Browsing by Author "Bandali, Elhaam"
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Item Audiologic Improvement Following MCF Approach for Spontaneous Cerebrospinal Fluid Leaks(Wolters Kluwer, 2019-09) Alwani, Mohamedkazim; Bandali, Elhaam; Van Buren, Lauren; Yates, Charles; Nelson, Rick; Otolaryngology -- Head and Neck Surgery, School of MedicineObjective: To determine the audiologic improvement after middle cranial fossa (MCF) approach to repair spontaneous cerebrospinal fluid (sCSF) leaks. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: Twenty-four consecutive patients (27 ears) with temporal bone sCSF leak over a 4-year period. Patient age, sex, ethnicity, body mass index (BMI), location of CSF leak, recurrence of CSF leak, and presence of encephalocele(s) were recorded. Intervention: Audiometric testing in patients undergoing MCF repair of temporal bone sCSF leak. Main Outcome Measures: Comparison of preoperative and postoperative pure-tone average (PTA), air-bone gap (ABG), and word recognition score (WRS) in the sCSF leak ear. Results: Out of 27 ears, 55% had multiple tegmen defects and 82% had more than or equal to 1 encephaloceles. There were no recurrent CSF leaks at a median follow up of 4 months. The mean (SD) preoperative PTA and ABG were 40.58 [15.67] and 16.44 [6.93] dB, respectively. There was significant improvement in mean PTA (10.28 [8.01] dB; p < 0.001; Cohen d = 0.95) and ABG (9.31 [7.16] dB; p < 0.001; Cohen d = 0.88) after sCSF repair. Mean WRS improved (by 3.07 [6.11] %; p = 0.024; Cohen d = 0.46) from a mean preoperative WRS of 93.16 [9.34]% to a mean postoperative WRS of 96.26 [6.49]%. Conclusions: MCF approach for repair of sCSF leaks yields significant improvement in conductive hearing loss and is highly effective in management of the entire lateral skull base where multiple bony defects are often identified.Item Clinicopathological characteristics of ypT0N0 urothelial carcinoma following neoadjuvant chemotherapy and cystectomy(BMJ, 2019-08) Magers, Martin J.; Kaimakliotis, Hristos Z.; Barboza, Marcelo P.; Bandali, Elhaam; Adra, Nabil; Koch, Michael O.; Cheng, Liang; Pathology and Laboratory Medicine, School of MedicineAims To describe a large tertiary care academic centre’s experience with patients who achieve a complete pathological response (ie, ypT0N0) following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) with emphasis on morphological features present in the RC and clinical outcome. Methods 41 patients with ypT0N0 disease following transurethral resection of bladder tumour (TURBT), NAC and RC with available clinical follow-up information were analysed. Slides from all RCs were reviewed to confirm pathological stage and assess for morphological parameters (eg, foreign body giant cell reaction, dystrophic calcification, scar and fat necrosis). Results With median follow-up of 32.8 months, the recurrence-free survival at 1 and 5 years was 97.4% and 93.5%, while the overall survival at 3 and 5 years was 94.2% and 88.6%, respectively. No patients died of urothelial carcinoma. Stage assigned at TURBT was 1 pTa (2%), 1 pT1 (2%), 38 pT2 (93%) and 1 pT3a (2%). 17 TURBTs demonstrated variant histology, with the majority of these being squamous (65%). The most common morphological features present at RC were scar (100%), foreign body giant cell reaction (80%), chronic inflammation within lamina propria (68%) and dystrophic calcifications (39%). Other morphological features were less common or absent. Conclusion ypT0N0 disease at RC portends an excellent prognosis, regardless of stage or variant histology in the TURBT; scar, foreign body giant cell reaction, chronic inflammation and dystrophic calcifications are often present.Item Consulting “Dr. YouTube”: an objective evaluation of hypospadias videos on a popular video-sharing website(Elsevier, 2020-02-16) Salama, Amr; Panoch, Janet; Bandali, Elhaam; Carroll, Aaron; Wiehe, Sarah; Downs, Stephen; Cain, Mark P.; Frankel, Richard; Chan, Katherine H.; Urology, School of MedicineIntroduction: Parents who make decisions about hypospadias repair for their child may seek information from online platforms such as YouTube. Objective: The purpose of this study is to evaluate the health literacy demand of hypospadias videos on YouTube using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V). Study design: We performed a YouTube search using the term "hypospadias," limiting results to the first 100 videos. We excluded videos that were <1 min or >20 min and videos that were not in English or did not include subtitles. Two evaluators independently examined videos and determined PEMAT-A/V scores for understandability and actionability (i.e., ability to identify actions the viewer can take). Videos with scores >70% are understandable or actionable. The inter-rater reliability (kappa) and intraclass correlation coefficient (ICC) of PEMAT scores were calculated. Bivariate and multivariable linear regression models assessed the association of video characteristics with respective scores. Results: Of the 100 videos that were identified on YouTube, 47 (47%) were excluded leaving 53 for analysis: 14 were >20 min, 14 were <1 min, 9 had no audio or subtitles, 7 were not in English, 1 was a duplicate, 1 was unrelated to hypospadias, and 1 was deleted at the time of data analysis. Three (5.6%) were understandable (mean score 54.5%, standard deviation (SD) 14.9) and eight (15.1%) were actionable (mean score 21.8%, SD 16.6) (Extended Summary Figure). Kappa values ranged from 0.4 to 1. The ICC's were 0.55 and 0.33 for understandability and actionability, respectively. In the bivariate analysis, mean understandability scores were significantly higher for English language videos (p = 0.04), videos with animation (p = 0.002), and those produced by industry (p = 0.02). In the multivariable analysis, mean understandability scores were significantly higher for "expert testimonial" or "other" video types after adjusting for graphics type and overall tone (p = 0.04). Mean understandability scores were also significantly higher for videos with animation after adjusting for video type and overall tone (p = 0.01). Mean actionability scores were significantly higher for videos with a negative tone (p = 0.01). Discussion: The vast majority of hypospadias-related YouTube content is not appropriate for users with low health literacy although certain types of videos, such those with animation and expert testimonials, scored higher on understandability than other types. Conclusion: Due to the lack of sufficient online informational content regarding hypospadias, we plan to engage parents of sons with hypospadias in the development of high-quality patient educational materials about hypospadias.Item Facing Facts: Facial Injuries from Stand-up Electric Scooters(ACOG, 2020-01-15) Alwani, Mohamedkazim; Jones, Alexander J.; Sandelski, Morgan; Bandali, Elhaam; Lancaster, Benjamin; Sim, Michael W.; Shipchandler, Taha; Ting, Jonathan; Otolaryngology -- Head and Neck Surgery, School of MedicineBackground Stand-up electric scooters (SES) are a popular public transportation method. Numerous safety concerns have arisen since their recent introduction. Methods A retrospective chart review was performed to identify patients presenting to the emergency departments in Indianapolis, who sustained SES-related injuries. Results A total of 89 patients were included in our study. The average patient age was 29 ± 12.9 years in a predominantly male cohort (65.2%). No patient was documented as wearing a helmet during the event of injury. Alcohol intoxication was noted in 14.6% of accidents. Falling constituted the leading trauma mechanism (46.1%). Injuries were most common on Saturday (24.7%) from 14h00 to 21h59 (55.1%). Injury types included: abrasions/contusions (33.7%), fractures (31.5%), lacerations (27.0%), or joint injuries (18.0%). The head and neck region (H&N) was the most frequently affected site (42.7%). Operative management under general anesthesia was necessary for 13.5% of injuries. Nonoperative management primarily included conservative orthopedic care (34.8%), pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) (34.8%) and/or opioids (4.5%), bedside laceration repairs (27.0%), and wound dressing (10.1%). Individuals sustaining head and neck injuries were more likely to be older (33.8 vs. 25.7 years, p=0.003), intoxicated by alcohol (29.0% vs. 3.9%, p=0.002), and requiring CT imaging (60.5% vs. 9.8%, p <0.001). Conclusion Although SESs provide a convenient transportation modality, unregulated use raises significant safety concerns. More data need to be collected to guide future safety regulations.Item The Impact of the COVID-19 Pandemic on Behavioral Health in Indiana(The Center for Health Policy, 2021-06-01) Kooreman, Harold; Gutta, Jyotsna; Bandali, Elhaam; Greene, Marion S.As of January 2021, the Johns Hopkins Coronavirus Resource Center has confirmed more than 20 million SARS-CoV-2 cases and over 350,000 deaths in the United States alone and 100 million cases and more than 2 million deaths globally. As of December 31, 2020, over half a million Hoosiers had tested positive for COVID-19 and more than 8,000 had died as a result of complications from the disease. This report is a review on the impact the COVID-19 pandemic had (and has) on the mental and behavioral health of Hoosiers. Specifically, we reviewed pandemic-related stress on children, parents, and the elderly; substance use, misuse, and overdose deaths; mental health concerns; suicide; domestic violence; and child abuse and neglect. The current report is a summary of findings. It provides a snapshot in time. Data and conclusions were relevant and timely at the time the report was produced.Item Low Misrepresentation Rates of Scholarly Work in Otolaryngology-Head and Neck Surgery Residency Applications(Cureus, 2020-02) Alwani, Mohamedkazim; Sandelski, Morgan; Van Buren, Lauren; Bandali, Elhaam; Ting, Jonathan; Shipchandler, Taha; Illing, Elisa A.; Otolaryngology -- Head and Neck Surgery, School of MedicineObjectives To evaluate research trends, including rates of misrepresentation of scholarly work, in otolaryngology residency applications received by a single institution during the 2018-2019 residency application cycle. Methods After obtaining Institutional Review Board approval, all residency applications to the Department of Otolaryngology-Head and Neck Surgery at Indiana University School of Medicine, Indianapolis, IN for the 2018-2019 cycle were de-identified and analyzed. Demographic and research information including the number of listed peer-reviewed articles/abstracts, types of research projects, and misrepresentations were retrospectively evaluated. Results Our institution received 321 applications, which represented 69.5% of the entire 2018-2019 otolaryngology applicant pool. The average United States Medical Licensing Examination (USMLE) Step 1 score was 246 ±12.4. There were 203 (62.2%) applicants who reported 591 published citations with 20 (6.2%) applicants misrepresenting 26 items (4.4%). Applicants who misrepresented research output had lower average Step 1 scores (237.4 vs 246.4, p: <0.05). Self-promotion to higher authorship status was the most common form of misrepresentation (61.5%). Conclusions The role of scholarly work in stratifying applicants continues to expand. Although a competitive application climate motivates a minority of applicants to misrepresent scholarly work, rates of misrepresentation in otolaryngology applications are low and continue to decline. The level of evidence assigned to this study is III.Item Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population(Elsevier, 2019) Abedali, Zain A.; Large, Tim; Heiman, Joshua M.; Bandali, Elhaam; Anderson, Blake B.; Lingeman, James E.; Krambeck, Amy E.; Urology, School of MedicineObjective To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals. Methods From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999 to 2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes. Results Of the 1,647 patients, median age was 46, 66, and 83, respectively ( P <0.0001). Three patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients ( P = 0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group ( P = 0.06). Mean preoperative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, P <.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; P = 0.02) and transfusions (2.3, 4.7, 10.2%; P <0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted. Conclusion PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long-term survival.Item Plasmacytoid/diffuse urothelial carcinoma: a single-institution immunohistochemical and molecular study of 69 patients(Elsevier, 2019-08) Perrino, Carmen M.; Eble, John; Kao, Chia-Sui; Whaley, Rumeal D.; Cheng, Liang; Idrees, Mohammad; Hashemi-Sadraei, Neda; Monn, M. Francesca; Kaimakliotis, Hristos Z.; Bandali, Elhaam; Grignon, David; Pathology and Laboratory Medicine, School of MedicineAccurate diagnosis of plasmacytoid urothelial carcinoma (PUC) is important given its poor prognosis and frequent presentation at high stage. We aim to assess the clinicopathological features, molecular aberrations, and follow-up data in a series of PUC cases from a single tertiary cancer center. Seventy-two urinary bladder, ureteral, and renal pelvic specimens with urothelial carcinoma with plasmacytoid differentiation were identified. Immunohistochemical stains were performed on 48 cases. Among urinary bladder origin markers, GATA3 was most sensitive (96%). Breast carcinoma markers (estrogen receptor, mammaglobin) were usually negative, but progesterone receptor stained 1 case (4%). Neuroendocrine markers CD56 and TTF-1 were each positive in 1 case (4% and 4%, respectively). Gastrointestinal adenocarcinoma marker CDX2 was positive in 4 cases (15%), but nuclear β-catenin was negative in all cases. CD138 was positive in 83% and E-cadherin expression was lost in 57% of cases. Fluorescence in situ hybridization using the UroVysion Bladder Cancer Kit and FGFR3 mutational analysis using polymerase chain reaction were performed on 15 cases; deletion of chromosome 9p21 was common (60%), and FGFR3 mutations were detected in 60% of cases (5 cases had both deletion 9p21 and FGFR3 mutations). Cases were divided into 3 morphologic groups: classic (29%), desmoplastic (35%), and pleomorphic (36%). The 3 morphologic subtypes had distinct survival outcomes (P = .083), with median survival for all patients 18 being months versus 10 months for the desmoplastic group.Item The Consumption and Consequences of Alcohol, Tobacco, and Drugs in Indiana: A State Epidemiological Profile 2020(Richard M. Fairbanks School of Public Health, 2020) Greene, Marion; Gutta, Jyotsna; Kooreman, Harold; Bandali, ElhaamDuring state fiscal year 2020, there was a total of 7,502 child removals from their parents by the Department of Child Services in Indiana. Parental drug and/or alcohol use contributed to almost two thirds (63.6%) of these removals.Item The Impact of the COVID-19 Pandemic on Behavioral Health in Indiana(Richard M. Fairbanks School of Public Health, 2021) Kooreman, Harold; Gutta, Jyotsna; Bandali, Elhaam; Greene, MarionThe coronavirus disease of 2019 (COVID-19) is caused by a novel, highly contagious virus called SARS-CoV-2. The first cases of COVID-19 were identified in Wuhan, China, in December of 2019, but the disease quickly spread to other parts of the world. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. As of January 2021, the Johns Hopkins Coronavirus Resource Center has confirmed more than 20 million SARS-CoV-2 cases and over 350,000 deaths in the United States alone and 100 million cases and more than 2 million deaths globally.