- Infectious Disease
Clinical Instructor, Surgery - Vascular Surgery
Board Certification: American Board of Internal Medicine, Infectious Disease (2018)
Fellowship: UT Southwestern Infectious Disease Fellowship (2018) TX
Board Certification: American Board of Internal Medicine, Internal Medicine (2016)
Residency: Saint Barnabas Medical Center Dept of Medicine (2016) NJ
Medical Education: M S Ramaiah Medical College (2011) India
Early observations on large language models for venous disease
SAGE PUBLICATIONS LTD. 2023: 510
View details for Web of Science ID 001083593400040
A Systematic Review on Ablation Techniques for Larger Saphenous Veins in Patients with Symptomatic Superficial Venous Disease.
Journal of vascular surgery. Venous and lymphatic disorders
To summarize the existing evidence for the treatment of saphenous veins >10 mm in diameter, determine whether there were vein size limits for treatment modalities and if there are specific technical considerations for treatment of large veins.We searched the literature for reports of treatment methods and outcomes for patients with large-diameter saphenous veins treated with various ablation methods between 1993 and 2023. These studies were evaluated for the size of the vein determined as "large diameter," type of ablation method, study type, outcomes, adverse events, and any technical considerations noted. A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The COVIDENCE software was used for full-text screening and data extraction. Three reviewers reviewed the data, and the content expert served as the tiebreaker.Seventy-one records were identified, of which, twenty-four studies were deemed appropriate for extraction. Most of the studies identified reported outcomes of endovenous thermal ablation (EVTA) modalities. There were fewer studies on non-thermal non-tumescent techniques (NTNT) and these studies reported an overall lower occlusion rate compared to EVTA techniques.Large head-to-head trials or randomized controlled that compare all the modalities over a long follow-up duration are yet to be performed. In the existing literature, there is considerable heterogeneity in terms of the study size, design, definition of large veins, site of vein measurement and follow-up periods making it challenging to make fair comparisons and draw firm conclusions. Currently available evidence supports the use of endothermal ablation techniques for the treatment of veins > 10 mm in diameter as they have a more favorable efficacy and safety profile and have a larger body of evidence available compared to NTNT techniques or surgery.
View details for DOI 10.1016/j.jvsv.2023.08.020
View details for PubMedID 37703943
The potential of chatbots in chronic venous disease patient management.
Health care providers and recipients have been using artificial intelligence and its subfields, such as natural language processing and machine learning technologies, in the form of search engines to obtain medical information for some time now. Although a search engine returns a ranked list of webpages in response to a query and allows the user to obtain information from those links directly, ChatGPT has elevated the interface between humans with artificial intelligence by attempting to provide relevant information in a human-like textual conversation. This technology is being adopted rapidly and has enormous potential to impact various aspects of health care, including patient education, research, scientific writing, pre-visit/post-visit queries, documentation assistance, and more. The objective of this study is to assess whether chatbots could assist with answering patient questions and electronic health record inbox management.We devised two questionnaires: (1) administrative and non-complex medical questions (based on actual inbox questions); and (2) complex medical questions on the topic of chronic venous disease. We graded the performance of publicly available chatbots regarding their potential to assist with electronic health record inbox management. The study was graded by an internist and a vascular medicine specialist independently.On administrative and non-complex medical questions, ChatGPT 4.0 performed better than ChatGPT 3.5. ChatGPT 4.0 received a grade of 1 on all the questions: 20 of 20 (100%). ChatGPT 3.5 received a grade of 1 on 14 of 20 questions (70%), grade 2 on 4 of 16 questions (20%), grade 3 on 0 questions (0%), and grade 4 on 2/20 questions (10%). On complex medical questions, ChatGPT 4.0 performed the best. ChatGPT 4.0 received a grade of 1 on 15 of 20 questions (75%), grade 2 on 2 of 20 questions (10%), grade 3 on 2 of 20 questions (10%), and grade 4 on 1 of 20 questions (5%). ChatGPT 3.5 received a grade of 1 on 9 of 20 questions (45%), grade 2 on 4 of 20 questions (20%), grade 3 on 4 of 20 questions (20%), and grade 4 on 3 of 20 questions (15%). Clinical Camel received a grade of 1 on 0 of 20 questions (0%), grade 2 on 5 of 20 questions (25%), grade 3 on 5 of 20 questions (25%), and grade 4 on 10 of 20 questions (50%).Based on our interactions with ChatGPT regarding the topic of chronic venous disease, it is plausible that in the future, this technology may be used to assist with electronic health record inbox management and offload medical staff. However, for this technology to receive regulatory approval to be used for that purpose, it will require extensive supervised training by subject experts, have guardrails to prevent "hallucinations" and maintain confidentiality, and prove that it can perform at a level comparable to (if not better than) humans. (JVS-Vascular Insights 2023;1:100019.).
View details for DOI 10.1016/j.jvsvi.2023.100019
View details for PubMedID 37701430
View details for PubMedCentralID PMC10497234
Cyanoacrylate Glue Reactions: A Systematic Review, Cases, and Proposed Mechanisms.
Journal of vascular surgery. Venous and lymphatic disorders
OBJECTIVE: Cyanoacrylate Glue Closure (CAC) was first used in humans ten years ago to treat venous reflux of the axial veins. Studies have since shown its clinical efficacy in vein closure. However, there is much need to elucidate further, the types of specific adverse reactions that cyanoacrylate glue can cause, and to perform patient selection better and minimize these events. In this study, we systematically reviewed the literature to identify the types of reported reactions. In addition, we explored the pathophysiology contributing to these and proposed the mechanistic pathway with a showcase of actual cases.METHODS: We searched the literature for reports of reactions following cyanoacrylate glue use in patients with venous diseases between 2012 and 2022. The search was performed using Medical Subject Headings (MeSH) terms. The terms included cyanoacrylate, venous insufficiency, chronic venous disorder, varicose veins, vein varicosities, venous ulcer, venous wound, CEAP, vein, adverse events, phlebitis, hypersensitivity, foreign body granuloma, giant cell, endovenous glue induced thrombosis (EGIT), and allergy. The search was limited to the literature published in English. These studies were evaluated for the type of product used, and the reactions noted. A systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, was performed. The COVIDENCE software was used for full-text screening and data extraction. Two reviewers reviewed the data, and the content expert served as the tiebreaker.RESULTS: One hundred and two records were identified, of which, thirty-seven records reported on cyanoacrylate use other than in the context of chronic venous diseases and were excluded. Fifty-five reports were determined appropriate for data extraction. The adverse reactions to cyanoacrylate glue were phlebitis, hypersensitivity, foreign body granuloma, and endovenous glue induced thrombosis (EGIT).CONCLUSIONS: Although cyanoacrylate glue closure for venous reflux is generally a safe and clinically effective treatment choice for symptomatic chronic venous disease patients with axial reflux, some adverse events may be specific to the properties of the cyanoacrylate product. We proposed mechanisms for how such reactions can occur based on histological changes, published reports, and case examples; however, further exploration is necessary to confirm these theories.
View details for DOI 10.1016/j.jvsv.2023.03.018
View details for PubMedID 37054883
Rare adverse event following cyanoacrylate closure of greater saphenous vein
SAGE PUBLICATIONS LTD. 2022: NP7-NP8
View details for Web of Science ID 000923957000029