Kern Medical Center

Bakersfield, CA, United States

Kern Medical Center

Bakersfield, CA, United States

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Salam M.T.,University of Southern California | Salam M.T.,Kern Medical Center | Avoundjian T.,Health-U | Gilliland F.D.,University of Southern California
PLoS ONE | Year: 2015

Background: Asthma and rhinitis are common childhood health conditions. Being an understudied and rapidly growing population in the US, Hispanic children have a varying risk for these conditions that may result from sociocultural (including acculturative factors), exposure and genetic diversities. Hispanic populations have varying contributions from European, Amerindian and African ancestries. While previous literature separately reported associations between genetic ancestry and acculturation factors with asthma, whether Amerindian ancestry and acculturative factors have independent associations with development of early-life asthma and rhinitis in Hispanic children remains unknown. We hypothesized that genetic ancestry is an important determinant of early-life asthma and rhinitis occurrence in Hispanic children independent of sociodemographic, acculturation and environmental factors. Methods: Subjects were Hispanic children (5-7 years) who participated in the southern California Children's Health Study. Data from birth certificates and questionnaire provided information on acculturation, sociodemographic and environmental factors. Genetic ancestries (Amerindian, European, African and Asian) were estimated based on 233 ancestry informative markers. Asthma was defined by parental report of doctor-diagnosed asthma. Rhinitis was defined by parental report of a history of chronic sneezing or runny or blocked nose without a cold or flu. Sample sizes were 1,719 and 1,788 for investigating the role of genetic ancestry on asthma and rhinitis, respectively. Results: Children had major contributions from Amerindian and European ancestries. After accounting for potential confounders, per 25% increase in Amerindian ancestry was associated with 17.6% (95% confidence interval [CI]: 0.74-0.99) and 13.6% (95% CI: 0.79-0.98) lower odds of asthma and rhinitis, respectively. Acculturation was not associated with either outcome. Conclusions: Earlier work documented that Hispanic children with significant contribution from African ancestry are at increased asthma risk; however, in Hispanic children who have little contribution from African ancestry, Amerindian ancestry was independently associated with lower odds for development of early-childhood asthma and rhinitis.

Spinello I.M.,University of California at Los Angeles | Spinello I.M.,Kern Medical Center
Journal of Intensive Care Medicine | Year: 2015

In the United States, each year 1% to 2% of deaths are brain deaths. Considerable variation in the practice of determining brain death still remains, despite the publication of practice parameters in 1995 and an evidence-based guideline update in 2010. This review is intended to give bedside clinicians an overview of definition, the causes and pitfalls of misdiagnosing brain death, and a focus on the specifics of the brain death determination process. © SAGE Publications.

Janfaza M.,Kern Medical Center | Martin M.,Kern Medical Center | Skinner R.,Kern Medical Center
World Journal of Surgery | Year: 2012

Background: The biologic materials currently available for hernia repairs are costly and there are limited statistics on recurrences and rates of infection in connection with their use in complex cases. Methods: We performed a retrospective review and comparison of two types of biologic mesh used at our institution for abdominal hernia repairs spanning a 1-year period. Demographic data and outcomes relating to surgical site infections, hernia recurrences, and mortality were analyzed. Of the 35 patients in the study, 23 patients (Group I) were managed with SurgiMend, a neonatal bovine mesh, and 12 patients (Group II) were managed with Flex HD, a human-derived mesh. Results: The study cohorts met criteria for high-risk stratification based on body mass index, comorbid conditions, and a high prevalence of contaminated wounds. The overall surgical site infection rate was 17 % for Group I and 50 % for Group II. These differences reached statistical significance when comparing superficial infections but not for deep infections with mesh involvement. Hernia recurrences in Group I were 5 % compared to 33 % in Group II. No deaths were observed. Conclusions: These preliminary data demonstrate promising short-term outcomes for high-risk complex hernias repaired with biologic mesh, particularly SurgiMend, but the long-term durability of these biological materials is yet to be determined. © Société Internationale de Chirurgie 2012.

Pakula A.M.,The Surgical Center | Phillips W.,Kern Medical Center | Skinner R.A.,The Surgical Center
World Journal of Emergency Surgery | Year: 2011

Background: Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Thoracic duct ligation is often the treatment of choice in postsurgical patients; however the optimal treatment of this disease process after traumatic injury remains unclear 1. We present a rare case of a thoracic duct injury secondary to a blunt thoracic spine fracture and subluxation which was successfully treated non-operatively.Case Presentation: A 51 year old male presented as a tier one trauma code due to an automobile versus bicycle collision. His examination and radiographic work-up revealed fractures and a subluxation at the third and fourth thoracic spine levels resulting in paraplegia. He also sustained bilateral hemothoraces secondary to multiple rib fractures. Drainage of the left hemothorax led to the diagnosis of a traumatic chylothorax. The thoracic spine fractures were addressed with surgical stabilization and the chylothorax was successfully treated with drainage and dietary manipulation.Conclusions: This unusual and complex blunt thoracic duct injury required a multidisciplinary approach. Although the spine injury required surgical fixation, successful resolution of the chyle leak was achieved without surgical intervention. © 2011 Pakula et al; licensee BioMed Central Ltd.

Manunga Jr. J.,Kern Medical Center | Olak J.,Kern Medical Center | Rivera C.,Kern Medical Center | Martin M.,Kern Medical Center
American Surgeon | Year: 2012

Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of postoperative surgical site infections (SSIs). It is unclear, however, whether asymptomatic colonization or nosocomial acquisition of MRSA results in postoperative SSI. We conducted a retrospective review of patients screened for MRSA between May 2008 and October 2010 at our institution. End points included rates of MRSA infection, SSI, and the cost of routine MRSA screening of patients undergoing elective surgery. Of the 1039 patients screened preoperatively, 48 (4.6%) tested positive for MRSA by nasal or oral swab, whereas 991 (95.4%) tested negative. Forty-five (93.8%) MRSA-positive patients received vancomycin or linezolid and three (6.25%) received cefazolin perioperatively. Three (6.25%) MRSA-positive patients developed postoperative SSIs. Two required rehospitalization for intravenous antimicrobials, whereas a third patient required removal of infected abdominal mesh. Twenty (2.02%) MRSA-negative patients and four (5.26%) unscreened patients developed non-MRSA SSIs. Regardless of MRSA status, none of 609 patients who had a laparoscopic procedure or inguinal hernia repair developed SSI. Twenty-two patients needed to be screened to obtain one positive test. The role of MRSA screening and longer perioperative coverage for MRSA-positive patients undergoing complex elective procedures remains to be determined.

Khurana J.,Kern Medical Center
Journal of intensive care medicine | Year: 2013

Splenic artery aneurysm (SAA) is the most common (60%) of all visceral artery aneurysms. The majority of these cases are asymptomatic, but the presentation of their rupture can vary from abdominal/chest pain to cardiovascular collapse (Sadat U, Dar O, Walsh S, Varty K. Splenic artery aneurysms in pregnancy-a systematic review. Int J Surg. 2008;6(3):261-265.). Although rare, the mortality associated with the rupture is as high as 25% (De Vries JE, Schattenkerk ME, Malt RA. Complications of splenic artery aneurysm other than intraperitoneal rupture. Surgery. 1982;91(2):200-204; Caillouette JC, Merchant EB: Ruptured splenic artery aneurysm in pregnancy. Twelfth reported case with maternal and fetal survival. Am J Obstet Gynecol 1993;168(6 Pt 1):1810-1811) and increases to 75% among pregnant women with a concomitant fetal mortality of 95% (O'Grady JP, Day EJ, Toole AL, et al. Splenic artery aneurysm rupture in pregnancy. A review and case report. Obstet Gynecol. 1977; 50(5):627-630). Because of such high maternal and fetal mortality prompt management of SAAs is of utmost importance. We are presenting a case of a 35-year-old woman with a missed ruptured SAA who after an emergent cesarean section went into profound shock and was unable to be resuscitated. This case illustrates the importance of considering the diagnosis of SAA rupture in hemodynamically unstable peripartum females.

Spinello I.M.,Kern Medical Center
Journal of Intensive Care Medicine | Year: 2011

Proper critical care training and management rests on 3 pillars-evidence-based patient care, proficient procedural skills, and compassionate end-of-life (EOL) management. The purpose of this manuscript is to provide a practical guide to EOL management for all bedside practitioners. The manuscript outlines not all but some fundamentally important ethical concepts and provides helpful rules and steps on end-of-life management based on my own personal experience and practice. Moreover, nowhere in the rigorous training of critical care or hospitalist physicians do we teach the procedure for removal of life-sustaining measures. Like any other procedure in medicine, it requires preparation, implementation and conclusion, as well as supervision and repetition to become proficient. Therefore, at the conclusion of this paper, an attempt is made to correct this lack of training by providing such outline and a guide. © SAGE Publications 2011.

Sheykholeslami K.,Rockford College | Thomas J.,Rockford College | Chhabra N.,Case Western Reserve University | Trang T.,Kern Medical Center | Rezaee R.,Case Western Reserve University
American Journal of Otolaryngology - Head and Neck Medicine and Surgery | Year: 2012

Background: Percutaneous endoscopic gastrostomy (PEG) has become a mainstay in providing enteral access for patients with obstructive head and neck tumors. PEG tube placement is considered safe and complications are infrequent. Methods: A comprehensive review of the literature in MEDLINE (1962-2011) was performed. We report herein 3 new cases. Results: The literature search revealed 43 previous cases. The interval between PEG placement and diagnosis of metastasis ranged from 1 to 24 months. Conclusions: Metastatic cancer should be considered in patients with head and neck cancer that have persistent, unexplained skin changes at PEG site, anemia, or guaiac positive stools without a clear etiology. The direct implantation of tumor cells through instrumentation is the most likely explanation, although hematogenous and/or lymphatic seeding is also a possibility. Our review of the literature and clinical experience indicate that the pull technique of PEG placement may directly implant tumor cells at the gastrostomy site. © 2012 Elsevier Inc. All rights reserved.

Katlic M.R.,Geisinger Wyoming Valley Medical Center | Katlic M.R.,Sinai Hospital | Facktor M.A.,Geisinger Medical Center | Berry S.A.,Dartmouth Hitchcock Medical Center | And 9 more authors.
CA Cancer Journal for Clinicians | Year: 2011

Geisinger's ProvenCare™ Program (for elective coronary artery bypass surgery, total hip replacement, and others) has shown that the principles of reliability science, facilitated by a robust electronic health record and institutional commitment, allow the re-engineering of complicated clinical processes. This eliminates unwarranted variation and promotes the completion of evidence-based elements of care. It has not been established that ProvenCare can be generalized to other institutions. Now, under the auspices of the American College of Surgeons Commission on Cancer, ProvenCare has been adapted to a multi-institutional collaborative for the care of the patient with resectable lung cancer. Copyright © 2011 American Cancer Society, Inc.

Manunga J.,Kern Medical Center | Olak J.,Kern Medical Center
American Surgeon | Year: 2010

Before thoracoscopy became popular in the 1990s, thoracotomy and decortication was the treatment of choice for empyema thoracis not responding to tube thoracostomy. An Institutional Review Board-approved, retrospective review of all patients treated for empyema between September 1, 2006, and August 31, 2009, at Kern Medical Center was conducted. A total of 37 patients (male = 33; female = 4) with a mean age of 43.7 years were treated. Empyema developed after community-acquired pneumonia (CAP) in 27, traumatic hemothorax (TH) in nine, and other cause in one. For 34 of 36 patients (91%), a thoracoscopic approach was successful. Two of 36 patients required conversion to thoracotomy, whereas one patient required an initial thoracotomy in each case as a result of tenacious adhesions. Mean duration of the chest tube was 4.1 days in patients with CAP and 4.6 days in patients with TH. Mean length of stay after surgery was 6 days for patients with CAP and 9.1 days for patients with TH. Five of 37(13.5%) had complications and one patient died (2.7%). Follow-up was complete for 81.1 per cent of patients, none of whom required a subsequent intervention. Compared with the literature, it appears that the conversion rate to thoracotomy, length of chest tube duration, and postoperative length of stay have decreased as experience has increased.

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