Browsing by Author "Thamba, Aish"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    A Retrospective Review of 30-Day Hospital Readmission Risk After Open Heart Surgery in Patients With Atrial Fibrillation
    (Springer Nature, 2023-09-22) Rao, Varun; DeLeon, Genaro; Thamba, Aish; Flanagan, Mindy; Nickel, Kathleen; Gerue, Michael; Gray, Douglas; Neurological Surgery, School of Medicine
    Introduction: Readmission rates after open heart surgery (OHS) remain an important clinical issue. The causes are varied, with identifying risk factors potentially providing valuable information to reduce healthcare costs and the rate of post-operative complications. This study aimed to characterize the reasons for 30-day hospital readmission rates of patients after open heart surgery. Methods: All patients over 18 years of age undergoing OHS at a community hospital from January 2020 through December 2020 were identified. Demographic data, medical history, operative reports, post-operative complications, and telehealth interventions were obtained through chart review. Descriptive statistics and readmission rates were calculated, along with a logistic regression model, to understand the effects of medical history on readmission. Results: A total of 357 OHS patients met the inclusion criteria for the study. Within the population, 8.68% of patients experienced readmission, 10.08% had an emergency department (ED) visit, and 95.80% had an outpatient office visit. A history of atrial fibrillation (AFib) significantly predicted 30-day hospital readmissions but not ED or outpatient office visits. Telehealth education was delivered to 66.11% of patients. Conclusion: The study investigated factors associated with 30-day readmission following OHS. AFib patients were more likely to be readmitted than patients without atrial fibrillation. No other predictors of readmission, ED visits, or outpatient office visits were found. Patients reporting symptoms of tachycardia, pain, dyspnea, or "other" could be at increased risk for readmission.
  • Thumbnail Image
    Item
    At The Heart of the Matter: An Atypical Case of Spontaneous Coronary Artery Dissection
    (2022-03) Thamba, Aish; Patel, Bhumi; Vander Missen, Marissa; Frey, Julianne
    CASE: A 51-year-old female with a history of hypertension and ADHD presented to the emergency department with sharp substernal pain and nausea. Initial EKG showed anterior ST-segment elevation. Patient vitals were 53 bpm, 170/110 mmHg, and 90% O2 saturation on room air. The patient was on a prescribed amphetamine for ADHD and propanol. She was given nitroglycerin by EMS; and carvedilol, heparin, and ticagrelor at the hospital. Echocardiogram found diffusely hypokinetic to akinetic apex, distal anteroseptal wall, and mid to distal anterior/anterolateral walls, suggestive of ischemia or stress-induced cardiomyopathy. Subsequent coronary angiography demonstrated 95% stenosis in the left anterior descending artery with ulceration, type 4 dissection segment, and thrombosis. Two drug-eluting stents were placed successfully; lisinopril and carvedilol were increased, and atorvastatin and ticagrelor were initiated. CONCLUSION: This patient presented with multiple risks for SCAD: female, hypertension, use of dextroamphetamine-amphetamine, family cardiac history, and middle-age. However, the consult differential did not include SCAD. Instead, the leading diagnosis was stress-induced cardiomyopathy due to EKG presentation. SCAD was discovered after initial stent placement. SCAD is a rare vascular emergency where a tear spontaneously forms in a coronary artery and can precipitate myocardial infarction by occluding perfusion, potentially resulting in sudden death. Confounding factors in the presentation were newly increased dextroamphetamine-amphetamine and alcohol use, indicating that typical SCAD presentations, as taught, may not be inclusive of all cases. CLINICAL SIGNIFICANCE: Broadening differentials or diagnostic criteria for SCAD could improve SCAD screening and diagnosis. Additionally, providers have been shown in the literature to underdiagnose cardiac events and undertreat pain in females relative to male patients experiencing the same events. This case exemplifies the importance of a more inclusive differential to provide comprehensive care for female patients.
  • Thumbnail Image
    Item
    Examination and Scientific Analysis of Thoracic Vertebral Fractures
    (Springer Nature, 2023-09-09) Singh, Gurbinder; Rao, Varun; Thamba, Aish; Roth, Dylan; Zaazoue, Mohamed A.; Neurological Surgery, School of Medicine
    Background: Thoracic vertebral fractures are clinically important due to their association with the thoracic spinal cord and the potential to cause devastating neurological injury. Using the National Electronic Injury Surveillance System (NEISS) data, this study investigated fracture patterns to understand associated factors to improve prevention strategies. We explored different factors associated with thoracic vertebral fractures to improve our understanding of preventative strategies and patient care standards, focusing on spatial distribution, sex-age dynamics, and location of injury. Methodology: This retrospective, cross-sectional study examines thoracic vertebral fractures across diverse age groups from 2013 to 2022, utilizing the NEISS database from the U.S. Consumer Product Safety Commission. Inclusion criteria based on specific terms related to thoracic fractures were employed. Descriptive statistics illustrated fracture distribution by age groups and associated products. Statistical analyses, including chi-square tests and multivariate logistic regressions, were conducted to explore associations between fracture occurrence, locations, products, age, and gender. Results: The analysis of thoracic vertebral fractures by location and associated products yielded several statistically significant findings. Notably, the prevalence of fractures at home (39.67%) was significantly higher than in other locations, and these differences in fracture distribution were statistically significant (χ² = 7.34, p < 0.001). Among the associated products, ladders (10.46%) emerged as the most frequent product associated with fractures. Multivariate logistic regression analysis showed that the age groups of 41-50, 51-60, and 61-70 had increased odds of fractures with adjusted odds ratios (AORs) of 1.08 (95% confidence interval (CI) = 1.04-1.42, p < 0.05), 1.21 (95% CI = 1.13-1.56, p < 0.001), and 1.17 (95% CI = 1.08-1.39, p < 0.001), respectively. The likelihood of thoracic vertebral fractures did not significantly differ between males and females (AOR = 1.12, 95% CI = 0.87-1.53, p = 0.262). Fracture distribution by age groups and products indicated increasing ladder-related fractures within the 41-50 age group and 51-60 age group. Football-related fractures peaked within the 21-30 age group. Fracture distribution patterns for bicycles had increased prevalence within the 11-20 and 21-30 age groups, and football-related fractures in younger age groups. Conclusions: This study analyzed factors associated with thoracic vertebral fractures, showing the significance of targeted preventative interventions, such as earlier screening, physical therapy, and nutritional status assessment, in the setting of significant location and age-related susceptibilities. The observed patterns of injury provide a foundation for future research to elucidate the underlying mechanisms between different environments and the likelihood of injury to improve preventive strategies.
  • Thumbnail Image
    Item
    Expanded Utility of Human Acellular Vessel in Hemodialysis Access Surgery and Arterial Aneurysm Repair
    (Springer Nature, 2023-10-01) Nickerson, Margaret C.; Thamba, Aish; Rao, Varun; Peterson, David B.; Peterson, David A.; Cuddy, Duangnapa S.; Surgery, School of Medicine
    Vascular access is essential for hemodialysis (HD) in patients with end-stage renal disease (ESRD). When the standard of care arteriovenous fistula (AVF) is limited, secondary to aneurysmal degeneration, trauma, and thrombus, interposition grafting is a reasonable reconstruction approach. As these grafts and comorbidities place ESRD patients at sustained risk of complications, reconstructions with regenerative medicine biologic conduits hold promise in improving safety and efficacy. Here, a biocompatible human acellular vessel (HAV) is our conduit of interest. With United States Food and Drug Administration use authorization under the Expanded Access Program, we report three cases of complex vascular access surgery with four aneurysm repairs using HAV. Patient selection focused on meeting unmet needs for those without adequate care alternatives, including active access and endoprosthetic stent graft infections, right heart failure due to high-output AVF, and arterial and access outflow aneurysms. In this high-risk expanded access population, operative technical success and interval success for patients given their inherent comorbidities, offer potential expanded utility of HAV in HD access surgery and arterial aneurysm repair.
  • Thumbnail Image
    Item
    Inspired to Learn: Integrating Pre-Clinical Respiratory Educational Principles into Clinical Clerkship Practice​
    (2023-04-28) Sharpe, Shannen; Friel, Rylee; Barron, Emily; Shockley, Emily; Thamba, Aish; Bontrager, Erin; Ganapaneni, Sruthri; Stoll, Kennedy; Vellutini, Natalie; Roy, Lynn; Cooper, Shannon; Kochhar, Komal; Carlos, Graham
    Introduction: IUSM students have reported on the Graduation Questionnaire (GQ) that there is a lack of pre-clinical content incorporated into clinical rotations. Student performance on respiratory/pulmonology questions on the USMLE Step 1 and 2 exams is similar to other medical disciplines at IUSM, despite feedback from students that the Pulmonary Grand Rounds (PGR) teaching method is very effective. Rather than presenting content via recorded didactic lectures, the PGR team, composed of a multidisciplinary physician panel, presents clinical vignettes in an interactive setting. Furthermore, according to student feedback, the current model lacks a sufficient content review of relevant Phase I material. Students have requested additional support with pre-clerkship study/review materials content. Through this study, we aim to empirically evaluate the impact of designing interactive pre-clerkship modules reviewing relevant Phase 1 PGR material on the medical knowledge and clinical competencies of Phase II students. Background: The American Medical Women’s Association organization called for scholarship pertaining to educational innovation. The PGR curriculum provides us with a unique opportunity to evaluate the impact of undergraduate medical education on student knowledge retention and engagement from a metacognition perspective. A diverse group of students and faculty was pulled together with the IUSM Research in Medical Education unit to creatively address the ability to quantify engagement and knowledge retention above in a scholarly project. PGR is a unique multi-modal teaching design built at a large medical school with nine campuses to increase student engagement via zoom, Top Hat, and a case-based teaching approach with a multidisciplinary panel. Study objective: Evaluate student engagement and knowledge retention through clerkship standardized examination performance, Step 2 performance, and GQ with the implementation of a spaced repetition learning model comprised of interactive pre-clerkship modules which reinforce session objectives introduced in pre-clinical education. Methods: In Phase I, PGR includes over 200 board-style questions throughout nine sessions. Students engage with the medical content by answering these questions on TopHat and discussing the reasoning for correct vs. Incorrect answers with the expert panel. Students are again tested over similar content during their local and NBME exams. We proposed the creation of an optional module for each clerkship for students to use prior to Phase II. The modules would include a question bank supplemented with videos to foster preparation and enhance performance on clinical clerkships and Step 2. This question bank would utilize the same questions students had originally seen in PGR months earlier to improve concept retention and memory. The instructional videos would connect physiology to the clinical scenarios the students expect to encounter during their clerkship. We would anonymously track student engagement through a pilot-tested survey and performance on the modules along with clerkship National Board of Medical Examiners exams, Step 2, and the GQ. Finally, we plan to assess knowledge gaps to supplement future grand rounds curriculum while providing clinically relevant information to improve patient care.
  • Thumbnail Image
    Item
    Spine Injuries in Household Environments: A Comprehensive Analysis
    (Springer Nature, 2023-08-28) Singh, Gurbinder; Rao, Varun; Thamba, Aish; Pahwa, Bhavya; Zaazoue, Mohamed; Neurological Surgery, School of Medicine
    Introduction: Recognizing the concerns posed by spine injuries within homes, stemming from falls, interactions with furnishings, and daily activities, it is imperative to consider preventive strategies. Our analysis of spine injuries utilizing the National Electronic Injury Surveillance System (NEISS) data sheds light on falls, furnishings, age-specific risks, recreation, technology, and socioeconomic disparities as contributing elements, accentuating the need for targeted interventions. This study aims to provide insights into the prevalence of spine injuries in different household locations, associated products, age groups, and gender, thus informing injury prevention strategies for safer living environments. Methods: This is a retrospective, cross-sectional study utilizing data between 2013 to 2022 from the National Electronic Injury Surveillance System database. Specific household product codes and demographic data, such as age and gender, were analyzed. Statistical analysis in R (R Foundation for Statistical Computing, Vienna, Austria) involved descriptive statistics and multivariate logistic regressions. Results: In analyzing 44,267 spine injuries, the study revealed location-specific variations in spine injuries within households. Living rooms and bedrooms had the highest injury rates at 34.17% and 21.65%, respectively. Significant differences in injury rates between males and females across various home locations. Females accounted for 51.78% of injuries in the living room and 59.99% in the bedroom. In the kitchen, females experienced 53.21% of injuries, while males accounted for 46.79% of cases. Notably, overall spine injuries exhibited a significant difference between males and females, with females having a higher total likelihood of injuries (AOR = 1.21, 95% CI: 1.14-1.77, p < 0.001). Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, accounting for 17.98% of total cases. Notably, the age group of 61-70 years exhibited a substantial proportion of injuries at 17.12%, while the age group of 71-80 years accounted for 14.39%. The age group of 41-50 years also displayed a notable injury rate of 14.12%. The youngest age group, 0-10 years, demonstrated the lowest percentage of injuries at 4.79%. This age-based analysis provides valuable insights into the distribution of spine injuries across different demographic segments. Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, comprising 17.98% of total cases. Age groups of 41-50 and 61-70 years also showed substantial proportions of injuries, accounting for 14.12% and 17.12%, respectively. The youngest age group, 0-10, exhibited the lowest percentage of injuries at 4.79%. Conclusion: The study focuses on the occurrence of spinal injuries in common sites of injury in the household, such as the living room, bedroom, kitchen, and stairs. There is increased prevalence amongst females and increased risk vulnerability amongst people 51 to 60 years of age. Our research emphasizes the necessity of implementing specific injury prevention measures tailored to different demographic groups within their home setting. This approach should involve collaborative decision-making with patients while prioritizing patient education to create a safer living environment and reduce the likelihood of spine injuries.