Neal Atul Patel

All Publications

• A Retrospective Cohort Study of Implantable Pulse Generator Surgical Site Infections After Deep Brain Stimulation Surgery With an Antibacterial Envelope. Neuromodulation : journal of the International Neuromodulation Society Sayadi, J. J., Rodrigues, A. J., Patel, N. A., Ayer, A., Henderson, J. M. 2022

  Abstract

  INTRODUCTION: Deep brain stimulation (DBS) surgery is an established treatment for many patients with neurologic disease, and a common complication of DBS is surgical site infection (SSI). In 2016, neurosurgeons at our institution began enclosing implantable pulse generators (IPGs) within fully absorbable, antibacterial envelopes in patients who underwent initial DBS implantation. We sought to determine whether the use of antibacterial envelopes reduced IPG-related SSIs.MATERIALS AND METHODS: We performed a retrospective chart review of all adult patients who underwent initial DBS implantation at Stanford Hospital between November 14, 2012, and November 9, 2020. Operative details, perioperative antibiotics, comorbidities, and postoperative complications were extracted for all patients. Univariate and multivariate logistic regression were used to identify factors associated with SSIs within three months of surgery, and interrupted time-series analysis was performed to assess whether the departmental adoption of the antibacterial envelope led to a reduction in IPG SSIs.RESULTS: Of 344 patients who underwent initial IPG implantation with the antibacterial envelope, one developed an SSI within three months of surgery (0.3%), compared with six of 204 patients (2.9%) who underwent the same procedure without the antibacterial envelope (odds ratio: 0.10, 95% CI: 0.01-0.80, p= 0.031). Univariate logistic regression revealed that the antibacterial envelope and 2000-mg intravenous cefazolin perioperatively were associated with reduced SSI risk, whereas no other factors reached statistical significance. After adjusting for comorbidities, no association remained statistically significant. Interrupted time-series analysis showed a reduction in SSIs after 2016, but the effect was not significant.CONCLUSIONS: The adoption of antibacterial envelopes was found to reduce IPG SSIs at the univariate level, but this association did not remain significant after controlling for confounding variables including perioperative antibiotic administration. Although encouraging, this study does not conclusively establish that the use of antibacterial pouches in patients who underwent initial DBS implantation reduces the incidence of IPG SSIs. Future prospective studies that control for confounding variables are necessary to determine the efficacy of antibacterial envelopes in reducing post-DBS infections at the IPG site before clear recommendationscan be made.

  View details for DOI 10.1016/j.neurom.2022.02.227

  View details for PubMedID 35422367

• A mobile vision testing application based on dynamic distance determination from the human corneal limbus. Health informatics journal Patel, N. A., Alagappan, P. N., Pan, C., Karth, P. 2020: 1460458220958537

  Abstract

  Here we present a mobile application that accurately determines the distance between an optical sensor and the human corneal limbus for visual acuity assessment. The application uses digital image processing and randomized circle detection to locate the cornea. Then, a reference scaling measurement is employed to calculate distance from the sensor to a user. To determine accuracy and generalizability, testing was conducted both with 200 static images, 25 images each of males and females for four ethnic groups from a facial image database, and live image streams from a test subject. Average absolute corneal radius error over 10 trials for the static images was 6.36%, while average absolute distance error for the live image streams was less than 1%. Subsequently, distance measurements were used to scale letter sizes for a Snellen Chart-based visual acuity assessment. This system enables monitoring of chronic retinal diseases, as patients can quickly and accurately measure their visual acuity through the mobile eye exam suite.

  View details for DOI 10.1177/1460458220958537

  View details for PubMedID 32993413

• Sensory Particles with Optical Telemetry Ganesan, K., Flores, T. A., Le, B. Q., Muratore, D. G., Patel, N., Mitra, S., Murmann, B., Palanker, D., IEEE IEEE. 2020

  View details for Web of Science ID 000706854700088