A 55-year-old man presented to his general practitioner with sudden local discomfort in the left ... more A 55-year-old man presented to his general practitioner with sudden local discomfort in the left calf. His symptoms were atypical and vague. Subsequently, he was referred for diagnostic imaging. Ultrasound identified a well circumscribed nodular mass in the popliteal fossa with a diameter of approximately 25 mm and a heterogeneous, hypoechoic appearance (Fig. ). The origin of the mass was not entirely clear on US and subsequently a MRI study was performed. A hyperintense mass on T2weighted imaging (WI) was surrounded with a hypo-intense peripheral rim. The lesion was in the popliteal fossa (Fig. ). Surrounded muscular edema was noted. On T1 WI this lesion showed low central signal intensity with a hyperintense peripheral rim. This rim further intensified following intravenous contrast administration (Fig. ). Sagittal images showed clear continuity of the mass with a thrombosed gastrocnemius vein (Fig. ). The diagnosis of thrombosed popliteal aneurysm of a gastrocnemius vein was made. Further imaging with CT following intravenous contrast administration showed extension of the thrombus in the popliteal vein and into the superficial femoral vein. The patient was treated by intravenous heparin and subsequently underwent surgery, which confirmed the diagnosis. During surgery, the aneurysm was resected and the proximal and distal vein were ligated (Fig. ). A follow-up duplex US the next day showed normal flow in the popliteal vein. The patient was dismissed from the hospital, and placed on warfarin therapy for 3 months.
BackgroundSedentary behavior is considered a separate construct from physical activity and engagi... more BackgroundSedentary behavior is considered a separate construct from physical activity and engaging in sedentary behaviors results in health effects independent of physical activity levels. A major source of sedentary behavior in children is time spent viewing TV or movies, playing video games, and using computers. To date no study has examined the impact of neighborhood socioeconomic status (SES) on pre-school children's screen time behavior.MethodsProxy reports of weekday and weekend screen time (TV/movies, video games, and computer use) were completed by 1633 parents on their 4-5 year-old children in Edmonton, Alberta between November, 2005 and August, 2007. Postal codes were used to classified neighborhoods into low, medium or high SES. Multiple linear and logistic regression models were conducted to examine relationships between screen time and neighborhood SES.ResultsGirls living in low SES neighborhoods engaged in significantly more weekly overall screen time and TV/movie...
Background The objective of this study was to identify predictors of mortality among patients pre... more Background The objective of this study was to identify predictors of mortality among patients presenting to the emergency department (ED) with attempted suicides. Methods We analyzed data on emergency department (ED) visits for attempted suicides from the Nationwide Emergency Department Sample (NEDS) database from January 2010 to December 2017. The predictors of mortality were determined in multivariate analysis including age, sex, insurance, annual income, region of the country, mechanism of injury, mental health conditions (schizophrenia; depression; and anxiety, bipolar, and personality disorders), chronic illnesses (hypertension, diabetes, obesity, and dementia), and social risk factors such as alcohol addiction, smoking, and substance abuse. Results From 2010 to 2017, there were 979,383 ED visits for attempted suicides in the NEDS database. Among these patients, 10,301 (1.1%) died. Of these completed suicides, 73.9% were male with the median age of 43 years (IQR, 30) while the ...
Background This study aimed to investigate the relationship between community-level economic depr... more Background This study aimed to investigate the relationship between community-level economic deprivation, as measured by the Distressed Communities Index (DCI) and ED visits on account of firearm injuries (assaults and unintentional). Methods A retrospective analysis was conducted using the Maryland State Emergency Department Databases (SEDD) from January 2019 to December 2020 to explore the association between the DCI and ED visits because of firearm injuries (assaults and unintentional). The DCI utilizes 7 variables, based on zip codes, generating 5 levels of socioeconomic distress (prosperous, comfortable, mid-tier, at-risk, and distressed). In a multivariate analysis, we adjusted for age, sex, mental conditions, alcohol addiction, substance abuse, smoking, race/ethnicity, insurance type, and median income. Results Of the 2725 ED visits for firearm injuries, 84.5% were Black and 88.5% male. The median age was 27 (21-35) years, and the mortality rate was 17.7%. A statistically sig...
Objective: To examine patterns and trends of firearm injuries in a nationally representative samp... more Objective: To examine patterns and trends of firearm injuries in a nationally representative sample of US women. Summary of Background Data: Gun violence in the United States exceeds rates seen in most other industrialized countries. Due to the paucity of data little is known regarding demographics and temporal variations in firearm injuries among women. Methods: Data were extracted from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (2001–2017) for women 18 years and older. Number of nonfatal firearm assaults and homicide per year were extracted and crude population-based injury rates were calculated. Sub-stratification by age-group and time period were performed. Results: Between 2001 and 2017, there were 88,823 nonfatal firearm assaults involving women and 29,106 firearm homicides. There were 4116 victims of nonfatal firearm assault in 2001 (3.8 per 105) and 12,959 by 2017 (10.0 per 105). Homicide rates were 1.5 per 105...
African Annals of Thoracic and Cardiovascular Surgery, 2021
Department of Health Policy and Management, School of Public Health, University of Maryland, 4200... more Department of Health Policy and Management, School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD 20742, United States. Department of Surgery, Howard University College of Medicine, 2041 Georgia Ave NW, Washington, DC 20060, United States. Louis Stokes Health Sciences Library, College of Medicine, Howard University, 501 W Street NW, Washington, DC 20060, United States. Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD 20742, United States. University of Maryland Capital Region Health, 3001 Hospital Dr, Cheverly, MD 20785, United States.
OBJECTIVE While several studies have evaluated the impact of obesity on outcomes following abdomi... more OBJECTIVE While several studies have evaluated the impact of obesity on outcomes following abdominal aortic aneurysm repair, literature examining this association in thoracic endovascular aortic repair (TEVAR) is sparse. Here, we use a multi-institutional, international database to assess the role of body mass index (BMI) on adverse outcomes in patients undergoing TEVAR for descending thoracic aortic aneurysms (DTAA) and type B dissections (TBD). METHODS A retrospective review of all patients undergoing TEVAR for DTAA or TBD from August 2014 to August 2020 was performed. Patients who were underweight (BMI<18.5Kg/m2) or obese (BMI≥30Kg/m2) were compared to those of normal weight (≥18.5-<30Kg/m2). Adjustment for confounding was done with multivariable logistic regression or Cox proportional hazards regression as appropriate for studying postoperative or long-term outcomes. Primary outcomes were 30-day and 1-year mortality. Other outcomes included any postoperative complication, stroke, and spinal cord ischemia. RESULTS A total of 3,423 participants were included in the study, of which 3.3% (n=113) were underweight, 65.9% (n=2,253) had normal weight and 30.8% (n=1,053) were obese. Compared to normal weight, there was no significant difference in 30-day mortality in underweight patients (OR, 1.81; 95%CI, 0.80-4.14; P=0.156). Obese patients undergoing TEVAR for TBD had a 2.7-fold increase in the odds of 30-day mortality compared to normal weight (OR, 2.67, 95%CI, 1.52-4.68; P=0.001). Obese and normal weight patients with DTAA had equivalent odds of 30-day mortality (OR, 1.32; 95%CI, 0.79-2.23, P=0.292). The adjusted hazard of 1-year mortality was 2-fold higher in underweight patients compared to normal weight (HR, 2.15, 95%CI, 1.41-3.29, P<0.001), driven by a higher risk of mortality among patients with thoracic aortic aneurysm (OR, 2.62; 95%CI, 1.63-4.21; P<0.001). There was no significant difference in 1-year mortality risk between normal weight and obesity in both DTAA (OR, 0.77; 95%, 0.54-1.09; P=0.146) and TBD (OR, 1.26; 95%CI, 0.85-1.86; P=0.248). CONCLUSIONS In this study, obese patients undergoing TEVAR for DTAA had comparable 30-day and 1-year mortality risk as normal weight individuals. Obese patients undergoing TEVAR for TBD demonstrated 2.7-fold increase in the odds of 30-day mortality, but equivalent mortality risk as normal weight patients at 1 year. TEVAR represents a safe minimally invasive option for treatment of DTAA in obese patients. Future work should be directed towards minimizing perioperative mortality among patients with TBD in order to optimize TEVAR outcomes.
OBJECTIVE Our aim was to describe the racial and ethnic differences in presentation, baseline and... more OBJECTIVE Our aim was to describe the racial and ethnic differences in presentation, baseline and operative characteristics, and outcomes after aortoiliac aneurysm repair. SUMMARY OF BACKGROUND DATA Previous studies have demonstrated racial and ethnic differences in prevalence of abdominal aortic aneurysms and showed more complex iliac anatomy in Asian patients. METHODS We identified all White, Black, Asian, and Hispanic patients undergoing aortoiliac aneurysm repair in the VQI from 2003 to 2019. We compared baseline comorbidities, operative characteristics, and perioperative outcomes by race and ethnicity. RESULTS In our 60,435 patient cohort, Black patients, followed by Asian patients, were most likely to undergo repair for aortoiliac (W:23%, B:38%, A:31%, H:22%, P < 0.001) and isolated iliac aneurysms (W:1.0%, B:3.1%, A:1.5%, H:1.6%, P < 0.001), and White and Hispanic patients were most likely to undergo isolated aortic aneurysm repair (W:76%, B:59%, A:68%, H:76%, P < 0.001). Black patients were more likely to undergo symptomatic repair and underwent rupture repair at a smaller aortic diameter. The iliac aneurysm diameter was largest in Black and Asian patients. Asian patients were most likely to have aortic neck angulation above 60 degree, graft oversizing above 20%, and completion endoleaks. Also, Asian patients were more likely to have a hypogastric artery aneurysm and to undergo hypogastric coiling. CONCLUSION Asian and Black patients were more likely to undergo repair for aortoiliac and isolated iliac aneurysms compared to White and Hispanic patients who were more likely to undergo repair for isolated aortic aneurysms. Moreover, there were significant racial differences in the demographics and anatomic characteristics that could be used to inform operative approach and device development.
Supplemental Material, Supplementrary_Table_1 for Atherosclerotic Peripheral Artery Disease in th... more Supplemental Material, Supplementrary_Table_1 for Atherosclerotic Peripheral Artery Disease in the United States: Gender and Ethnic Variation in a Multiple Cause-of-Death Analysis by Andy-Bleck Nwancha, Eduardo Alvarado, Jiali Ma, Richard F. Gillum and Kakra Hughes in Vascular and Endovascular Surgery
A 55-year-old man presented to his general practitioner with sudden local discomfort in the left ... more A 55-year-old man presented to his general practitioner with sudden local discomfort in the left calf. His symptoms were atypical and vague. Subsequently, he was referred for diagnostic imaging. Ultrasound identified a well circumscribed nodular mass in the popliteal fossa with a diameter of approximately 25 mm and a heterogeneous, hypoechoic appearance (Fig. ). The origin of the mass was not entirely clear on US and subsequently a MRI study was performed. A hyperintense mass on T2weighted imaging (WI) was surrounded with a hypo-intense peripheral rim. The lesion was in the popliteal fossa (Fig. ). Surrounded muscular edema was noted. On T1 WI this lesion showed low central signal intensity with a hyperintense peripheral rim. This rim further intensified following intravenous contrast administration (Fig. ). Sagittal images showed clear continuity of the mass with a thrombosed gastrocnemius vein (Fig. ). The diagnosis of thrombosed popliteal aneurysm of a gastrocnemius vein was made. Further imaging with CT following intravenous contrast administration showed extension of the thrombus in the popliteal vein and into the superficial femoral vein. The patient was treated by intravenous heparin and subsequently underwent surgery, which confirmed the diagnosis. During surgery, the aneurysm was resected and the proximal and distal vein were ligated (Fig. ). A follow-up duplex US the next day showed normal flow in the popliteal vein. The patient was dismissed from the hospital, and placed on warfarin therapy for 3 months.
BackgroundSedentary behavior is considered a separate construct from physical activity and engagi... more BackgroundSedentary behavior is considered a separate construct from physical activity and engaging in sedentary behaviors results in health effects independent of physical activity levels. A major source of sedentary behavior in children is time spent viewing TV or movies, playing video games, and using computers. To date no study has examined the impact of neighborhood socioeconomic status (SES) on pre-school children's screen time behavior.MethodsProxy reports of weekday and weekend screen time (TV/movies, video games, and computer use) were completed by 1633 parents on their 4-5 year-old children in Edmonton, Alberta between November, 2005 and August, 2007. Postal codes were used to classified neighborhoods into low, medium or high SES. Multiple linear and logistic regression models were conducted to examine relationships between screen time and neighborhood SES.ResultsGirls living in low SES neighborhoods engaged in significantly more weekly overall screen time and TV/movie...
Background The objective of this study was to identify predictors of mortality among patients pre... more Background The objective of this study was to identify predictors of mortality among patients presenting to the emergency department (ED) with attempted suicides. Methods We analyzed data on emergency department (ED) visits for attempted suicides from the Nationwide Emergency Department Sample (NEDS) database from January 2010 to December 2017. The predictors of mortality were determined in multivariate analysis including age, sex, insurance, annual income, region of the country, mechanism of injury, mental health conditions (schizophrenia; depression; and anxiety, bipolar, and personality disorders), chronic illnesses (hypertension, diabetes, obesity, and dementia), and social risk factors such as alcohol addiction, smoking, and substance abuse. Results From 2010 to 2017, there were 979,383 ED visits for attempted suicides in the NEDS database. Among these patients, 10,301 (1.1%) died. Of these completed suicides, 73.9% were male with the median age of 43 years (IQR, 30) while the ...
Background This study aimed to investigate the relationship between community-level economic depr... more Background This study aimed to investigate the relationship between community-level economic deprivation, as measured by the Distressed Communities Index (DCI) and ED visits on account of firearm injuries (assaults and unintentional). Methods A retrospective analysis was conducted using the Maryland State Emergency Department Databases (SEDD) from January 2019 to December 2020 to explore the association between the DCI and ED visits because of firearm injuries (assaults and unintentional). The DCI utilizes 7 variables, based on zip codes, generating 5 levels of socioeconomic distress (prosperous, comfortable, mid-tier, at-risk, and distressed). In a multivariate analysis, we adjusted for age, sex, mental conditions, alcohol addiction, substance abuse, smoking, race/ethnicity, insurance type, and median income. Results Of the 2725 ED visits for firearm injuries, 84.5% were Black and 88.5% male. The median age was 27 (21-35) years, and the mortality rate was 17.7%. A statistically sig...
Objective: To examine patterns and trends of firearm injuries in a nationally representative samp... more Objective: To examine patterns and trends of firearm injuries in a nationally representative sample of US women. Summary of Background Data: Gun violence in the United States exceeds rates seen in most other industrialized countries. Due to the paucity of data little is known regarding demographics and temporal variations in firearm injuries among women. Methods: Data were extracted from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (2001–2017) for women 18 years and older. Number of nonfatal firearm assaults and homicide per year were extracted and crude population-based injury rates were calculated. Sub-stratification by age-group and time period were performed. Results: Between 2001 and 2017, there were 88,823 nonfatal firearm assaults involving women and 29,106 firearm homicides. There were 4116 victims of nonfatal firearm assault in 2001 (3.8 per 105) and 12,959 by 2017 (10.0 per 105). Homicide rates were 1.5 per 105...
African Annals of Thoracic and Cardiovascular Surgery, 2021
Department of Health Policy and Management, School of Public Health, University of Maryland, 4200... more Department of Health Policy and Management, School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD 20742, United States. Department of Surgery, Howard University College of Medicine, 2041 Georgia Ave NW, Washington, DC 20060, United States. Louis Stokes Health Sciences Library, College of Medicine, Howard University, 501 W Street NW, Washington, DC 20060, United States. Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD 20742, United States. University of Maryland Capital Region Health, 3001 Hospital Dr, Cheverly, MD 20785, United States.
OBJECTIVE While several studies have evaluated the impact of obesity on outcomes following abdomi... more OBJECTIVE While several studies have evaluated the impact of obesity on outcomes following abdominal aortic aneurysm repair, literature examining this association in thoracic endovascular aortic repair (TEVAR) is sparse. Here, we use a multi-institutional, international database to assess the role of body mass index (BMI) on adverse outcomes in patients undergoing TEVAR for descending thoracic aortic aneurysms (DTAA) and type B dissections (TBD). METHODS A retrospective review of all patients undergoing TEVAR for DTAA or TBD from August 2014 to August 2020 was performed. Patients who were underweight (BMI<18.5Kg/m2) or obese (BMI≥30Kg/m2) were compared to those of normal weight (≥18.5-<30Kg/m2). Adjustment for confounding was done with multivariable logistic regression or Cox proportional hazards regression as appropriate for studying postoperative or long-term outcomes. Primary outcomes were 30-day and 1-year mortality. Other outcomes included any postoperative complication, stroke, and spinal cord ischemia. RESULTS A total of 3,423 participants were included in the study, of which 3.3% (n=113) were underweight, 65.9% (n=2,253) had normal weight and 30.8% (n=1,053) were obese. Compared to normal weight, there was no significant difference in 30-day mortality in underweight patients (OR, 1.81; 95%CI, 0.80-4.14; P=0.156). Obese patients undergoing TEVAR for TBD had a 2.7-fold increase in the odds of 30-day mortality compared to normal weight (OR, 2.67, 95%CI, 1.52-4.68; P=0.001). Obese and normal weight patients with DTAA had equivalent odds of 30-day mortality (OR, 1.32; 95%CI, 0.79-2.23, P=0.292). The adjusted hazard of 1-year mortality was 2-fold higher in underweight patients compared to normal weight (HR, 2.15, 95%CI, 1.41-3.29, P<0.001), driven by a higher risk of mortality among patients with thoracic aortic aneurysm (OR, 2.62; 95%CI, 1.63-4.21; P<0.001). There was no significant difference in 1-year mortality risk between normal weight and obesity in both DTAA (OR, 0.77; 95%, 0.54-1.09; P=0.146) and TBD (OR, 1.26; 95%CI, 0.85-1.86; P=0.248). CONCLUSIONS In this study, obese patients undergoing TEVAR for DTAA had comparable 30-day and 1-year mortality risk as normal weight individuals. Obese patients undergoing TEVAR for TBD demonstrated 2.7-fold increase in the odds of 30-day mortality, but equivalent mortality risk as normal weight patients at 1 year. TEVAR represents a safe minimally invasive option for treatment of DTAA in obese patients. Future work should be directed towards minimizing perioperative mortality among patients with TBD in order to optimize TEVAR outcomes.
OBJECTIVE Our aim was to describe the racial and ethnic differences in presentation, baseline and... more OBJECTIVE Our aim was to describe the racial and ethnic differences in presentation, baseline and operative characteristics, and outcomes after aortoiliac aneurysm repair. SUMMARY OF BACKGROUND DATA Previous studies have demonstrated racial and ethnic differences in prevalence of abdominal aortic aneurysms and showed more complex iliac anatomy in Asian patients. METHODS We identified all White, Black, Asian, and Hispanic patients undergoing aortoiliac aneurysm repair in the VQI from 2003 to 2019. We compared baseline comorbidities, operative characteristics, and perioperative outcomes by race and ethnicity. RESULTS In our 60,435 patient cohort, Black patients, followed by Asian patients, were most likely to undergo repair for aortoiliac (W:23%, B:38%, A:31%, H:22%, P < 0.001) and isolated iliac aneurysms (W:1.0%, B:3.1%, A:1.5%, H:1.6%, P < 0.001), and White and Hispanic patients were most likely to undergo isolated aortic aneurysm repair (W:76%, B:59%, A:68%, H:76%, P < 0.001). Black patients were more likely to undergo symptomatic repair and underwent rupture repair at a smaller aortic diameter. The iliac aneurysm diameter was largest in Black and Asian patients. Asian patients were most likely to have aortic neck angulation above 60 degree, graft oversizing above 20%, and completion endoleaks. Also, Asian patients were more likely to have a hypogastric artery aneurysm and to undergo hypogastric coiling. CONCLUSION Asian and Black patients were more likely to undergo repair for aortoiliac and isolated iliac aneurysms compared to White and Hispanic patients who were more likely to undergo repair for isolated aortic aneurysms. Moreover, there were significant racial differences in the demographics and anatomic characteristics that could be used to inform operative approach and device development.
Supplemental Material, Supplementrary_Table_1 for Atherosclerotic Peripheral Artery Disease in th... more Supplemental Material, Supplementrary_Table_1 for Atherosclerotic Peripheral Artery Disease in the United States: Gender and Ethnic Variation in a Multiple Cause-of-Death Analysis by Andy-Bleck Nwancha, Eduardo Alvarado, Jiali Ma, Richard F. Gillum and Kakra Hughes in Vascular and Endovascular Surgery
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