Umar Sanda Ali - Academia.edu (original) (raw)

Papers by Umar Sanda Ali

Background: Perioperative statin therapy can have pleiotropic effects beyond reducing plasma chol... more Background: Perioperative statin therapy can have pleiotropic effects beyond reducing plasma cholesterol level. Whether perioperative statin therapy can reduce surgical infection after cardiac surgery remains unclear. We aimed to assess whether preoperative statin therapy is associated with a reduced risk of surgical site infections and pneumonia after cardiac surgery.Methods: This retrospective cohort study included 1902 adult patients who had cardiac surgery between February 2015 and April 2019 at a major cardiothoracic centre in Western Australia. The primary outcomes were surgical site infections and pneumonia; secondary outcomes were inotrope requirement, duration of mechanical ventilation, intensive care unit (ICU) and hospital stay, and 30-day mortality. We used propensity-score matching to minimise confounding.Results: Following propensity-score matching (N=1098), patients on preoperative statins (n=551) were associated with a reduced risk of postoperative wound infections (...

BMJ case reports, Jan 17, 2018

A 22-year-old man underwent mediastinal metastasectomy for a testicular germ cell tumour via medi... more A 22-year-old man underwent mediastinal metastasectomy for a testicular germ cell tumour via median sternotomy. Intraoperatively, the tumour was massive, measuring 88 mm in anterior-posterior (AP) diameter. It was densely adherent to the trachea and aggressive debulking resulted in tracheal injury. Therefore, the patient was kept nil by mouth for 3 days postoperatively and was discharged uneventfully. He represented only 2 days later with a large right-sided chylothorax. His chylothorax was managed conservatively with insertion of an intercostal catheter (ICC) and a low-fat diet. Over the course of 9 days, the ICC drained approximately 5 L of fluid. His admission was further complicated by severe gastroparesis requiring feeding Nasojejunal (NJ) tube placement. The delayed feeding in this case resulted in late detection of the occult thoracic duct injury. This case illustrates that conservative and multidisciplinary management of a postoperative chylothorax from a suspected thoracic ...

Heart, lung & circulation, Jan 6, 2018

Patent foramen ovale (PFO) is a potential mechanism for paradoxical embolism in cryptogenic ischa... more Patent foramen ovale (PFO) is a potential mechanism for paradoxical embolism in cryptogenic ischaemic stroke or transient ischaemic attack (TIA). PFO is typically demonstrated with agitated saline ("bubble study", BS) during echocardiography. We hypothesised that the BS is frequently requested in patients that have a readily identifiable cause of stroke, that any PFO detected is likely incidental, and its detection often does not alter management. This was a retrospective observational study of patients with recent ischaemic stroke/TIA referred for a BS. Patient demographics, stroke risk factors, vascular/cerebral imaging results and transoesophageal echocardiogram (TOE) reports were recorded. A "modified" Risk of Paradoxical Embolism (RoPE) score was calculated. Change in management was defined as antiplatelet/anticoagulant therapy alteration or referral for PFO closure. Bubble Study complications were recorded. Among 715 patients with ischaemic stroke/TIA refer...

Journal of the American College of Cardiology, 2018

Background: Anomalous coronary morphologies present uncommon electrocardiographic and clinical pr... more Background: Anomalous coronary morphologies present uncommon electrocardiographic and clinical presentations that warrant urgent diagnostics and interventions. Case: A 15-year-old male experienced his first syncopal event after running a 400-meter race. After a minute of unconsciousness, emergency services brought him for medical evaluation. Physical exam was unremarkable. Electrocardiogram (EKG) showed diffuse STsegment depressions inferolaterally in leads V 4-V6 with ST-segment elevation in lead aVR. Initial troponin I was 0.6 ng/dL which increased to >50 ng/dL after 6 hours with a peak creatine kinase of 6,973 and creatine kinase-MB of 554 ng/mL. Transthoracic echocardiogram showed mildly decreased systolic function (LVEF 45-49%) with focal apical akinesis. Decision-making: Due to abnormalities on EKG and elevated cardiac enzymes, he was brought to cardiac catheterization, which revealed an anomalous origin of the left coronary artery close to the commissure in the right coronary cusp. With cardiovascular compromise, an intra-aortic balloon pump was placed and immediate surgical consultation was requested. The patient received urgent left internal mammary artery to left anterior descending artery coronary bypass and a saphenous vein graft to the ramus intermedius. Following 6 months of medical therapy with beta-blockade and angiotensin-receptor blockade, left ventricular systolic function improved to low-normal (LVEF ~50%). He remains asymptomatic on aspirin for coronary artery disease. Conclusion: Up to 15% of sudden cardiac deaths can be attributed to anomalous coronaries. The aVR ST-segment elevation carries a strong prognostic value toward left main or triple-vessel disease. This finding with a clinical presentation of syncope should furthermore indicate an anomalous left coronary from where the right cusp presents as an ischemic event. Early recognition allows for risk stratification and impact decision making, such immediate coronary angiography and urgent balloon pump with bridge to emergency surgical revascularization.

Background: Perioperative statin therapy can have pleiotropic effects beyond reducing plasma chol... more Background: Perioperative statin therapy can have pleiotropic effects beyond reducing plasma cholesterol level. Whether perioperative statin therapy can reduce surgical infection after cardiac surgery remains unclear. We aimed to assess whether preoperative statin therapy is associated with a reduced risk of surgical site infections and pneumonia after cardiac surgery.Methods: This retrospective cohort study included 1902 adult patients who had cardiac surgery between February 2015 and April 2019 at a major cardiothoracic centre in Western Australia. The primary outcomes were surgical site infections and pneumonia; secondary outcomes were inotrope requirement, duration of mechanical ventilation, intensive care unit (ICU) and hospital stay, and 30-day mortality. We used propensity-score matching to minimise confounding.Results: Following propensity-score matching (N=1098), patients on preoperative statins (n=551) were associated with a reduced risk of postoperative wound infections (...

BMJ case reports, Jan 17, 2018

A 22-year-old man underwent mediastinal metastasectomy for a testicular germ cell tumour via medi... more A 22-year-old man underwent mediastinal metastasectomy for a testicular germ cell tumour via median sternotomy. Intraoperatively, the tumour was massive, measuring 88 mm in anterior-posterior (AP) diameter. It was densely adherent to the trachea and aggressive debulking resulted in tracheal injury. Therefore, the patient was kept nil by mouth for 3 days postoperatively and was discharged uneventfully. He represented only 2 days later with a large right-sided chylothorax. His chylothorax was managed conservatively with insertion of an intercostal catheter (ICC) and a low-fat diet. Over the course of 9 days, the ICC drained approximately 5 L of fluid. His admission was further complicated by severe gastroparesis requiring feeding Nasojejunal (NJ) tube placement. The delayed feeding in this case resulted in late detection of the occult thoracic duct injury. This case illustrates that conservative and multidisciplinary management of a postoperative chylothorax from a suspected thoracic ...

Heart, lung & circulation, Jan 6, 2018

Patent foramen ovale (PFO) is a potential mechanism for paradoxical embolism in cryptogenic ischa... more Patent foramen ovale (PFO) is a potential mechanism for paradoxical embolism in cryptogenic ischaemic stroke or transient ischaemic attack (TIA). PFO is typically demonstrated with agitated saline ("bubble study", BS) during echocardiography. We hypothesised that the BS is frequently requested in patients that have a readily identifiable cause of stroke, that any PFO detected is likely incidental, and its detection often does not alter management. This was a retrospective observational study of patients with recent ischaemic stroke/TIA referred for a BS. Patient demographics, stroke risk factors, vascular/cerebral imaging results and transoesophageal echocardiogram (TOE) reports were recorded. A "modified" Risk of Paradoxical Embolism (RoPE) score was calculated. Change in management was defined as antiplatelet/anticoagulant therapy alteration or referral for PFO closure. Bubble Study complications were recorded. Among 715 patients with ischaemic stroke/TIA refer...

Journal of the American College of Cardiology, 2018

Background: Anomalous coronary morphologies present uncommon electrocardiographic and clinical pr... more Background: Anomalous coronary morphologies present uncommon electrocardiographic and clinical presentations that warrant urgent diagnostics and interventions. Case: A 15-year-old male experienced his first syncopal event after running a 400-meter race. After a minute of unconsciousness, emergency services brought him for medical evaluation. Physical exam was unremarkable. Electrocardiogram (EKG) showed diffuse STsegment depressions inferolaterally in leads V 4-V6 with ST-segment elevation in lead aVR. Initial troponin I was 0.6 ng/dL which increased to >50 ng/dL after 6 hours with a peak creatine kinase of 6,973 and creatine kinase-MB of 554 ng/mL. Transthoracic echocardiogram showed mildly decreased systolic function (LVEF 45-49%) with focal apical akinesis. Decision-making: Due to abnormalities on EKG and elevated cardiac enzymes, he was brought to cardiac catheterization, which revealed an anomalous origin of the left coronary artery close to the commissure in the right coronary cusp. With cardiovascular compromise, an intra-aortic balloon pump was placed and immediate surgical consultation was requested. The patient received urgent left internal mammary artery to left anterior descending artery coronary bypass and a saphenous vein graft to the ramus intermedius. Following 6 months of medical therapy with beta-blockade and angiotensin-receptor blockade, left ventricular systolic function improved to low-normal (LVEF ~50%). He remains asymptomatic on aspirin for coronary artery disease. Conclusion: Up to 15% of sudden cardiac deaths can be attributed to anomalous coronaries. The aVR ST-segment elevation carries a strong prognostic value toward left main or triple-vessel disease. This finding with a clinical presentation of syncope should furthermore indicate an anomalous left coronary from where the right cusp presents as an ischemic event. Early recognition allows for risk stratification and impact decision making, such immediate coronary angiography and urgent balloon pump with bridge to emergency surgical revascularization.