Sina Zarandi - Academia.edu (original) (raw)
Papers by Sina Zarandi
Translational Andrology and Urology
Background: Information regarding the Medicaid coverage of artificial urinary sphincter (AUS) and... more Background: Information regarding the Medicaid coverage of artificial urinary sphincter (AUS) and male suburethral slings (MS) placement in the United States (US) is not readily available. In this manuscript, we seek to elucidate the state-by-state Medicaid coverage of these two procedures in the US. Methods: State Medicaid websites were utilized to access publicly available physician fee schedules for the calendar year 2020. Fee schedules were searched for current procedural terminology (CPT) codes. CPT codes representing insertion of tandem cuff, insertion of AUS, removal of AUS, removal and replacement AUS, sling operation for correction of male SUI, and removal or revision of sling for male SUI were utilized. Data were recorded by the procedure for each device, including the coverage status and physician fees. Results: Of the 50 US states analyzed, 49 publish publicly accessible physician fee schedules. All 49 of these states reported coverage for removal with and without revision of the AUS, and 48 states reported coverage for insertion of an AUS, and insertion of a tandem cuff. The median reimbursement for each AUS
Current Sexual Health Reports
Purpose of Review There is a paucity of peer-reviewed evidence to guide medical management of stu... more Purpose of Review There is a paucity of peer-reviewed evidence to guide medical management of stuttering priapism. The purpose of this review is to summarize the current understanding regarding the pathophysiology of priapism and management options for stuttering priapism. Recent Findings Conducting large-scale, randomized, placebo-controlled trials that elucidate the optimal treatment of stuttering priapism is challenging. Therefore, recent treatment guidelines are based upon small case series, retrospective studies, and expert opinions. Nonetheless, multiple compounds from various drug classes have shown promise in treating stuttering priapism, and a few pharmacotherapies such as Crizanlizumab are currently under active investigation. Summary Stuttering priapism is an under-investigated disorder with a complex pathophysiology. Currently, there is no wildly adopted universal therapeutic strategy. Further research is warranted to identify the appropriate treatment of stuttering pria...
Journal of Otorhinolaryngology, Hearing and Balance Medicine
The application of machine learning (ML) techniques to otolaryngology remains a topic of interest... more The application of machine learning (ML) techniques to otolaryngology remains a topic of interest and prevalence in the literature, though no previous articles have summarized the current state of ML application to management and the diagnosis of lateral skull base (LSB) tumors. Subsequently, we present a systematic overview of previous applications of ML techniques to the management of LSB tumors. Independent searches were conducted on PubMed and Web of Science between August 2020 and February 2021 to identify the literature pertaining to the use of ML techniques in LSB tumor surgery written in the English language. All articles were assessed in regard to their application task, ML methodology, and their outcomes. A total of 32 articles were examined. The number of articles involving applications of ML techniques to LSB tumor surgeries has significantly increased since the first article relevant to this field was published in 1994. The most commonly employed ML category was tree-ba...
Journal of Urology
INTRODUCTION AND OBJECTIVE: Standard of care for diagnosing nephrolithiasis is shifting from comp... more INTRODUCTION AND OBJECTIVE: Standard of care for diagnosing nephrolithiasis is shifting from computed tomography (CT) to Ultrasonography (US). Identifying a stone on US may lead to a CT scan, however if no stone is identified on CT, the patient will have been exposed to unnecessary radiation. We hypothesize that sonographic and patient factors predict true positivity (TP) and false positivity (FP) for nephrolithiasis on US vs. CT. METHODS: To avoid repeated measures, patients with one stone documented in the radiological report of renal US who had a CT within 24 hours in 2019, were included retrospectively at one institution. Stones were categorized as TP or FP by correlating US and CT images (as reviewed by the researchers) according to a novel stone likelihood scoring system (US-SLS, Figure 1) including stone location (collecting system or parenchyma) and size. Patient and sonographic variables were incorporated into a binary logistic regression to predict FP. RESULTS: 449 patients had an US followed by CT; 139 (30.10%) US reports documented "stones", of which 90 (20.04%) were solitary stones. There were 56 TP's and 34 FP's, thus the PPV for US was 62%. Univariate predictors of FP were (Table 1): no prior stones (OR 3.41, CI 1.32-8.85, p[0.011), age (OR 1.024, CI 1.001e1.024, p[0.042), and a US-SLS of 1 (OR 9.09, CI 2.67e31.25, p <0.001). Adjusting for these variables, a low US-SLS (OR: 8.70, CI: 2.42e31.25, p[0.001) was the only significant predictor of FP findings of "stones" within radiology reports on multivariate analysis. Non-significant variables included: US gain, twinkling, shadowing, depth to stone, hydronephrosis, hematuria, flank pain, BMI, and medical history. CONCLUSIONS: Our US-SLS identifies clinically relevant stones on subsequent CT better than other criteria such as shadowing or twinkling. Providers should consider utilizing this US-SLS prior to ordering a CT in response to a radiological report documenting "stones", as it may limit patient exposure to unnecessary radiation. Further study will prospectively validate these scores among surgical cohorts.
Journal of Urology
Alejandra Bravo-Balado*, Sofía Fontanet, Barcelona, Spain; Andreas Skolarikos, Athens, Greece; Al... more Alejandra Bravo-Balado*, Sofía Fontanet, Barcelona, Spain; Andreas Skolarikos, Athens, Greece; Ali Serdar Gozen, Heilbronn, Germany; Bhaskar Somani, Southampton, United Kingdom; Olivier Traxer, Paris, France; Michele Talso, Luca Villa, Milan, Italy; Athanasios Papatsoris, Athens, Greece; Amelia Pietropaolo, Southampton, United Kingdom; Senol Tonyali, Istanbul, Turkey; Etienne Xavier Keller, Zurich, Switzerland; Thomas Tailly, Ghent, Belgium; Panagiotis Kallidonis, Patras, Greece; Emre Sener, Istanbul, Turkey; Udo Nagele, Hall in Tirol, Austria; Esteban Emiliani, Barcelona, Spain
Otology & Neurotology, 2020
OBJECTIVES To investigate the clinical presentation, treatment breakdown, and overall survival (O... more OBJECTIVES To investigate the clinical presentation, treatment breakdown, and overall survival (OS) outcomes of patients with neurofibromatosis type 2 (NF2)-associated bilateral vestibular schwannoma (NVS). METHODS The 2004 to 2016 National Cancer Database was queried for patients with a diagnosis of VS. The "Laterality" code was used to stratify patients into sporadic unilateral vestibular schwannoma (UVS) and NVS. RESULTS Of the 33,839 patients with VS, 155 (0.46%) were coded for NVS with an average age and tumor size of 37.4 ± 20.5 years and 23.5 ± 18.2 mm. Patients underwent observation (45.3%), surgery (29.3%), and radiotherapy (20.0%), and had a 5.8% 5-year mortality rate. Compared with UVS, NVS was negatively associated with receiving surgery (40.2% versus 29.3%, p = 0.02) while watchful observation was more prevalent (30.1% versus 45.3%, p = 0.001). In NVS, undergoing surgery was associated with larger tumor size (34.5 ± 21.2 versus 17.8 ± 13.3 mm, p = 0.001) and shorter diagnosis-to-treatment time (49.1 ± 60.6 versus 87.0 ± 78.5 d, p = 0.02), radiotherapy was associated with older age (44.4 ± 18.9 versus 35.2 ± 20.6 yr, p = 0.02) and longer diagnosis-to-treatment time (85.9 ± 77.9 versus 53.9 ± 65.5 d, p = 0.04), and observation was associated with smaller tumor size (17.8 ± 15.9 versus 28.0 ± 19.2 mm, p = 0.01). Kaplan-Meier log-rank analysis demonstrated similar 10-year OS between NVS and UVS patients (p = 0.58) without factoring the earlier age of presentation. Furthermore, there were no temporal changes in presentation/management of NVS, and OS was not dependent on the received treatment (p = 0.30). CONCLUSIONS With younger age, larger tumors, and more conservative management, NVS's OS was not treatment-dependent and was similar to sporadic UVS, though the latter should not be interpreted as similar life expectancies due to the much earlier presentation.
The Laryngoscope, 2021
To assess and characterize online ratings and comments on pediatric otolaryngologists and determi... more To assess and characterize online ratings and comments on pediatric otolaryngologists and determine factors that correlate with higher ratings.
Cell reports, Jan 12, 2018
Atrophy of neurons in the prefrontal cortex (PFC) plays a key role in the pathophysiology of depr... more Atrophy of neurons in the prefrontal cortex (PFC) plays a key role in the pathophysiology of depression and related disorders. The ability to promote both structural and functional plasticity in the PFC has been hypothesized to underlie the fast-acting antidepressant properties of the dissociative anesthetic ketamine. Here, we report that, like ketamine, serotonergic psychedelics are capable of robustly increasing neuritogenesis and/or spinogenesis both in vitro and in vivo. These changes in neuronal structure are accompanied by increased synapse number and function, as measured by fluorescence microscopy and electrophysiology. The structural changes induced by psychedelics appear to result from stimulation of the TrkB, mTOR, and 5-HT2A signaling pathways and could possibly explain the clinical effectiveness of these compounds. Our results underscore the therapeutic potential of psychedelics and, importantly, identify several lead scaffolds for medicinal chemistry efforts focused on...
Clinical Neurology and Neurosurgery, 2020
Objective: To evaluate whether increased body mass index (BMI), age, or frailty influence vestibu... more Objective: To evaluate whether increased body mass index (BMI), age, or frailty influence vestibular schwannoma (VS) short-term surgical morbidity. Methods: The 2005-2017 National Surgical Quality Improvement Program database was queried for patients with VS undergoing surgical resection. Age was stratified according to age <50, 50-64, and ≥65, while BMI was stratified based on a threshold of 30. Frailty score (0-5) was indicated based on functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. Results: A total of 1405 patients were included consisting of 56.7% females with a mean age of 50.7±13.8 years and mean BMI of 29.4±6.6. Patients <50 (n=604), 50-64 (n=578), and ≥65 (n=223), had different duration of surgery (428±173 vs. 392±149 vs. 387±154 minutes; p<0.001) and 30-day mortality rates (0.7% vs. 0% vs. 1.8%; p=0.01). However, post-operative length of stay (LOS) (p=0.16), readmission (p=0.08), reoperation (p=0.54), and complication rates were similar. Post-operative myocardial infarction (p=0.03) and wound infection (p=0.02) were more commonly observed in the obese cohort (BMI≥30) but readmission (p=0.18), reoperation (p=0.44), and complication rates were similar to those with BMI<30. Severely obese patients (BMI≥35) also had higher rates of deep vein thrombosis (p=0.004). Frailty score 0 (n=921), 1 (n=375), and 2-4
Translational Andrology and Urology
Background: Information regarding the Medicaid coverage of artificial urinary sphincter (AUS) and... more Background: Information regarding the Medicaid coverage of artificial urinary sphincter (AUS) and male suburethral slings (MS) placement in the United States (US) is not readily available. In this manuscript, we seek to elucidate the state-by-state Medicaid coverage of these two procedures in the US. Methods: State Medicaid websites were utilized to access publicly available physician fee schedules for the calendar year 2020. Fee schedules were searched for current procedural terminology (CPT) codes. CPT codes representing insertion of tandem cuff, insertion of AUS, removal of AUS, removal and replacement AUS, sling operation for correction of male SUI, and removal or revision of sling for male SUI were utilized. Data were recorded by the procedure for each device, including the coverage status and physician fees. Results: Of the 50 US states analyzed, 49 publish publicly accessible physician fee schedules. All 49 of these states reported coverage for removal with and without revision of the AUS, and 48 states reported coverage for insertion of an AUS, and insertion of a tandem cuff. The median reimbursement for each AUS
Current Sexual Health Reports
Purpose of Review There is a paucity of peer-reviewed evidence to guide medical management of stu... more Purpose of Review There is a paucity of peer-reviewed evidence to guide medical management of stuttering priapism. The purpose of this review is to summarize the current understanding regarding the pathophysiology of priapism and management options for stuttering priapism. Recent Findings Conducting large-scale, randomized, placebo-controlled trials that elucidate the optimal treatment of stuttering priapism is challenging. Therefore, recent treatment guidelines are based upon small case series, retrospective studies, and expert opinions. Nonetheless, multiple compounds from various drug classes have shown promise in treating stuttering priapism, and a few pharmacotherapies such as Crizanlizumab are currently under active investigation. Summary Stuttering priapism is an under-investigated disorder with a complex pathophysiology. Currently, there is no wildly adopted universal therapeutic strategy. Further research is warranted to identify the appropriate treatment of stuttering pria...
Journal of Otorhinolaryngology, Hearing and Balance Medicine
The application of machine learning (ML) techniques to otolaryngology remains a topic of interest... more The application of machine learning (ML) techniques to otolaryngology remains a topic of interest and prevalence in the literature, though no previous articles have summarized the current state of ML application to management and the diagnosis of lateral skull base (LSB) tumors. Subsequently, we present a systematic overview of previous applications of ML techniques to the management of LSB tumors. Independent searches were conducted on PubMed and Web of Science between August 2020 and February 2021 to identify the literature pertaining to the use of ML techniques in LSB tumor surgery written in the English language. All articles were assessed in regard to their application task, ML methodology, and their outcomes. A total of 32 articles were examined. The number of articles involving applications of ML techniques to LSB tumor surgeries has significantly increased since the first article relevant to this field was published in 1994. The most commonly employed ML category was tree-ba...
Journal of Urology
INTRODUCTION AND OBJECTIVE: Standard of care for diagnosing nephrolithiasis is shifting from comp... more INTRODUCTION AND OBJECTIVE: Standard of care for diagnosing nephrolithiasis is shifting from computed tomography (CT) to Ultrasonography (US). Identifying a stone on US may lead to a CT scan, however if no stone is identified on CT, the patient will have been exposed to unnecessary radiation. We hypothesize that sonographic and patient factors predict true positivity (TP) and false positivity (FP) for nephrolithiasis on US vs. CT. METHODS: To avoid repeated measures, patients with one stone documented in the radiological report of renal US who had a CT within 24 hours in 2019, were included retrospectively at one institution. Stones were categorized as TP or FP by correlating US and CT images (as reviewed by the researchers) according to a novel stone likelihood scoring system (US-SLS, Figure 1) including stone location (collecting system or parenchyma) and size. Patient and sonographic variables were incorporated into a binary logistic regression to predict FP. RESULTS: 449 patients had an US followed by CT; 139 (30.10%) US reports documented "stones", of which 90 (20.04%) were solitary stones. There were 56 TP's and 34 FP's, thus the PPV for US was 62%. Univariate predictors of FP were (Table 1): no prior stones (OR 3.41, CI 1.32-8.85, p[0.011), age (OR 1.024, CI 1.001e1.024, p[0.042), and a US-SLS of 1 (OR 9.09, CI 2.67e31.25, p <0.001). Adjusting for these variables, a low US-SLS (OR: 8.70, CI: 2.42e31.25, p[0.001) was the only significant predictor of FP findings of "stones" within radiology reports on multivariate analysis. Non-significant variables included: US gain, twinkling, shadowing, depth to stone, hydronephrosis, hematuria, flank pain, BMI, and medical history. CONCLUSIONS: Our US-SLS identifies clinically relevant stones on subsequent CT better than other criteria such as shadowing or twinkling. Providers should consider utilizing this US-SLS prior to ordering a CT in response to a radiological report documenting "stones", as it may limit patient exposure to unnecessary radiation. Further study will prospectively validate these scores among surgical cohorts.
Journal of Urology
Alejandra Bravo-Balado*, Sofía Fontanet, Barcelona, Spain; Andreas Skolarikos, Athens, Greece; Al... more Alejandra Bravo-Balado*, Sofía Fontanet, Barcelona, Spain; Andreas Skolarikos, Athens, Greece; Ali Serdar Gozen, Heilbronn, Germany; Bhaskar Somani, Southampton, United Kingdom; Olivier Traxer, Paris, France; Michele Talso, Luca Villa, Milan, Italy; Athanasios Papatsoris, Athens, Greece; Amelia Pietropaolo, Southampton, United Kingdom; Senol Tonyali, Istanbul, Turkey; Etienne Xavier Keller, Zurich, Switzerland; Thomas Tailly, Ghent, Belgium; Panagiotis Kallidonis, Patras, Greece; Emre Sener, Istanbul, Turkey; Udo Nagele, Hall in Tirol, Austria; Esteban Emiliani, Barcelona, Spain
Otology & Neurotology, 2020
OBJECTIVES To investigate the clinical presentation, treatment breakdown, and overall survival (O... more OBJECTIVES To investigate the clinical presentation, treatment breakdown, and overall survival (OS) outcomes of patients with neurofibromatosis type 2 (NF2)-associated bilateral vestibular schwannoma (NVS). METHODS The 2004 to 2016 National Cancer Database was queried for patients with a diagnosis of VS. The "Laterality" code was used to stratify patients into sporadic unilateral vestibular schwannoma (UVS) and NVS. RESULTS Of the 33,839 patients with VS, 155 (0.46%) were coded for NVS with an average age and tumor size of 37.4 ± 20.5 years and 23.5 ± 18.2 mm. Patients underwent observation (45.3%), surgery (29.3%), and radiotherapy (20.0%), and had a 5.8% 5-year mortality rate. Compared with UVS, NVS was negatively associated with receiving surgery (40.2% versus 29.3%, p = 0.02) while watchful observation was more prevalent (30.1% versus 45.3%, p = 0.001). In NVS, undergoing surgery was associated with larger tumor size (34.5 ± 21.2 versus 17.8 ± 13.3 mm, p = 0.001) and shorter diagnosis-to-treatment time (49.1 ± 60.6 versus 87.0 ± 78.5 d, p = 0.02), radiotherapy was associated with older age (44.4 ± 18.9 versus 35.2 ± 20.6 yr, p = 0.02) and longer diagnosis-to-treatment time (85.9 ± 77.9 versus 53.9 ± 65.5 d, p = 0.04), and observation was associated with smaller tumor size (17.8 ± 15.9 versus 28.0 ± 19.2 mm, p = 0.01). Kaplan-Meier log-rank analysis demonstrated similar 10-year OS between NVS and UVS patients (p = 0.58) without factoring the earlier age of presentation. Furthermore, there were no temporal changes in presentation/management of NVS, and OS was not dependent on the received treatment (p = 0.30). CONCLUSIONS With younger age, larger tumors, and more conservative management, NVS's OS was not treatment-dependent and was similar to sporadic UVS, though the latter should not be interpreted as similar life expectancies due to the much earlier presentation.
The Laryngoscope, 2021
To assess and characterize online ratings and comments on pediatric otolaryngologists and determi... more To assess and characterize online ratings and comments on pediatric otolaryngologists and determine factors that correlate with higher ratings.
Cell reports, Jan 12, 2018
Atrophy of neurons in the prefrontal cortex (PFC) plays a key role in the pathophysiology of depr... more Atrophy of neurons in the prefrontal cortex (PFC) plays a key role in the pathophysiology of depression and related disorders. The ability to promote both structural and functional plasticity in the PFC has been hypothesized to underlie the fast-acting antidepressant properties of the dissociative anesthetic ketamine. Here, we report that, like ketamine, serotonergic psychedelics are capable of robustly increasing neuritogenesis and/or spinogenesis both in vitro and in vivo. These changes in neuronal structure are accompanied by increased synapse number and function, as measured by fluorescence microscopy and electrophysiology. The structural changes induced by psychedelics appear to result from stimulation of the TrkB, mTOR, and 5-HT2A signaling pathways and could possibly explain the clinical effectiveness of these compounds. Our results underscore the therapeutic potential of psychedelics and, importantly, identify several lead scaffolds for medicinal chemistry efforts focused on...
Clinical Neurology and Neurosurgery, 2020
Objective: To evaluate whether increased body mass index (BMI), age, or frailty influence vestibu... more Objective: To evaluate whether increased body mass index (BMI), age, or frailty influence vestibular schwannoma (VS) short-term surgical morbidity. Methods: The 2005-2017 National Surgical Quality Improvement Program database was queried for patients with VS undergoing surgical resection. Age was stratified according to age <50, 50-64, and ≥65, while BMI was stratified based on a threshold of 30. Frailty score (0-5) was indicated based on functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. Results: A total of 1405 patients were included consisting of 56.7% females with a mean age of 50.7±13.8 years and mean BMI of 29.4±6.6. Patients <50 (n=604), 50-64 (n=578), and ≥65 (n=223), had different duration of surgery (428±173 vs. 392±149 vs. 387±154 minutes; p<0.001) and 30-day mortality rates (0.7% vs. 0% vs. 1.8%; p=0.01). However, post-operative length of stay (LOS) (p=0.16), readmission (p=0.08), reoperation (p=0.54), and complication rates were similar. Post-operative myocardial infarction (p=0.03) and wound infection (p=0.02) were more commonly observed in the obese cohort (BMI≥30) but readmission (p=0.18), reoperation (p=0.44), and complication rates were similar to those with BMI<30. Severely obese patients (BMI≥35) also had higher rates of deep vein thrombosis (p=0.004). Frailty score 0 (n=921), 1 (n=375), and 2-4