Publications by authors named "Suma Yalamanchili"

5 Publications

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Point Blank: A Retrospective Review of Self-inflicted Gunshot Wounds to the Hand.

Hand (N Y) 2021 Jun 10:15589447211014603. Epub 2021 Jun 10.

University of Cincinnati College of Medicine, OH, USA.

Background: A paucity of literature exists specifically examining self-inflicted (SI) gunshot wounds (GSWs) to the hand and wrist, which impart greater energy and have a higher risk of adverse events than non-self-inflicted (NSI) GSWs.

Methods: We retrospectively reviewed records of patients who presented to our plastic surgery service after sustaining acute GSWs involving the hand and wrist between 2016 and 2018.

Results: We identified 60 patients who sustained GSWs involving the hand and wrist; 17 (28%) were SI, and 43 (72%) were NSI. Within the SI group, 100% of patients were Caucasian, with an average age of 54 years. Within the NSI cohort, 77% of patients were Black, 19% were Caucasian, and 4% identified as other. While not statistically significant, we noted a substantial increase in patients requiring operative intervention in the SI cohort (65% SI vs 37% NSI, = .08). There was a statistically significant increase in patients requiring more than 1 operation in SI patients (24% SI vs 5% NSI, = .04). Patients who sustained SI injuries were also more likely to present with acute carpal tunnel syndrome requiring urgent surgical release and to develop wound infections (12% vs 0%, = .08).

Conclusions: Self-inflicted GSWs involving the hand and wrist are associated with greater morbidity than their low-energy NSI counterparts. Individuals presenting with SI GSWs are more likely to be older, to require multiple operations, to develop infections, and to present with acute carpal tunnel syndrome requiring urgent surgical decompression.
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http://dx.doi.org/10.1177/15589447211014603DOI Listing
June 2021

A look at racial and socioeconomic disparities in post-mastectomy breast reconstruction at a midwestern academic hospital.

Breast J 2021 05 5;27(5):461-465. Epub 2021 Mar 5.

Division of Plastic and Reconstructive Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.

Purpose of this study was to assess likelihood of undergoing breast reconstruction based on race, socioeconomic status, insurance, and distance from the hospital. Patients with public insurance were less likely to undergo reconstruction than patients with private insurance (OR = 2.99, p < 0.001). White patients were more likely to undergo reconstruction (OR = 0.62, p = 0.02). Patients who lived 10-20 miles and 20-40 miles from UCMC were more likely to undergo reconstruction (OR = 1.93, p = 0.01; OR = 3.06, p < 0.001). White patients and patients with private insurance are disproportionately undergoing breast reconstruction after mastectomy.
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http://dx.doi.org/10.1111/tbj.14213DOI Listing
May 2021

Swipe right for surgical residency: Exploring the unconscious bias in resident selection.

Surgery 2020 10 14;168(4):724-729. Epub 2020 Jul 14.

Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, OH; Department of Surgery, University of Cincinnati, OH. Electronic address:

Background: Applicants provide a photo with their application through the Electronic Residency Application Service, which may introduce appearance-based bias. We evaluated whether an unconscious appearance bias exists in surgical resident selection.

Methods: After the match, applicant data from the 2018 to 2019 and 2019 to 2020 application cycles were examined. Reviewers were not provided the applicant photo or self-identified race during the second cycle. Photos provided by candidates were then rated by 4 surgical subspecialty residents who had no prior exposure to applications or interview status. Photos were rated on perceived fitness level, visual appearance, and photo professionalism. An overall photo score was then calculated.

Results: In the study, 422 applications were reviewed and 164 received interview invitations during the 2018 to 2019 cycle. Alpha Omega Alpha membership (odds ratio, 2.31; 95% confidence interval, 1.18-4.51), overall photo score (odds ratio, 2.29, 95% confidence interval, 1.43-3.66), research (odds ratio, 5.61, 95% confidence interval, 2.84-11.20), age (odds ratio, 0.86, 95% confidence interval, 0.76-0.99), and step 2 (odds ratio, 1.06, 95% confidence interval, 1.03-1.09) were predictors for receiving an interview. For the 2019 to 2020 cycle, 398 applications were reviewed, and 75 applicants received an invitation. Step 2 (odds ratio, 1.07, 95% confidence interval, 1.02-1.12), research (odds ratio, 2.78, 95% confidence interval, 1.40-5.55), age (odds ratio, 0.82, 95% confidence interval, 0.71-0.95), and overall photo score (odds ratio, 2.27; 95% confidence interval, 1.14-4.52) remained predictors despite reviewers being blinded to the photo during this cycle.

Conclusion: Although objective metrics remain critical in determining interview invitations, overall perceived applicant appearance may influence the selection process. Although visual appearance was associated with receiving an interview, the Electronic Residency Application Service photo does not ultimately affect selection. This may suggest that appearance may influence other objective and subjective aspects of the application.
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http://dx.doi.org/10.1016/j.surg.2020.05.029DOI Listing
October 2020

Hand and Upper Extremity Infections in Intravenous Drug Users: Epidemiology and Predictors of Outcomes.

J Hand Surg Am 2020 Jun 28;45(6):503-511. Epub 2020 Mar 28.

Department of Orthopedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH.

Purpose: Injectable drug use (IDU) is a national epidemic, public health problem, and common cause of hand and upper extremity (UE) infections. This study assesses the epidemiology of the IDU patient population presenting to a Midwestern academic medical center emergency department (ED) and examines predictors influencing morbidity and outcomes.

Methods: A retrospective review was performed using International Classification of Diseases, Ninth Revision (ICD-9) codes to identify all adult patients presenting to the ED with hand/UE infections, with and without concurrent IDU diagnoses, over a period of 2.5 years. Demographics and clinical factors were examined utilizing bivariate and multivariable analyses to identify predictors of outcomes, including not completing outpatient follow-up and leaving against medical advice (AMA).

Results: A total of 1,482 patients with 1,754 ED visits for hand/UE infections were identified, including 308 patients with IDU-acquired infections (396 visits) and 1,174 patients with non-IDU infections (1,358 visits). Psychiatric comorbidities and hepatitis C were common in the IDU group (51% and 39%, respectively), and 31% of IDU patients were uninsured. Heroin use was identified in 96% of visits. The IDU infections were more likely to have surgical intervention than those in non-IDU patients (16% vs 6%), and a longer mean length hospital stay (2.4 vs 0.9 days). The IDU patients were more likely than non-IDU patients to leave AMA. In multivariable analysis, IDU, psychiatric comorbidity, and insurance status were independent predictors (P < .05) for leaving AMA.

Conclusions: In the setting of a national epidemic, hand/UE infections due to IDU are a common problem seen by hand surgeons. This study characterizes the growing IDU patient population at an urban academic medical center, examining the largest cohort of these patients to date.

Type Of Study/level Of Evidence: Prognostic IV.
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http://dx.doi.org/10.1016/j.jhsa.2020.02.004DOI Listing
June 2020

Bromocriptine improves glucose tolerance independent of circadian timing, prolactin, or the melanocortin-4 receptor.

Am J Physiol Endocrinol Metab 2020 01 3;318(1):E62-E71. Epub 2019 Dec 3.

Department of Biological Sciences, Marquette University, Milwaukee, Wisconsin.

Bromocriptine, a dopamine D2 receptor agonist originally used for the treatment of hyperprolactinemia, is largely successful in reducing hyperglycemia and improving glucose tolerance in type 2 diabetics. However, the mechanism behind bromocriptine's effect on glucose intolerance is unclear. Here, we tested three hypotheses, that bromocriptine may exert its effects on glucose metabolism by ) decreasing prolactin secretion, ) indirectly increasing activity of key melanocortin receptors in the central nervous system, or ) improving/restoring circadian rhythms. Using a diet-induced obese (DIO) mouse model, we established that a 2-wk treatment of bromocriptine is robustly effective at improving glucose tolerance. We then demonstrated that bromocriptine is effective at improving the glucose tolerance of both DIO prolactin-deficient and melanocortin-4 receptor (MC4R)-deficient mice, pointing to bromocriptine's ability to affect glucose tolerance independently of prolactin or MC4R signaling. Finally, we tested bromocriptine's dependence on the circadian system by testing its effectiveness in environmental (e.g., repeated shifts to the light-dark cycle) and genetic (e.g., the mutant mouse) models of circadian disruption. In both models of circadian disruption, bromocriptine was effective at improving glucose tolerance, indicating that a functional or well-aligned endogenous clock is not necessary for bromocriptine's effects on glucose metabolism. Taken together, these results do not support the role of prolactin, MC4R, or the circadian clock as integral to bromocriptine's underlying mechanism. Instead, we find that bromocriptine is a robust diabetic treatment and resilient to genetically induced obesity, diabetes, and circadian disruption.
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http://dx.doi.org/10.1152/ajpendo.00325.2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985791PMC
January 2020
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