Pelvic Parameters.

    Nessim, Adam / Cho, Woojin / Yang, Xiuyi Alexander / Applebaum, Ariella / Sekerak, Richard / Brill, Sam / Kim, Soo Yeon

    Spine

    2021  Volume 46, Issue 16, Page(s) E888–E892

    Abstract: Study design: Cross-sectional observational cohort study.: Objective: The aim of this study was to determine the incidence and risk factors associated with the development of sacroiliac joint (SIJ) dysfunction following lumbosacral fusion.: Summary ...

    Abstract Study design: Cross-sectional observational cohort study.
    Objective: The aim of this study was to determine the incidence and risk factors associated with the development of sacroiliac joint (SIJ) dysfunction following lumbosacral fusion.
    Summary of background data: Adjacent segment degeneration to both proximal and distal areas of spinal fusion is a postoperative complication of lumbar fusion. Various studies examined supra-adjacent degeneration following lumbar fusion, but few focused on infra-adjacent degeneration. In lumbosacral fusion, fusion extends to the sacrum, placing increased stress on the SIJ.
    Methods: A total of 2069 sequential patients who underwent lumbosacral fusion surgery from 2008 to 2018 at a single academic medical center were retrospectively reviewed. Patients who subsequently developed SIJ dysfunction were identified. SIJ dysfunction was defined as patients who met the diagnostic criteria with physical examination and received an SIJ injection with clinical evidence of improvement. Controls, without subsequent SIJ dysfunction, were matched with cases based on levels of fusion, age, sex, and body mass index. Pre-and postoperative pelvic parameters were measured, including pelvic incidence, pelvic tilt (PT), sacral slope, lumbar lordosis, lumbosacral angle, L4 incidence and L5 incidence.
    Results: Of 2069 patients who underwent lumbosacral fusion, 81 patients (3.9%) met criteria for SIJ dysfunction. Measurements were made for 47 of 81 patients who had SIJ dysfunction, that had both pre- and post-operative imaging. Measurements for 44 matched controls were taken. Postoperative PT was significantly lower in SIJ dysfunction patients compared to controls (20.82° ± 2.19° vs. 27.28° ± 2.30°; P < 0.05), as was L5 incidence (28.64° ± 3.38° vs. 37.11° ± 3.50°; P < 0.05).
    Conclusion: Incidence of the SIJ dysfunction after lumbosacral fusion surgery was 3.9% and these patients had a significantly lower PT and L5 incidence compared to the control group. Significantly low PT may be derived from weak hamstring muscles, predisposing a patient to SIJ dysfunction. Therefore, hamstring muscle strengthening exercise for patients with decreased PT after lumbosacral fusion may decrease the incidence of SIJ dysfunction.Level of Evidence: 3.
    MeSH term(s) Cross-Sectional Studies ; Humans ; Lordosis ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Lumbosacral Region/diagnostic imaging ; Lumbosacral Region/surgery ; Retrospective Studies ; Spinal Fusion/adverse effects
    Language English
    Publishing date 2021-07-12
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 752024-4
    ISSN 1528-1159 ; 0362-2436
    ISSN (online) 1528-1159
    ISSN 0362-2436
    DOI 10.1097/BRS.0000000000003998
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1305: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: Racial Differences in Iliac Crest Cancellous Bone Composition: Implications for Preoperative Planning in Spinal Fusion Procedures.

    Cho, Woojin / Nessim, Adam / Gartenberg, Ariella / Sekerak, Richard / Brill, Sam / Lian, Jayson / Sperling, Karen / Chang, Dong-Gune

    Clinical spine surgery

    2021  Volume 35, Issue 3, Page(s) E400–E404

    Abstract: Study design: This was a retrospective cohort study.: Objective: The objective of this study was to determine whether race, specifically American white and American black, correlates with the ratio of cancellous to total bone at the iliac crest.: ... ...

    Abstract Study design: This was a retrospective cohort study.
    Objective: The objective of this study was to determine whether race, specifically American white and American black, correlates with the ratio of cancellous to total bone at the iliac crest.
    Summary of background data: Studies have demonstrated higher proximal femur bone density in American blacks than American whites. However, whether differences occur at the iliac crest, a common site for autologous graft material in spinal fusion surgery, is not well studied. Understanding such differences could aid orthopedic surgeon decision-making regarding graft options.
    Materials and methods: A retrospective review was performed on 133 sequential patients ages 18-75 who underwent computed tomography scan of the pelvis, at a single academic medical center from January 1, 2014, to January 1, 2016. The cohort included 46 American white (21 females, 25 males) and 87 American black participants (40 females, 37 males), an average age of 51.8 years. Groups were matched regarding age, sex, body mass index, and Charlson Comorbidity Score. Measurements of cortical and cancellous bone thickness in the right and left iliac crests were performed using bone window protocol on computed tomography scans. Statistical significance was determined using a 2-tailed t test.
    Results: The interobserver interclass correlation coefficient reliability (N=2) for measurements at the right iliac crest is 0.895 (95% confidence interval, 0.852-0.925), and the interclass correlation coefficient for the left iliac crest is 0.912 (95% confidence interval, 0.877-0.938). A statistically significant difference in the mean cancellous bone ratio was found between American black (0.667±0.065) and American white (0.750±0.051) groups (P<0.001).
    Conclusions: At the iliac crest, American black patients had a lower mean ratio of cancellous to the total bone as compared with American white patients. This population may benefit from alternative graft options. While iliac crest autograft remains the first option for fusion surgeries, alternative options should be considered to ensure that each patient receives the best-personalized care.
    MeSH term(s) Adolescent ; Adult ; Aged ; Bone Transplantation/methods ; Cancellous Bone/transplantation ; Female ; Humans ; Ilium/transplantation ; Male ; Middle Aged ; Race Factors ; Reproducibility of Results ; Retrospective Studies ; Spinal Fusion/methods ; Young Adult
    Language English
    Publishing date 2021-12-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2849646-2
    ISSN 2380-0194 ; 2380-0186
    ISSN (online) 2380-0194
    ISSN 2380-0186
    DOI 10.1097/BSD.0000000000001274
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2427: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Coronary artery calcification and epicardial adipose tissue as independent predictors of mortality in COVID-19.

    Slipczuk, Leandro / Castagna, Francesco / Schonberger, Alison / Novogrodsky, Eitan / Sekerak, Richard / Dey, Damini / Jorde, Ulrich P / Levsky, Jeffrey M / Garcia, Mario J

    The international journal of cardiovascular imaging

    2021  Volume 37, Issue 10, Page(s) 3093–3100

    Abstract: Recent epidemiological studies have demonstrated that common cardiovascular risk factors are strongly associated with adverse outcomes in COVID-19. Coronary artery calcium (CAC) and epicardial fat (EAT) have shown to outperform traditional risk factors ... ...

    Abstract Recent epidemiological studies have demonstrated that common cardiovascular risk factors are strongly associated with adverse outcomes in COVID-19. Coronary artery calcium (CAC) and epicardial fat (EAT) have shown to outperform traditional risk factors in predicting cardiovascular events in the general population. We aim to determine if CAC and EAT determined by Computed Tomographic (CT) scanning can predict all-cause mortality in patients admitted with COVID-19 disease. We performed a retrospective, post-hoc analysis of all patients admitted to Montefiore Medical Center with a confirmed COVID-19 diagnosis from March 1st, 2020 to May 2nd, 2020 who had a non-contrast CT of the chest within 5 years prior to admission. We determined ordinal CAC scores and quantified the epicardial (EAT) and thoracic (TAT) fat volume and examined their relationship with inpatient mortality. A total of 493 patients were analyzed. There were 197 deaths (39.95%). Patients who died during the index admission had higher age (72, [64-80] vs 68, [57-76]; p < 0.001), CAC score (3, [0-6] vs 1, [0-4]; p < 0.001) and EAT (107, [70-152] vs 94, [64-129]; p = 0.023). On a competing risk analysis regression model, CAC ≥ 4 and EAT ≥ median (98 ml) were independent predictors of mortality with increased mortality of 63% (p = 0.003) and 43% (p = 0.032), respectively. As a composite, the group with a combination of CAC ≥ 4 and EAT ≥ 98 ml had the highest mortality. CAC and EAT measured from chest CT are strong independent predictors of inpatient mortality from COVID-19 in this high-risk cohort.
    MeSH term(s) Adipose Tissue/diagnostic imaging ; COVID-19 ; COVID-19 Testing ; Coronary Artery Disease/diagnostic imaging ; Coronary Vessels/diagnostic imaging ; Humans ; Pericardium/diagnostic imaging ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; SARS-CoV-2 ; Vascular Calcification/diagnostic imaging
    Language English
    Publishing date 2021-05-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2055311-0
    ISSN 1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
    ISSN (online) 1875-8312 ; 1573-0743
    ISSN 1569-5794 ; 0167-9899
    DOI 10.1007/s10554-021-02276-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2104: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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