Residency, UCLA, General Surgery (2013)
Residency, University of Southern California, General Surgery (2012)
Research Fellowship, Stanford, Minimally Invasive & Robotic Surgery (2011)
Doctor of Medicine, Tabriz University of Medical Sciences (2008)
Annals of surgery
Pressure injury is seen across all healthcare settings and affects people of any age and health condition. It imposes a significant burden, with annual costs of up to $17.8 billion in the United States alone. Despite considerable resources it exhausts, the disease remains very prevalent, and the incidence is on the rise. This is in part due to aging population, growing number of nursing home residents, poorly understood biology, and dismal track record of clinical research in this field.In our Review Article, we discuss the disease pathophysiology, clinical manifestation, evidence based recommendations for risk assessment, prevention and timely management, existing challenges, and directions to improve research on the field. This article encompasses dedicated sections on the full spectrum of the pressure related pathologies including "conventional pressure ulcers", "medical device related pressure injuries", "pressure injuries in mucosal membranes", "pressure injuries in pediatric population", "pressure injury at end of life", and the "role of pressure in pathogenesis of diabetic foot ulcers".
View details for DOI 10.1097/SLA.0000000000003567
View details for PubMedID 31460882
Pneumoperitoneum 48 Days After Laparoscopic Hysterectomy
JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS
2013; 17 (4): 661-664
Postoperative pneumoperitoneum following laparoscopic surgery is self-limited, typically resolving within days.We analyzed the case of a 48-y-old woman who presented with acute abdominal pain 48 d after a total laparoscopic hysterectomy. Imaging studies revealed free air under the diaphragm suggesting a perforated viscus.An exploratory laparotomy was performed, but no perforations or organic traumas were found intraoperatively. To the best of our knowledge, this is the longest period of time reported for persistent pneumoperitoneum after laparoscopic surgery.Absent clinical findings, introduction of atmospheric air into the abdominal cavity during the original laparoscopic surgery was the most likely cause and is supported by the literature. Pneumoperitoneum observed up to 48 d status post laparoscopic hysterectomy, in the absence of peritoneal signs, fever, leukocytosis, or hemodynamic instability, may be considered for expectant management and serial inspection for clinical change.
View details for DOI 10.4293/108680813X13794522666446
View details for Web of Science ID 000329781900026
View details for PubMedID 24398214
Evaluating Deceased Donor Registries: Identifying Predictive Factors of Donor Designation
2013; 79 (3): 235-241
The objectives of this study were to evaluate and compare the performance of the deceased donor registries of the 50 states and the District of Columbia and to identify possible predictive factors of donor designation. Data were collected retrospectively by Donate Life America using a questionnaire sent to Donor Designation Collaborative state teams between 2007 and 2010. By the end of 2010, there were 94,669,081 designated donors nationwide. This accounted for 39.8 per cent of the U.S. population aged 18 years and over. The number of designated organ donors and registry-authorized recovered donors increased each year; however, the total number of recovered donors in 2010 was the lowest since 2004. Donor designation rate was significantly higher when license applicants were verbally questioned at the Department of Motor Vehicles (DMV) regarding their willingness to register as a donor and when DMV applicants were not given an option on DMV application forms to contribute money to support organ donation, compared with not being questioned verbally, and being offered an option to contribute money. State registries continue to increase the total number of designated organ donors; however, the current availability of organs remains insufficient to meet the demand. These data suggest that DMV applicants who are approached verbally regarding their willingness to register as a donor and not given an option on DMV application forms to contribute money to support organ donation might be more likely to designate themselves to be a donor.
View details for Web of Science ID 000315606500003
View details for PubMedID 23461946
Mediastinal goiter: a comprehensive study of 60 consecutive cases with special emphasis on identifying predictors of malignancy and sternotomy
AMERICAN JOURNAL OF SURGERY
2012; 203 (4): 442-447
We describe the clinical characteristics of patients with mediastinal goiter and our principles in surgical management of this pathology; we also identify the predictive factors of malignancy, sternotomy, and posterior mediastinal extension.We conducted a retrospective chart review of 60 patients with mediastinal goiter who underwent surgical intervention.Major perioperative complications were recurrent laryngeal nerve sacrifice (3.3%) and vagus nerve sacrifice (1.7%). A total of 12.7% of cases were malignant. The presence of dysphonia increased the likelihood of malignancy (P = .02), and malignancy was associated with a significant increase in sternotomy (P = .04) and nerve sacrifice (P < .001) during surgery. A history of thyroidectomy was a predictive factor for extension of the tumor to the posterior mediastinum (P = .02).Presenting with dysphonia is a predictor of malignancy that necessitates careful surgical planning because malignancy is associated with an increase in nerve injury and sternotomy during surgery.
View details for DOI 10.1016/j.amjsurg.2011.03.010
View details for Web of Science ID 000302913700006
View details for PubMedID 21890099
On- versus Off-Pump Coronary Artery Bypass Grafting: No Difference in Early Postoperative Kidney Function Based on TNF-alpha or C-Reactive Protein
2012; 2 (3): 190-199
BACKGROUND/AIMS: There are controversial data about renal function following off-pump coronary artery bypass grafting (CABG). The present study aimed to evaluate renal function changes 24 h after on- and off-pump CABG, as well as renal function correlated with high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α). METHODS: Ninety patients with coronary artery disease referred to our center for CABG from July 2006 to November 2007 were enrolled in the study. Patients were equally and randomly divided in two groups, on- and off-pump. Serum levels of creatinine (Cr), blood urea nitrogen, creatinine clearance (CrCl), hs-CRP, and TNF-α were determined immediately before and 24 h after surgery. RESULTS: Cr and CrCl changes after surgery were not significantly different between the two groups; however, blood urea nitrogen levels after surgery were significantly higher in the on-pump group (p = 0.035). No statistically significant difference was noted between the two groups in terms of changes in levels of hs-CRP and TNF-α (p = 0.350 and 0.805, respectively). The changes in CrCl levels had no significant correlation with hs-CRP and TNF-α. CONCLUSIONS: The early Cr and CrCl levels after surgery are not significantly different in on- and off-pump groups. The early renal function after on- or off-pump CABG is not correlated with the levels of inflammatory markers including hs-CRP and TNF-α.
View details for DOI 10.1159/000339171
View details for Web of Science ID 000312167900005
View details for PubMedID 22969775
View details for PubMedCentralID PMC3433023
Laparoscopic Management of Adnexal Masses
OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA
2011; 38 (4): 663-?
With the continued expansion of endoscopic techniques and instruments, laparoscopy and minimally invasive techniques are quickly emerging as a feasible alternative to laparotomy in managing adnexal masses and ovarian cancer.Laparoscopy has the potential to completely and successfully treat both benign and malignant adnexal pathology while decreasing unnecessary morbidity among patients. Further advances in technology, techniques, and instruments can only increase this potential.
View details for DOI 10.1016/j.ogc.2011.09.003
View details for Web of Science ID 000298765600004
View details for PubMedID 22134015
Laparoscopic Management of Bowel Endometriosis: Predictors of Severe Disease and Recurrence
JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS
2011; 15 (4): 431-438
The identification of highstage and recurrent cases of bowel endometriosis is critical, because these cases require careful surgical planning. We aim to describe the clinical characteristics of women with bowel endometriosis, our principles in laparoscopic management of this pathology, and to identify predictors of severe disease and recurrence.This was a retrospective study of 193 patients with pathologically confirmed bowel endometriosis.Predictors of higher-stage endometriosis include a history of previous laparoscopic surgery (P=.04) and a presenting complaint of abnormal uterine bleeding (P=.01). The higher the stage of endometriosis, the more likely there would be coexistent urinary tract endometriosis (P=.02), a need for enterolysis (P=.002), ovarian cystectomy (P<.001), and bowel resection (P=.01) performed during laparoscopy. Patients with higher body mass index (BMI) had significantly higher recurrence rates of endometriosis compared to those with lower BMI (P=.002). Within our cohort, 87% of our patients achieved amelioration of symptoms by the end of the first postoperative month.Our study confirms that laparoscopic management of bowel endometriosis is safe and effective. We found 2 statistically significant predictors of higher-stage disease that should prompt careful surgical planning. Obesity is associated with a higher rate of recurrence of endometriosis.
View details for DOI 10.4293/108680811X13176785203752
View details for Web of Science ID 000303606700001
View details for PubMedID 22643495
View details for PubMedCentralID PMC3340949
Atherogenic changes of low-density lipoprotein susceptibility to oxidation, and antioxidant enzymes in pulmonary tuberculosis
2011; 217 (1): 268-273
Tuberculosis remains one of the most common infectious diseases and a leading cause of mortality world wide. There is some evidence for the possible involvement of Mycobacterium tuberculosis in atherosclerosis. We aim to investigate total antioxidant capacity (TAC), red blood cell superoxide dismutase (SOD) activity, whole blood glutathione peroxidase (GPX) activity, low-density lipoprotein (LDL) susceptibility to oxidation, and malondialdehyde (MDA) levels in patients with pulmonary tuberculosis (PTB).Forty-five males with active PTB (case group) and 45 healthy age-matched males (control group) were enrolled in the study. TAC, SOD and GPX activities were determined by commercial ELISA kits. MDA levels were measured using the thiobarbituric acid method. LDL susceptibility to oxidation was assessed by measuring lag phase duration.TAC, SOD and GPX activities, and lag phase duration in the case group were significantly lower than the control group (p=.002, p=.004, p=.008, and p=.004, respectively; independent), while the MDA levels was higher in case group (p=.024).Our findings suggest a higher susceptibility of LDL to oxidation and higher levels of lipid peroxidation, and therefore, a possible higher risk of atherosclerosis in patients with PTB.
View details for DOI 10.1016/j.atherosclerosis.2011.03.025
View details for Web of Science ID 000292731300042
View details for PubMedID 21497814
Robotic-Assisted Laparoscopic Treatment of Bowel, Bladder, and Ureteral Endometriosis
JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS
2011; 15 (3): 387-392
Endometriosis commonly affects the pelvic organs but can also affect organs outside the pelvis and is then termed extragenital endometriosis.Successful robotically assisted laparoscopic management of extragenital endometriosis, specifically, endometriosis of the bowel, bladder, and ureter in 5 patients.A substantial body of evidence supports the laparoscopic approach as the preferred method for many procedures; yet, a majority of procedures today still are performed by laparotomy. This preference for open procedures is likely due to the lack of trained endoscopic surgeons, the difficulty in obtaining proper instruments, and the long learning curve of operative laparoscopy. The recent advent of computer-enhanced technology may provide the bridge necessary for more surgeons to incorporate laparoscopic surgery in the treatment of complex cases.
View details for DOI 10.4293/108680811X13125733356396
View details for Web of Science ID 000295890800022
View details for PubMedID 21985730
View details for PubMedCentralID PMC3183562
- Pioneers in Laparoscopic Colon Surgery JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2011; 212 (3): 423-424
Lovastatin enhances paraoxonase enzyme activity and quells low-density lipoprotein susceptibility to oxidation in type 2 diabetic nephropathy
2011; 44 (2-3): 165-170
: To investigate the effect of lovastatin therapy and withdrawal on paraoxonase 1 (PON1) and arylesterase (ARE) activities, and low-density lipoprotein cholesterol (LDL-C) susceptibility to oxidation in people with type 2 diabetic nephropathy (T2DN).: Lovastatin (20mg/day) was administered to 30 people with T2DN for 90days and then withdrawn for 30days. PON1 and ARE activities were measured by the spectrophotometric method. Susceptibility of LDL-C to oxidation was determined as the production of conjugated dienes.: After 90days of lovastatin intervention, PON1 and ARE activities and LDL-C lag phase were significantly increased (p=0.004, 0.002, and <0.001), while after 30days of lovastatin withdrawal, PON1 and ARE activities and LDL-C lag phase had not changed significantly.: Lovastatin therapy improves PON1 and ARE activities, and LDL-C susceptibility to oxidation. Despite withdrawal of lovastatin, PON1 and ARE activities, and LDL-C susceptibility to oxidation remain unchanged in people with T2DN.
View details for DOI 10.1016/j.clinbiochem.2010.10.006
View details for Web of Science ID 000286959100005
View details for PubMedID 20970413
Robotic versus standard laparoscopy for the treatment of endometriosis
FERTILITY AND STERILITY
2010; 94 (7): 2758-2760
To compare robot assisted laparoscopic platform to standard laparoscopy for the treatment of endometriosis.A retrospective cohort controlled study.Tertiary referral center.Seventy-eight reproductive aged women.Robot assisted or standard laparoscopy for the treatment of endometriosis between January 2008 and January 2009.Operative time, estimated blood loss, hospitalization time, intraoperative and postoperative complications.Seventy-eight patients underwent treatment of endometriosis, 40 by robot assisted laparoscopy and 38 by standard laparoscopy. The two groups were matched for age, body mass index (BMI), stage of endometriosis, and previous abdominal surgery. Mean operative time with the robot was 191 minutes (range 135-295 minutes) compared with 159 minutes (range 85-320 minutes) during standard laparoscopy. There were no significant differences in blood loss, hospitalization, intraoperative or postoperative complications. There were no conversions to laparotomy.Both robot assisted laparoscopic and standard laparoscopic treatment of endometriosis have excellent outcomes. The robotic technique required significantly longer surgical and anesthesia time, as well as larger trocars.
View details for DOI 10.1016/j.fertnstert.2010.04.031
View details for Web of Science ID 000284573700053
View details for PubMedID 20537632
Familial Cystic Teratomas: Four Case Reports and Review of the Literature
JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY
2010; 17 (6): 782-786
Mature cystic teratomas (MCTs) are some of the most common ovarian neoplasms in women of reproductive age. However, familial teratomas are exceedingly rare. We present 4 cases of dermoid cysts seen in a mother and her 3 daughters with left MCTs. None of the patients had symptoms at the time of diagnosis, but all of them were diagnosed in their twenties during an annual gynecologic examination. In this report, we elaborate on MCTs familial incidence, genetic linkage, theories of pathogenesis, diagnosis, complications, and surgical management. To our knowledge, after extensive review of the literature, there have been only 2 cases, in addition to the present case, of unilateral MCTs across generations reported.
View details for DOI 10.1016/j.jmig.2010.06.006
View details for Web of Science ID 000283897500020
View details for PubMedID 20955989
CLINICAL OBSTETRICS AND GYNECOLOGY
2010; 53 (2): 449-466
In recent years, there have been significant changes in many aspects of extragenital endometriosis ranging from the epidemiology to the management of the disease. Advances in minimally invasive surgery and expansion of the field have lead to further research in management of extragenital endometriosis. As a result, treatment has shifted from medical management toward a surgical, multidisciplinary approach. Surgery for extragenital endometriosis clearly improves outcome through relief of symptoms, improved quality-of-life, increased fertility rates, and reduced recurrences. Endoscopy has a pivotal role as both a diagnostic and therapeutic tool.
View details for DOI 10.1097/GRF.0b013e3181e0ea6e
View details for Web of Science ID 000280369900020
View details for PubMedID 20436322
Endometriosis of the Diaphragm: Four Cases Treated with a Combination of Laparoscopy and Thoracoscopy
JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY
2009; 16 (5): 573-580
We aim to describe the clinical characteristics and the principles of combined laparoscopic and thoracoscopic management of women with diaphragmatic endometriosis at our institution.Case series (Canadian Task Force Classification II2).Tertiary care referral center.Four women with diaphragmatic endometriosis.Laparoscopy and thoracoscopy.We retrospectively reviewed the charts of 4 consecutive women with diaphragmatic endometriosis who underwent laparoscopy and thoracoscopy from June 2008 through September 2008.Four patients underwent a combination of laparoscopy for treatment of abdominopelvic endometriosis and thoracoscopy for treatment of diaphragmatic endometriosis. All patients had a history of chest pain. Three had a history of pelvic pain. Two had a history of catamenial hemothorax or pneumothorax. Two had been previously diagnosed with endometriosis, and three had a history of hormonal pharmacotherapy. All underwent laparoscopy and thoracoscopy without complications. All had uneventful recoveries. At nine-month follow-up, all patients were free of chest pain, and one patient had recurring pelvic pain.To the best of our knowledge, this constitutes the only reported series of patients with endometriosis who underwent a procedure systematically combining both laparoscopy and thoracoscopy for treatment of abdominopelvic and thoracic disease. It confirms that combined laparoscopic and thoracoscopic diagnosis and management of diaphragmatic endometriosis is reasonable. The inferior aspect of the diaphragm should be evaluated in all patients undergoing laparoscopy for endometriosis. Concomitant thoracoscopy should be considered for all patients with history of catamenial hemopneumothorax, cyclic chest or shoulder pain, or cyclic dyspnea. The aim of treatment should be to remove endometriotic lesions, to provide symptomatic relief, and to avoid recurrence. The use of these minimally invasive techniques may reduce the need for laparotomy or thoracotomy in affected patients.
View details for DOI 10.1016/j.jmig.2009.06.012
View details for Web of Science ID 000269938300011
View details for PubMedID 19835800