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Biomedical subjects

Samir S Awad

Publications and source records attributed to Samir S Awad.

At least 19 recordsLinked to original sources
PubMed2006

Ertapenem versus cefotetan prophylaxis in elective colorectal surgery.

BACKGROUND: Ertapenem, a long-acting carbapenem, may be an alternative to the recommended prophylactic antibiotic cefotetan. METHODS: In this randomized, double-blind trial, we assessed the efficacy and safety of antibiotic prophylaxis with ertapenem, as compared with cefotetan, in patients undergoing elective colorectal surgery. A successful outcome was defined as the absence of surgical-site infection, anastomotic leakage, or antibiotic use 4 weeks postoperatively. All adverse events were collected until 14 days after the administration of antibiotic prophylaxis. RESULTS: Of the 1002 patients randomly assigned to study groups, 901 (451 in the ertapenem group and 450 in the cefotetan group) qualified for the modified intention-to-treat analysis, and 672 (338 in the ertapenem group and 334 in the cefotetan group) were included in the per-protocol analysis. After adjustment for strata, in the modified intention-to-treat analysis, the rate of overall prophylactic failure was 40.2% in the ertapenem group and 50.9% in the cefotetan group (absolute difference, -10.7%; 95% confidence interval [CI], -17.1 to -4.2); in the per-protocol analysis, the failure rate was 28.0% in the ertapenem group and 42.8% in the cefotetan group (absolute difference, -14.8%; 95% CI, -21.9 to -7.5). Both analyses fulfilled statistical criteria for the superiority of ertapenem. In the modified intention-to-treat analysis, the most common reason for failure of prophylaxis in both groups was surgical-site infection: 17.1% in the ertapenem group and 26.2% in the cefotetan group (absolute difference, -9.1; 95% CI, -14.4 to -3.7). In the treated population, the overall incidence of Clostridium difficile infection was 1.7% in the ertapenem group and 0.6% in the cefotetan group (P=0.22). CONCLUSIONS: Ertapenem is more effective than cefotetan in the prevention of surgical-site infection in patients undergoing elective colorectal surgery but may be associated with an increase in C. difficile infection. (ClinicalTrials.gov number, NCT00090272 [ClinicalTrials.gov].).

Adult↗
PubMed2006

Education of the modern surgical resident: novel approaches to learning in the era of the 80-hour workweek.

INTRODUCTION: Implementation of the 80-hour work week has resulted in limitations on the hours available for resident education, creating a need for innovative approaches to teach surgical residents successfully. Herein we report the methods and results of an innovative didactic learning program at a large academic surgical residency program. METHODS: Between 2004 and 2005, based on known principles of adult education and innovative learning techniques, a didactic learning program was instituted in a major academic surgery program. The course work consisted of a structured reading program using Schwartz's Textbook of Surgery, with weekly testing and problem-based learning (PBL) groups led by surgical faculty. The residents' progress was assessed by American Board of Surgery In-Training Examination (ABSITE) training scores before and after program implementation. A resident survey was also conducted to assess residents' attitudes toward the new program. Results were reported as a mean, and categoric variables were compared using a paired Student's t-test. RESULTS: During the academic year of the structured reading program, the mean ABSITE score improved by 10% (P=0.02) from the previous year. The postgraduate year 4 class had the largest change, with a score increase of 17% over the previous year's performance (P=0.02). Survey results demonstrated that 64% of the responders agreed that the small-group PBL was preferable for achieving educational goals. Furthermore, 89% of residents responded that the PBL groups improved interaction between residents and faculty members. CONCLUSIONS: An innovative formal learning program based on a major surgical textbook with weekly testing and small group sessions can significantly improve surgical training in the modern era of work-hour restrictions. Furthermore, surgical trainees find this format to be innovative and useful for improving didactic teaching.

General Surgery↗
PubMed2006

Decellularized human cadaveric dermis provides a safe alternative for primary inguinal hernia repair in contaminated surgical fields.

BACKGROUND: Repair options for inguinal hernias in contaminated surgical fields include local tissue repair or mesh repair. The former is associated with higher hernia recurrence rates. The latter generally is avoided because of an unacceptably high infection rate. AlloDerm (Lifecell Corp., Branchburg, NJ) can potentially provide a strong repair resistant to infection. The aim of our study was to evaluate if AlloDerm provides a safe alternative for inguinal hernia repair in contaminated surgical fields. METHODS: We retrospectively reviewed the medical records of all patients who underwent inguinal hernia repair with AlloDerm from December 2004 to April 2006. Demographics, risk factors, perioperative data, and recurrence rates were evaluated. RESULTS: Twelve patients with contaminated surgical fields underwent inguinal hernia repair with AlloDerm. Serious perioperative complications occurred in only 1 patient. Two patients developed superficial wound infections (treated conservatively). There were no mortalities. No hernia recurrence has been documented with a follow-up period of 3 to 17 months (median, 9 mo). CONCLUSIONS: AlloDerm provides a safe alternative for inguinal hernia repair in contaminated surgical fields.

Aged↗
PubMed2005

Length of human immunodeficiency virus disease and not immune status is a risk factor for development of anal carcinoma.

BACKGROUND: The anal epithelium is subject to dysplastic change in patients with human immunodeficiency virus (HIV). We sought to determine if the duration of HIV disease or the patient's immune status were associated with the development of anal carcinoma. METHODS: HIV-positive patients diagnosed with anal neoplasms were reviewed. Statistical analysis was performed via an unpaired Student t test and the Fisher exact test. RESULTS: Fourteen patients were identified, 7 with anal intraepithelial neoplasms (group 1) and 7 with anal carcinoma (group 2). Human papillomavirus was detected in 100% of patients in group 1 and in 67% of patients in group 2. There was no significant difference in the level of immunosuppression as assessed by the CD4 counts (266.9 +/- 48.5 vs. 274.7 +/- 92.0 cell/c microl; P = .94) and viral loads (19,243 +/- 18,034 vs. 67,140 +/- 39,570 RNA/mL; P = .29) between groups 1 and 2, respectively. Group 2 had been HIV positive for a significantly longer period of time (12.6 +/- 2.3 y) compared with group 1 (5.9 +/- 2.0 y, P = .05). CONCLUSIONS: The most significant factor for the development of invasive anal carcinoma in patients with HIV is duration of disease. As a result of improved long-term survival secondary to new HIV therapy, anal invasive carcinoma will become an increasing problem.

Adult↗
PubMed2005

Bridging the communication gap in the operating room with medical team training.

BACKGROUND: In the operating room (OR), poor communication among the surgeons, anesthesiologists, and nurses may lead to adverse events that can compromise patient safety. A survey performed at our institution showed low communication ratings from surgeons, anesthesiologists, and OR nursing staff. Our objective was to determine if communication in the operating room could be improved through medical team training (MTT). METHODS: A dedicated training session (didactic instruction, interactive participation, role-play, training films, and clinical vignettes) was offered to the entire surgical service using crew resource management principles. Attendees also were instructed in the principles of change management. A change team was formed to drive the implementation of the principles reviewed through a preoperative briefing conducted among the surgeon, anesthesiologist, and OR nurse. A validated Likert scale survey with questions specific to effective communication was administered to the nurses, anesthesiologists, and surgeons 2 months after the MTT to determine the impact on communication. Data are presented as mean +/- SEM. RESULTS: There was a significant increase in the anesthesiologist and surgeon communication composite score after medical team training (anesthesia pre-MTT = 2.0 +/- .3, anesthesia post-MTT = 4.5 +/- .6, P <.0008; surgeons pre-MTT = 5.2 +/- .2, surgeons post-MTT = 6.6+/-.3, P <.0004; nurses pre-MTT = 4.3 +/- .3, nurses post-MTT = 4.2 +/- .4, P = .7). CONCLUSIONS: Medical team training using crew resource management principles can improve communication in the OR, ensuring a safer environment that leads to decreased adverse events.

Anesthesiology↗
PubMed2004

Extracellular ATP activates c-jun N-terminal kinase signaling and cell cycle progression in hepatocytes.

Partial hepatectomy leads to an orchestrated regenerative response, activating a cascade of cell signaling events necessary for cell cycle progression and proliferation of hepatocytes. However, the identity of the humoral factors that trigger the activation of these pathways in the concerted regenerative response in hepatocytes remains elusive. In recent years, extracellular ATP has emerged as a rapidly acting signaling molecule that influences a variety of liver functions, but its role in hepatocyte growth and regeneration is unknown. In this study, we sought to determine if purinergic signaling can lead to the activation of c-jun N-terminal kinase (JNK), a known central player in hepatocyte proliferation and liver regeneration. Hepatocyte treatment with ATPgammaS, a nonhydrolyzable ATP analog, recapitulated early signaling events associated with liver regeneration-that is, rapid and transient activation of JNK signaling, induction of immediate early genes c-fos and c-jun, and activator protein-1 (AP-1) DNA-binding activity. The rank order of agonist preference, UTP>ATP>ATPgammaS, suggests that the effects of extracellular ATP is mediated through the activation of P2Y2 receptors in hepatocytes. ATPgammaS treatment alone and in combination with epidermal growth factor (EGF) substantially increased cyclin D1 and proliferating cell nuclear antigen (PCNA) protein expression and hepatocyte proliferation in vitro. Extracellular ATP as low as 10 nM was sufficient to potentiate EGF-induced cyclin D1 expression. Infusion of ATP by way of the portal vein directly activated hepatic JNK signaling, while infusion of a P2 purinergic receptor antagonist prior to partial hepatectomy inhibited JNK activation. In conclusion, extracellular ATP is a hepatic mitogen that can activate JNK signaling and hepatocyte proliferation in vitro and initiate JNK signaling in regenerating liver in vivo. These findings have implications for enhancing our understanding of novel factors involved in the initiation of regeneration, liver growth, and development.

Adenosine Triphosphate↗
PubMed2004

A novel technique for the repair of lumbar hernias after iliac crest bone harvest.

BACKGROUND: Lumbar hernia is a clinical entity that has been increasingly more common since the advent of iliac bone harvest for bone grafting procedures. These can be very technically difficult to repair and have a high recurrence rate. METHODS: Using a corkscrew anchor suture device, we have developed a novel and simple way to repair these hernias with no recurrence. Here we present our experience with the corkscrew suture anchor device. RESULTS: This technique has been performed in 2 patients at our institution, and in both cases, the hernia was successfully repaired. Our 1-year follow-up on this technique demonstrates intact repairs with no sign of recurrence. CONCLUSIONS: The placement of corkscrew suture anchors along the iliac crest remnant is a simple technique requiring minimal bony exposure. The anchors facilitate the long-term fixation of mesh despite the lack of fascia in this area. We conclude that this is a simple and effective approach for repair of these challenging hernias.

Bone Transplantation↗
PubMed2004

Use of a predictive equation for diagnosis of acute gangrenous cholecystitis.

BACKGROUND: Factors previously identified by multivariate logistic regression that were predictive for gangrenous cholecystitis (GC) were used to develop a predictive equation. Our objective was to evaluate the sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values of this equation for detecting GC in patients with acute cholecystitis (AC). METHODS: Medical records of patients who presented to a tertiary care hospital with AC were reviewed. Twenty-one patient and clinical variables were recorded. We prospectively tested the results of the following equation against pathologic diagnosis: P=e((0.7116+0.9944.DM+1.7157.WBC-1.0319.ALT.2.0518.ALP+2.7078.PCF))/(1+e([-0.7116+0.9944.DM+1.7157.WBC-1.0319.ALT-2.0518.ALP+2.7078.PCF])), where P = predicted value; DM = diabetes mellitus; WBC = white blood cell count; ALT = alanine aminotransferase; AST = aspartate aminotransferase; and PCF = pericholecystic fluid. RESULTS: Ninety-eight patients presented with AC and 18% had GC (18 of 98). Using a cutoff of P = 0.724, our equation had a specificity of 93%, sensitivity of 83%, PPV of 71%, and NPV of 96%, P <0.001 for the detection of GC. CONCLUSIONS: Our study demonstrates the equation may be useful in detecting the subset of AC patients who have GC.

Adult↗
PubMed2004

The impact of a novel resident leadership training curriculum.

BACKGROUND: Today's complex health care environment coupled with the 80-hour workweek mandate has required that surgical resident team interactions evolve from a military command-and-control style to a collaborative leadership style. METHODS: A novel educational curriculum was implemented with objectives of training the residents to have the capacity/ability to create and manage powerful teams through alignment, communication, and integrity integral tools to practicing a collaborative leadership style while working 80 hours per week. Specific strategies were as follows: (1) to focus on quality of patient care and service while receiving a high education-to-service ratio, and (2) to maximize efficiency through time management. RESULTS: This article shows that leadership training as part of a resident curriculum can significantly increase a resident's view of leadership in the areas of alignment, communication, and integrity; tools previously shown in business models to be vital for effective and efficient teams. CONCLUSION: This curriculum, over the course of the surgical residency, can provide residents with the necessary tools to deliver efficient quality of care while working within the 80-hour workweek mandate in a more collaborative style environment.

Clinical Competence↗
PubMed2004

Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients.

BACKGROUND: Cirrhotic patients who present for elective and emergent surgery pose a formidable challenge for the surgeon because of the high reported morbidity and mortality. The Child-Turcotte-Pugh (CTP) score previously has been used to evaluate preoperative severity of liver dysfunction and to predict postoperative outcome. Recently, a more objective scoring classification, the model for end-stage liver disease (MELD), has been shown to predict accurately the 3-month mortality for cirrhotic patients awaiting transplantation. We sought to compare the CTP and MELD scores in predicting outcomes in cirrhotic patients undergoing surgical procedures requiring general anesthesia. METHODS: During the study period, 40 patients with a history of cirrhosis who required elective (E) or emergent (EM) surgical procedures under general anesthesia were reviewed (E = 24, EM = 16). The preoperative CTP and MELD scores were calculated and patient short- (30-day) and long-term (3-month) outcomes were recorded. RESULTS: There was a significant difference in the 1-month and 3-month mortality rates between the emergent and elective groups (EM group: 1 mo = 19%, 3 mo = 44%; E group: 1 mo = 17%, 3 mo = 21%, P <0.05). There was good correlation between the CP and MELD scores, which was greater in the emergent groups as compared with the elective group (EM: r = 0.81; E: r = 0.65). CONCLUSIONS: Our study shows that cirrhotic patients who undergo surgery under general anesthesia have an extremely high 1- and 3-month mortality rate that progressively increases with severity of preoperative liver dysfunction. Additionally, the MELD score correlates well with the CTP score, providing a more objective predictor of postoperative mortality in cirrhotic patients undergoing surgery.

Adult↗
PubMed2004

Abdominal wall anatomy: the key to a successful inguinal hernia repair.

Over the past century, there has been a significant increase in the understanding of abdominal wall anatomy as it relates to inguinal and ventral hernia repairs. Since the initial reports of successful primary inguinal herniorrhaphy, recurrence rates have dramatically decreased because of the improved understanding of the pathologic defect. This article will review the important nomenclature of the groin region, briefly review the bony and tissue anatomy of the groin, and describe the anatomic hole from which the pathologic hole (hernia) originates.

Abdominal Wall↗
PubMed2004

Current approaches to inguinal hernia repair.

The repair of a simple inguinal hernia or a complicated incisional hernia no longer involves just the sewing together of a defect in the musculature. Present-day hernia operations require that the surgeon more fully understand the functional anatomy and pathophysiology of the abdominal wall and groin. Hernia surgeons must be familiar with a myriad of surgical techniques, ranging from the traditional tissue repairs with suture to the mesh-based "tension-free" open and laparoscopic techniques. Furthermore, the surgeon must comprehend outcome analysis in evaluating differing therapies. Several approaches have been used for repair of groin hernias and have included tissue repairs (later termed "tension" repairs), as well as mesh or tension-free repairs and laparoscopy. Although each of these repairs boasts its successes, there are advantages and disadvantages to each approach. This article highlights each of these repairs through review of the literature.

Hernia, Inguinal↗
PubMed2004

Serum response factor is alternatively spliced in human colon cancer.

BACKGROUND: Serum response factor (SRF) is a transcription factor that plays an important role in cellular differentiation and cell cycle regulation. SRF function is regulated in part by alternative splicing. Little is known about the expression or role of these alternatively spliced isoforms during tumorigenesis. We hypothesized that there is a change in the splice variants during intestinal tumorigenesis and that this change promotes the tumor phenotype. MATERIALS AND METHODS: SRF expression was determined by Western blotting of benign intestinal cells and human colon cancer cell lines. To determine the effect of alternative splicing of SRF on intestinal growth and proliferation, the predominant alternatively spliced isoform of SRF that we identified in colon cancer cells, SRFDelta5, was transfected into IEC-6 cells. IEC-6 and IEC-6SRFDelta5 cells were plated and cell numbers were determined at four time points. RESULTS: Western blotting demonstrates that full-length SRF is the predominant form of SRF in rat IEC-6 cells, normal human colonic mucosa, and HT-29 cells, derived from a well-differentiated human colonic adenocarcinoma. In the colon cancer cell lines derived from poorly differentiated tumors (WiDr, HCT 116, LoVo, and SW480), SRFDelta5 is the predominant isoform expressed. There was a significant increase in cell survival in IEC-6 cells transfected with SRFDelta5 compared to parental cells. CONCLUSION: Our data demonstrate that an alternatively spliced isoform of SRF, SRFDelta5, is expressed in human colon cancer cell lines. Additionally, these data demonstrate that expression of SRFDelta5 may contribute to the tumor phenotype by affecting cell survival. This is the first study to document a change in expression of the alternatively spliced isoform of SRF in human malignancy.

Alternative Splicing↗
PubMed2003

State-of-the-art therapy for severe sepsis and multisystem organ dysfunction.

Despite spectacular advances in life-support technology, the management of patients with severe sepsis continues to be a significant health care challenge because of the associated major morbidity, high mortality, and health economic implications. Severe sepsis with associated multisystem organ dysfunction (MOD) is the leading cause of death in the intensive care unit. Recent understanding of the pathophysiology now demonstrates that the syndrome of severe sepsis after a major physiologic insult is characterized by the activation of multiple overlapping and interacting cascades leading to systemic inflammation, a procoagulant state, and decreased fibrinolysis, which if unchecked leads to the progressive functional deterioration of multiple interdependent organs. This review will highlight the epidemiology, current understanding of the pathophysiology, management, and prevention of the syndrome of severe sepsis with MOD.

Humans↗