Tracing the start of COVID-19 in GA

At a time when COVID-19 appears to be receding in much of Georgia, it’s worth revisiting the start of the pandemic in early 2020. Emory virologist Anne Piantadosi and colleagues have a paper in Viral Evolution on the earliest SARS-CoV-2 genetic sequences detected in Georgia. Analyzing relationships between those virus sequences and samples from other states and countries can give us an idea about where the first COVID-19 infections in Georgia came from. We can draw Read more

Reddit as window into opioid withdrawal strategies

Drug abuse researchers are using the social media site Reddit as a window into the experiences of people living with opioid addiction. Abeed Sarker in Emory's Department of Biomedical Informatics has a paper in Clinical Toxicology focusing on the phenomenon of “precipitated withdrawal,” in collaboration with emergency medicine specialists from Penn, Rutgers and Mt Sinai. Precipitated withdrawal is a more intense form of withdrawal that can occur when someone who was using opioids starts medication-assisted treatment Read more

CROI: HIV cure report and ongoing research

The big news out of CROI (Conference on Retroviruses and Opportunistic Infections) was a report of a third person being cured of HIV infection, this time using umbilical cord blood for a hematopoetic stem cell transplant. Emory’s Carlos del Rio gave a nice overview of the achievement for NPR this morning. As del Rio explains, the field of HIV cure research took off over the last decade after Timothy Brown, known as “the Berlin patient,” Read more

John Puskas

Editorial on bilateral vs single coronary bypass surgery

John Puskas, chief of cardiac surgery at Emory University Hospital Midtown, recently had an editorial in the journal Circulation on the topic of coronary bypass surgery.

John Puskas, MD

Specifically, he says that many cardiac surgeons are reluctant to employ bilateral internal thoracic artery grafts (as opposed to a single graft), even though there is a long-term benefit, because of perceived risk of infection and suboptimal financial incentives.

Puskas’ key message paragraph was so clear that it demands reposting here:

Why are American surgeons doing so few BITA [bilateral internal thoracic artery] grafts? Fundamentally, U.S. surgeons are responding to their practice environment, especially to a fear of deep sternal wound infection in an increasingly obese, diabetic population of patients. The surgeon pays a large and immediate political price for a deep sternal wound infection and receives relatively little credit for the extra years that BITA grafting adds to a patient’s life in the future. There is also a relative Ray Ban outlet financial disincentive to perform BITA grafting: incremental payment for the second internal thoracic artery graft is small considering the extra time required in the operating room. Moreover, the Centers for Medicare and Medicaid Services no longer reimburse for extra care necessary for treatment of mediastinitis [internal chest inflammation/infection] after cardiac surgery, because this is now deemed a never event. Thus, surgeons, who are increasingly employed by hospitals and hospital systems, are under intense pressure to perform CABG surgery that is safe and cost-effective according to short-term metrics.

Puskas and his colleagues have published an analysis of bilateral vs single grafting at Emory, as well as a proposed metric for when single grafting should be used in the context of patients with diabetes:

Our present practice is generally to use BITA grafting in patients who are <75 years, have suitable coronary artery targets, are not morbidly obese, and whose glycosylated hemoglobin level is <7.0% to 7.5%.

Posted on by Quinn Eastman in Heart 1 Comment

Emory Heart & Vascular Center advances medicine

American Heart Month 2010

Learn about Emory Heart & Vascular Center advances during American Heart Month.

Research led by John Puskas, MD, professor of surgery and associate chief, Division of Cardiothoracic Surgery, Emory School of Medicine, has shown that off-pump bypass surgery reduces the risk of complications for high-risk patients, such as those that are especially frail or those with diabetes, obesity, kidney disease or a history of stroke.

This conclusion comes from a 10-year history of coronary bypass patients at Emory recently published in the Annals of Thoracic Surgery.

Puskas also recently presented long-term follow-up data from the first randomized U.S. trial to compare off-pump with conventional on-pump surgery.

The results from the landmark SMART (Surgical Management of Arterial Revascularization) study, which started in 2000, show that participants who had the off-pump procedure lost less blood, had less damage to their hearts during surgery and recovered more quickly than those who underwent on-pump surgery.

Beating-heart patients in the study also were able to breathe on their own sooner after surgery, spent less time in intensive care and left the hospital one day sooner, on average, than conventional coronary bypass patients.

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