Babak Sarani - Academia.edu (original) (raw)
Papers by Babak Sarani
Critical Care Medicine, Apr 1, 2008
To determine whether there is an association between transfusion of fresh frozen plasma and infec... more To determine whether there is an association between transfusion of fresh frozen plasma and infection in critically ill surgical patients. Retrospective study. A 24-bed surgical intensive care unit in a university hospital. A total of 380 non-trauma patients who received fresh frozen plasma from 2004 to 2005 were compared with 2,058 nontrauma patients who did not receive fresh frozen plasma. None. We calculated the relative risk of infectious complication for patients receiving and not receiving fresh frozen plasma. T-test allowed comparison of average units of fresh frozen plasma transfused to patients with and without infectious complications to describe a dose-response relationship. We used multivariate logistic regression analysis to evaluate the association between fresh frozen plasma and infectious complication, controlling for the effect of red blood cell transfusion, Acute Physiology and Chronic Health Evaluation II, and patient age. A significant association was found between transfusion of fresh frozen plasma and ventilator-associated pneumonia with shock (relative risk 5.42, 2.73-10.74), ventilator-associated pneumonia without shock (relative risk 1.97, 1.03-3.78), bloodstream infection with shock (relative risk 3.35, 1.69-6.64), and undifferentiated septic shock (relative risk 3.22, 1.84-5.61). The relative risk for transfusion of fresh frozen plasma and all infections was 2.99 (2.28-3.93). The t-test revealed a significant dose-response relationship between fresh frozen plasma and infectious complications (p = .02). Chi-square analysis showed a significant association between infection and transfusion of fresh frozen plasma in patients who did not receive concomitant red blood cell transfusion (p < .01), but this association was not significant in those who did receive red blood cells in addition to fresh frozen plasma. The association between fresh frozen plasma and infectious complications remained significant in the multivariate model, with an odds ratio of infection per unit of fresh frozen plasma transfused equal to 1.039 (1.013-1.067). This odds ratio resembled that noted for each unit of packed red blood cells, 1.074 (1.043-1.106). Transfusion of fresh frozen plasma is associated with an increased risk of infection in critically ill patients.
J Amer Coll Surgeons, 2011
Diseases of the Colon and Rectum, Oct 1, 2001
Anal carcinoma is being found in HIV-positive patients with increasing frequency. Most patients a... more Anal carcinoma is being found in HIV-positive patients with increasing frequency. Most patients are treated with combined chemotherapy and radiation. It was our impression that HIV-positive patients do not fare as well as HIV-negative patients in terms of both response to and tolerance of therapy. To test this hypothesis, we reviewed our experience with anal carcinoma and compared HIV-positive to HIV-negative patients by age, gender, sexual orientation, stage at diagnosis, treatment rendered, response to treatment, tolerance, and survival. From 1985 to 1998, 98 patients with anal neoplasms were treated. Seventy-three patients had invasive squamous-cell carcinoma (including cloacogenic carcinoma), and this cohort was analyzed. Thirteen patients were HIV positive and 60 were HIV negative. The HIV-positive and HIV-negative groups differed significantly by age (42 vs. 62 years, P < 0.001), male gender (92 vs. 42 percent, P < 0.001), and homosexuality (46 vs. 15 percent, P < 0.05). There were no differences by stage at diagnosis or radiation dose received. Acute treatment major toxicity differed significantly (HIV positive 80 percent vs. HIV negative 30 percent; P < 0.005). Only 62 percent of HIV-positive patients were rendered disease free after initial therapy vs. 85 percent of HIV-negative patients (P = 0.11). Median time to cancer-related death was 1.4 vs. 5.3 years (P < 0.05). A survival model did not show age, gender, stage, or treatment to be independent predictors. We found that HIV-positive patients with anal carcinoma seem to be a different population from HIV-negative patients by age, gender, and sexual orientation. They have a poorer tolerance for combined therapy and a shorter time to cancer-related death. A strong trend to poorer initial response rate was also seen. These results suggest that the treatment of HIV-positive patients with anal carcinoma needs to be reassessed.
The Journal of Trauma Injury Infection and Critical Care, Oct 1, 2007
Recognition of cervical spine (c-spine) injury is important to minimize the risk of disability. Y... more Recognition of cervical spine (c-spine) injury is important to minimize the risk of disability. Yet the ideal method to detect injury remains controversial, especially in unexaminable patients. The purpose of this study was to evaluate the incidence of c-spine injury detected by magnetic resonance imaging (MRI) in patients with no abnormalities detected by computerized tomography (CT) scan and to determine whether the treatment plan was altered. A retrospective study was performed on all patients who underwent both CT and MRI scanning of the c-spine in 2004 to 2005. Unexaminable patients formed a separate subgroup of the overall cohort. Patients were deemed to be unexaminable by the attending surgeon if their mental status remained depressed after intoxicants were judged to have been metabolized. CT and MRI scan findings were defined as normal if they were without any radiographic abnormality and showed only chronic degenerative changes. A total of 254 adult patients were included. Of these, 53 patients were unexaminable. Ninety patients showed abnormality on CT scan and were excluded from further analysis. MRI detected an injury in 42 of the remaining 164 patients whose CT scan disclosed nothing abnormal, 27 of which were ligamentous or cord injuries. The findings of the MRI resulted in surgery in 9, maintenance of the rigid cervical collar in 22, and discontinuance of the collar in 11 patients. In the unexaminable cohort, MRI detected an injury in 5 of 46 patients whose CT scan disclosed nothing abnormal, four of which were ligamentous and were treated by cervical collar immobilization. This study supports the practice of obtaining c-spine MRI in patients who are either unexaminable or symptomatic with the CT scan findings normal.
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
The journal of vascular access
Deep venous thrombosis and pulmonary embolism constitute common preventable causes of morbidity a... more Deep venous thrombosis and pulmonary embolism constitute common preventable causes of morbidity and mortality. The incidence of venous thromboembolism (VTE) continues to increase. Standard anticoagulation therapy may reduce the risk of fatal PE by 75% and that of recurrent VTE by over 90%. For patients who are not candidates for anticoagulation, a vena cava filter (VCF) may be beneficial. Despite a good overall safety record, significant complications related to VCF are occasionally seen. This review discusses both procedural and non-procedural complications associated with VCF placement and use. We will also discuss VCF use in the settings of pregnancy, malignancy, and the clinical need for more than one filter.
Critical Care Medicine, Apr 1, 2008
To determine whether there is an association between transfusion of fresh frozen plasma and infec... more To determine whether there is an association between transfusion of fresh frozen plasma and infection in critically ill surgical patients. Retrospective study. A 24-bed surgical intensive care unit in a university hospital. A total of 380 non-trauma patients who received fresh frozen plasma from 2004 to 2005 were compared with 2,058 nontrauma patients who did not receive fresh frozen plasma. None. We calculated the relative risk of infectious complication for patients receiving and not receiving fresh frozen plasma. T-test allowed comparison of average units of fresh frozen plasma transfused to patients with and without infectious complications to describe a dose-response relationship. We used multivariate logistic regression analysis to evaluate the association between fresh frozen plasma and infectious complication, controlling for the effect of red blood cell transfusion, Acute Physiology and Chronic Health Evaluation II, and patient age. A significant association was found between transfusion of fresh frozen plasma and ventilator-associated pneumonia with shock (relative risk 5.42, 2.73-10.74), ventilator-associated pneumonia without shock (relative risk 1.97, 1.03-3.78), bloodstream infection with shock (relative risk 3.35, 1.69-6.64), and undifferentiated septic shock (relative risk 3.22, 1.84-5.61). The relative risk for transfusion of fresh frozen plasma and all infections was 2.99 (2.28-3.93). The t-test revealed a significant dose-response relationship between fresh frozen plasma and infectious complications (p = .02). Chi-square analysis showed a significant association between infection and transfusion of fresh frozen plasma in patients who did not receive concomitant red blood cell transfusion (p < .01), but this association was not significant in those who did receive red blood cells in addition to fresh frozen plasma. The association between fresh frozen plasma and infectious complications remained significant in the multivariate model, with an odds ratio of infection per unit of fresh frozen plasma transfused equal to 1.039 (1.013-1.067). This odds ratio resembled that noted for each unit of packed red blood cells, 1.074 (1.043-1.106). Transfusion of fresh frozen plasma is associated with an increased risk of infection in critically ill patients.
J Amer Coll Surgeons, 2011
Diseases of the Colon and Rectum, Oct 1, 2001
Anal carcinoma is being found in HIV-positive patients with increasing frequency. Most patients a... more Anal carcinoma is being found in HIV-positive patients with increasing frequency. Most patients are treated with combined chemotherapy and radiation. It was our impression that HIV-positive patients do not fare as well as HIV-negative patients in terms of both response to and tolerance of therapy. To test this hypothesis, we reviewed our experience with anal carcinoma and compared HIV-positive to HIV-negative patients by age, gender, sexual orientation, stage at diagnosis, treatment rendered, response to treatment, tolerance, and survival. From 1985 to 1998, 98 patients with anal neoplasms were treated. Seventy-three patients had invasive squamous-cell carcinoma (including cloacogenic carcinoma), and this cohort was analyzed. Thirteen patients were HIV positive and 60 were HIV negative. The HIV-positive and HIV-negative groups differed significantly by age (42 vs. 62 years, P < 0.001), male gender (92 vs. 42 percent, P < 0.001), and homosexuality (46 vs. 15 percent, P < 0.05). There were no differences by stage at diagnosis or radiation dose received. Acute treatment major toxicity differed significantly (HIV positive 80 percent vs. HIV negative 30 percent; P < 0.005). Only 62 percent of HIV-positive patients were rendered disease free after initial therapy vs. 85 percent of HIV-negative patients (P = 0.11). Median time to cancer-related death was 1.4 vs. 5.3 years (P < 0.05). A survival model did not show age, gender, stage, or treatment to be independent predictors. We found that HIV-positive patients with anal carcinoma seem to be a different population from HIV-negative patients by age, gender, and sexual orientation. They have a poorer tolerance for combined therapy and a shorter time to cancer-related death. A strong trend to poorer initial response rate was also seen. These results suggest that the treatment of HIV-positive patients with anal carcinoma needs to be reassessed.
The Journal of Trauma Injury Infection and Critical Care, Oct 1, 2007
Recognition of cervical spine (c-spine) injury is important to minimize the risk of disability. Y... more Recognition of cervical spine (c-spine) injury is important to minimize the risk of disability. Yet the ideal method to detect injury remains controversial, especially in unexaminable patients. The purpose of this study was to evaluate the incidence of c-spine injury detected by magnetic resonance imaging (MRI) in patients with no abnormalities detected by computerized tomography (CT) scan and to determine whether the treatment plan was altered. A retrospective study was performed on all patients who underwent both CT and MRI scanning of the c-spine in 2004 to 2005. Unexaminable patients formed a separate subgroup of the overall cohort. Patients were deemed to be unexaminable by the attending surgeon if their mental status remained depressed after intoxicants were judged to have been metabolized. CT and MRI scan findings were defined as normal if they were without any radiographic abnormality and showed only chronic degenerative changes. A total of 254 adult patients were included. Of these, 53 patients were unexaminable. Ninety patients showed abnormality on CT scan and were excluded from further analysis. MRI detected an injury in 42 of the remaining 164 patients whose CT scan disclosed nothing abnormal, 27 of which were ligamentous or cord injuries. The findings of the MRI resulted in surgery in 9, maintenance of the rigid cervical collar in 22, and discontinuance of the collar in 11 patients. In the unexaminable cohort, MRI detected an injury in 5 of 46 patients whose CT scan disclosed nothing abnormal, four of which were ligamentous and were treated by cervical collar immobilization. This study supports the practice of obtaining c-spine MRI in patients who are either unexaminable or symptomatic with the CT scan findings normal.
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
Encyclopedia of Intensive Care Medicine, 2012
The journal of vascular access
Deep venous thrombosis and pulmonary embolism constitute common preventable causes of morbidity a... more Deep venous thrombosis and pulmonary embolism constitute common preventable causes of morbidity and mortality. The incidence of venous thromboembolism (VTE) continues to increase. Standard anticoagulation therapy may reduce the risk of fatal PE by 75% and that of recurrent VTE by over 90%. For patients who are not candidates for anticoagulation, a vena cava filter (VCF) may be beneficial. Despite a good overall safety record, significant complications related to VCF are occasionally seen. This review discusses both procedural and non-procedural complications associated with VCF placement and use. We will also discuss VCF use in the settings of pregnancy, malignancy, and the clinical need for more than one filter.