Publications by authors named "C Munro Cullum"

202 Publications

Local Anesthesia is Associated with Fewer Complications in Umbilical Hernia Repair in Frail Veterans.

J Surg Res 2021 May 11;266:88-95. Epub 2021 May 11.

North Texas VA Healthcare System, Department of Surgery, Dallas, Texas; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; University of Texas Southwestern, Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas, Texas.

Background: The optimal anesthesia modality for umbilical hernia repair is unclear. We hypothesized that using local rather than general anesthesia would be associated with improved outcomes, especially for frail patients.

Methods: We utilized the 1998-2018 Veterans Affairs Surgical Quality Improvement Program to identify patients who underwent elective, open umbilical hernia repair under general or local anesthesia. We used the Risk Analysis Index to measure frailty. Outcomes included complications and operative time.

Results: There were 4958 Veterans (13%) whose hernias were repaired under local anesthesia. Compared to general anesthesia, local was associated with a 12%-24% faster operative time for all patients, and an 86% lower (OR 0.14, 95%CI 0.03-0.72) complication rate for frail patients.

Conclusions: Local anesthesia may reduce the operative time for all patients and complications for frail patients having umbilical hernia repair.
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http://dx.doi.org/10.1016/j.jss.2021.04.006DOI Listing
May 2021

Defining traumatic encephalopathy syndrome - advances and challenges.

Nat Rev Neurol 2021 May 4. Epub 2021 May 4.

Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1038/s41582-021-00500-0DOI Listing
May 2021

Erratum to: Accelerating Teleneuropsychology Within Diverse Populations.

Arch Clin Neuropsychol 2021 Apr 19. Epub 2021 Apr 19.

Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1093/arclin/acab030DOI Listing
April 2021

Physical activity status and quality of life in patients with epilepsy - Survey from level four epilepsy monitoring units.

Epilepsy Res 2021 Jul 9;173:106639. Epub 2021 Apr 9.

Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX, 75390, USA. Electronic address:

Purpose: People with epilepsy (PWE) tend to have sedentary lifestyles which may predispose them to a lower perceived quality of life (QOL). Moreover, the relationship between physical activity (PA) and QOL in populations of PWE with high disease burden has been under-studied. The goal of this study was to evaluate PA level and its impact on health-related QOL in PWE who were admitted to Level-4 epilepsy monitoring units (EMU).

Methods: In this prospective observational study, 200 patients from two EMUs in Dallas, Texas completed the following standard surveys: Rapid Assessment of Physical Activity (RAPA), the Quality of Life in Epilepsy (QOLIE-31), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder 7-item (GAD-7) questionnaire. Information on self-reported epilepsy history, severity of disease, and socioeconomic status were also collected. The diagnosis of epilepsy was confirmed by video-EEG monitoring.

Results: Among the 200 who completed the survey, 113 had a diagnosis of epilepsy and 109 of them completed the RAPA. Ninety-two (84 %) of these PWE reported a sedentary level of physical activity (RAPA < 6) and 16 % reported an active level (RAPA ≥ 6). Self-reported QOL was slightly higher in PWE with an active level of PA compared to PWE with a sedentary level of PA (63.8 ± 15.0 vs 53.7 ± 17.9, p = 0.07), even though there was no difference in the severity of self-reported mood symptoms. After controlling for employment and seizure frequency, physical activity level measured by RAPA score was also positively related to QOL (r = 0.39, p = 0.01) and negatively correlated with anxiety symptoms (r = -0.28, p = 0.02) and depression symptoms (r = -0.25, p = 0.04).

Conclusion: The majority of PWE in this survey reported sedentary lifestyles despite most of them being young to middle-aged adults. Higher PA level was associated with fewer self-reported mood symptoms and higher QOL. In conjunction with the literature, these results suggest that PWE with a wide range of disease burden should be encouraged to participate in regular exercise to potentially improve QOL.
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http://dx.doi.org/10.1016/j.eplepsyres.2021.106639DOI Listing
July 2021

Frequency and Predictors of Traumatic Encephalopathy Syndrome in a Prospective Cohort of Retired Professional Athletes.

Front Neurol 2021 23;12:617526. Epub 2021 Feb 23.

Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States.

Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency of TES in a cohort of retired professional contact sport athletes, compare the frequency of TES to clinical consensus diagnoses, and identify predictors that increase the likelihood of TES diagnosis. Participants were 85 retired professional contact sport athletes from a prospective cohort at the University of Texas Southwestern Medical Center and the University of Texas at Dallas. Participants ranged in age from 23 to 79 (M = 55.95, SD = 13.82) and obtained 7 to 19 years of education (M = 16.08, SD = 1.03). Retirees were either non-Hispanic white ( = 62) or African-American ( = 23). Retired athletes underwent a standard clinical evaluation, which included a clinical interview, neurological exam, neuroimaging, neuropsychological testing, and consensus diagnosis of normal, mild cognitive impairment, or dementia. TES criteria were applied to all 85 athletes, and frequencies of diagnoses were compared. Fourteen predictors of TES diagnosis were evaluated using binary logistic regressions, and included demographic, neuropsychological, depression symptoms, and head-injury exposure variables. A high frequency (56%) of TES was observed among this cohort of retired athletes, but 54% of those meeting criteria for TES were diagnosed as cognitively normal via consensus diagnosis. Games played in the National Football League (OR = 0.993, = 0.087), number of concussions (OR = 1.020, = 0.532), number of concussions with loss of consciousness (OR = 1.141 = 0.188), and years playing professionally (OR = 0.976, = 0.627) were not associated with TES diagnosis. Degree of depressive symptomatology, as measured by the total score on the Beck Depression Inventory-II, was the only predictor of TES diagnosis (OR = 1.297, < 0.001). Our results add to previous findings underscoring the risk for false positive diagnosis, highlight the limitations of the TES criteria in clinical and research settings, and question the relationship between TES and head-injury exposure. Future research is needed to examine depression in retired professional athletes.
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http://dx.doi.org/10.3389/fneur.2021.617526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940833PMC
February 2021