Nanoparticle Compositions for Sustained Delivery of Pro-regenerative Growth Factors for Nerve Repair, Preparation Processes of the Same, and Treatment Methods Using the Same

Karim Sarhane
Karim Sarhane

Global incidence rates for peripheral nerve injury (PNI) are not well aggregated. However, US data collected shows that 20 million Americans suffer from peripheral nerve injury caused by trauma and medical disorders. When a tension-free early repair is possible, microsurgical direct nerve repair with epineural sutures remains the gold standard of care. The current standard for large nerve defects is autologous nerve grafts. However, disadvantages for this treatment approach include risk of neuroma formation and loss of donor nerve function. Acellular nerve conduits limit the disadvantages associated with autologous grafts. However, conduits are still insufficient for large deficits and require a combination of pharmacological and molecular therapies to yield prime results. Research indicates that these therapy additions should focus on both axonal regeneration and Schwann cell renewal. Insulin-like growth factor (IGF-1) has shown promising results because it optimizes axonal regeneration and Schwann cell renewal simultaneously. Previously reported encapsulation methods for growth factors either release the payload too rapidly or achieve prolonged presence through covalent conjugation. Therefore, there is a strong need to develop a delivery system that can provide sustained release of small proteins for an extended duration while maintaining encapsulation efficiency and bioactivity.

Karim Sarhane MD at Johns Hopkins created a nanoparticle-based delivery system that provides sustained release of bioactive insulin like growth-factor 1 (IGF-1) for 20 days in vitro to denervated nerve and muscle tissue within the peripheral nervous system. The delivery system fulfills the need to create a nanoparticle-based drug delivery system that provides sustained and controllable release of IGF-1 without sacrificing on encapsulation efficiency or retention of bioactivity. Preliminary results support potential to improve functional outcomes for PNI patients suffering from severe injury, presenting a significant value proposition with potential to improve significant sensory and motor impairments associated with 4th and 5th degree injury.

sarhane
karim sarhane

Treating An Acute Case of Phytophotodermatitis

karim sarhane
Dr. Karim

Dr. Karim Sarhane is a general and laparoscopic surgeon who provides treatment for numerous conditions at the Burjeel Royal Hospital in Al Ain, Abu Dhabi (United Arab Emirates). Extensively published in the surgery field, Karim Sarhane, MD, co-authored a paper detailing the management of a rare burn condition, called “Phytophotodermatitis.” The paper discussed a 30-year-old woman who arrived at the ER following two days of painful blistering wounds over the upper surfaces of her hands. The patient’s hands had started peeling a day after she sliced limes for an outdoor party, with no other precipitating events recalled. The diagnosis was one of phytophotodermatitis, or a skin reaction related to the photosensitizing chemicals contained in fruits and saps. When the chemicals are smeared on the skin and exposed to the sun, one result can be acute redness and blistering. This is easy to mistake for atopic dermatitis, chemical burn, or type IV hypersensitivity reaction. Phytophotodermatitis treatments range from the application of a moist dressing (in mild cases) to burn unit admission and local wound care (in severe cases). Emergency treatments include topical application of a corticosteroid and cooling of the affected area. In the case described, a conservative management approach was undertaken, featuring a dry, sterile dressing and bacitracin taken daily, as well as hand exercises to avoid stiffness.

Karim Sarhane, MD

karim sarhane

Growth Hormone Shows Promise in Treating Peripheral Nerve Injury

karim sarhane
Dr. Karim

With more than a decade of experience as an accomplished surgeon-scientist, Karim Sarhane, MD, is a physician who performs complex surgeries that address conditions such as nerve injuries. In the paper “Growth Hormone Therapy Accelerates Axonal Regeneration, Promotes Motor Reinnervation, and Reduces Muscle Atrophy following Peripheral Nerve Injury,” co-author Karim Sarhane, MD, explored an area in which research was largely lacking. In cases where peripheral nerve injury remains untreated, the prolonged denervation of Schwann cells and muscle can result in permanent nerve damage. The study evaluated growth hormone therapy’s impact in promoting axonal regeneration and maintenance of the target muscle and sensory end organs. The rats in the study underwent femoral nerve transection without repair, as well as sciatic nerve transection with repair. The control group received no treatment, while the other rats were provided with subcutaneous growth hormone on a daily basis. After five weeks, axonal regeneration of the sciatic nerve was assessed, as was muscle atrophy of the gastrocnemius muscle. In addition, Schwann cell proliferation in the denervated distal femoral nerve and motor endplate reinnervation in the soleus muscle were evaluated. The results showed that growth hormone-treated rats had a greater body mass percentage increase, greater cross-sectional muscle myofibril area, superior motor endplate reinnervation, and a greater number of myelinated axons regenerating. The bottom line is that growth hormone therapy seems to have a positive effect in preventing muscle atrophy and helping restore motor function.

Karim Sarhane, MD

karim sarhane

What Are Clinical Trials and Why Are They Important?

Karim Sarhane
Dr. Karim

Medical treatments are evolving quickly, and nowadays, the new alternatives that offer hope to individuals suffering from various illnesses come in the form of clinical trials. Clinical trials investigate the advantages and dangers of new therapies, interventions, and medications. Clinical trials are scientific investigations assessing the efficacy and safety of potential new medical therapies or interventions before their widespread distribution. They involve healthy volunteers and people diagnosed with a disease or disorder for which the standard treatments may not be effective. Clinical trials are usually conducted in four phases, each building on the previous one. Phase 1 trials are the earliest stage of human testing that involve a small group of people who are healthy or who have the condition under study. During phase 1, the primary goal is to determine the safety of the new intervention and the correct dosage. Phase 2 of clinical trials involve a larger group of people with the condition under study. Studying and assessing the intervention’s efficacy is the main focus of this phase. During Phase 3 trials, a larger group of people enrolled to participate in the study to test the new intervention’s effectiveness and safety. Phase 3 clinical trials are randomized, double-blind, and controlled. This means that people are assigned to different groups randomly to receive either the experimental intervention or a placebo treatment. Both the subjects nor the researchers are unaware of which group they are in. After the study, researchers compare both groups’ values. Following regulatory approval, researchers undertake phase 4 trials called post-marketing studies to make the treatment safe and effective. Patients may access innovative therapies and procedures not available to the general public by participating in a clinical study. Patients may also receive specialized medical care and attention from a team of healthcare professionals. However, there are risks to participating in clinical studies, such as getting sick or having unpleasant side effects. Additionally, patients assigned to receive the placebo may become frustrated due to seeing zero improvement in their condition. Placebos are essential to clinical trials because they show how well a new drug works compared to a placebo or standard care. In clinical trials, researchers ensure that their testing results accurately demonstrate a treatment’s safety and effectiveness. They often use a “randomized, placebo-controlled” clinical trial as the gold standard to achieve this. This trial randomly assigns volunteers to a test group that receives the experimental intervention or a control group that receives a placebo or routine care. A placebo is an inactive substance that looks like the drug or treatment being tried. Researchers can tell if improvements seen in the test group are the product of the intervention or simply coincidental by comparing the two data sets. In some trials (double-blind, placebo-controlled), the research team is unaware of which participants receive the treatment, the placebo, or another intervention. Several resources are available to participate in a clinical trial for a medical condition. ClinicalTrials.gov and the National Cancer Institute’s Cancer Trials Support Unit can assist in identifying appropriate clinical trials. Additionally, consulting with a doctor or healthcare provider can provide information about ongoing clinical studies. Support groups and advocacy groups for patients may also know of ongoing clinical trials that could help treat your disease.

Karim Sarhane, MD

Basketball

Ways to Improve Your Basketball Skills and Techniques

Karim Sarhane
Karim Sarhane, MD MSc

Basketball is a thrilling sport, but it’s also one that requires plenty of skill and technique. Whether you’re a beginner or a seasoned player, there’s always room for improvement in your basketball skills. Fortunately, there are plenty of ways to enhance your game and take your skills to the next level. Basketball is a dynamic sport that requires players to possess various skills to succeed. There are five main types of basketball skills: dribbling, passing, shooting, rebounding, and defense. Dribbling involves controlling the ball with your hands while moving around the court. Passing is the act of transferring the ball to a teammate. Shooting requires good hand-eye coordination and accuracy to score points. Rebounding is the ability to grab the ball when it bounces off the rim or backboard. And the defense is the skill of preventing the opposing team from scoring. Ball control is one of the most critical aspects of basketball. To improve your ball-handling skills, start by practicing dribbling drills. You can use cones or other obstacles to simulate game situations and improve your ability to maneuver around defenders. Focus on keeping your eyes up and your head steady while dribbling, as this will help you maintain control of the ball while scanning the court for passing opportunities. Hand alignment is crucial for accurate shooting and passing. When shooting, spread your fingers apart; the ball rests on your fingers’ pads, not your palm. Use your fingertips to control the ball’s trajectory and spin when passing. Practicing at game speed is essential to improving your basketball skills. Instead of going through the motions, simulate game situations during practice. This means practicing at full speed, with defenders and other obstacles present. Practicing consistently is the most effective way to improve your basketball skills. Not only will regular training help build muscle memory and fine-tune your movements, but it will also help you gain confidence on the court. Try setting aside a specific time slot each day or week for practice, and focus on specific areas you want to improve, such as ball handling or shooting accuracy. Watching professional basketball games or highlight reels can be a great way to learn new techniques and gain inspiration for your game. Pay attention to the moves and strategies of your favorite players, and try to incorporate them into your routine. Additionally, watching yourself play on video can help identify areas to improve and give you a new perspective on your game. Similarly, improve your footwork and reaction time if you have difficulty with defense. A key component of basketball is the physical demands placed on players. Improving your stamina, strength, and agility can significantly impact your overall performance on the court. Incorporating proper conditioning exercises, such as agility drills, weight training, and cardiovascular training, into your routine can help increase your endurance and reaction time while reducing the risk of injury. Mental toughness can help you stay focused and confident, even in high-pressure situations. Building mental resilience includes meditation, visualization, positive self-talk, and developing routines to prepare for games and practices. Finally, don’t be afraid to seek feedback and coaching from others. Whether it’s a more experienced teammate, a coach, or a specialized training program, receiving guidance and constructive criticism can help you identify areas where you need to improve and set goals.

Karim Sarhane, MD

Karim Sarhane

An Overview of Thyroid Cancer

Karim Sarhane
Karim Sarhane, MD

Thyroid cancer is a condition where malignancy grows in the thyroid gland. The thyroid gland is a butterfly-shaped organ that sits at the base of the trachea (windpipe) and has a right and left lobe. A thin body of tissue called the isthmus connects these lobes. Malignancy is a condition where cell division occurs abnormally and may invade and infect nearby cells. The thyroid gland uses iodine to synthesize several essential hormones, including triiodothyronine, tetraiodothyronine, and calcitonin. These hormones control and regulate various physiological functions such as body weight, heart rate, blood pressure, and body temperature. Within the thyroid gland, there may be nodules. A doctor may discover these abnormally grown thyroid gland cells during a patient’s check-up. These nodules may be solid or filled with liquid. Over 90 percent of these nodules are benign, while 10 percent are malignant. Initially, thyroid cancer may not exhibit symptoms. However, as the malignant cells invade more nearby cells, signs and symptoms will eventually appear. The most common of these include neck swelling, difficulty swallowing food and breathing, and voice changes. As a result, healthcare professionals recommend regular check-ups due to the silent nature of the condition’s onset. About 53,000 Americans get thyroid cancer treatment yearly. While most treatments are successful, around 2,000 patients die annually due to the disease. Women are at three times the risk of getting thyroid cancer than men. For women, most cases involve those between 40 and 50 years old, while in men, most of those affected are from 60 to 70 years old. The condition may also affect children, but only in rare cases. The condition’s risk factors include a diet low in iodine, gene mutations, a family history of the disease, an enlarged thyroid (also known as goiter), and obesity. Other risk factors are radiation therapy in the head and neck, especially for children, and exposure to radioactivity, such as that experienced during a nuclear power plant accident. There are different types of thyroid cancer, including anaplastic, follicular, medullary, and papillary. Accounting for about 2 percent of all thyroid cancer types, anaplastic thyroid cancer, though rare, is the hardest to treat. The malignant cells grow quickly and may spread to surrounding tissues and other parts of the body. Medullary thyroid cancer also accounts for around 2 percent of all cases. It is caused by a genetic mutation leading to a faulty gene. As a result, this condition is primarily hereditary, with a quarter of those infected having a family history of the disease. Similar to anaplastic thyroid cancer, follicular thyroid cancer is metastatic. This is a condition where the cancer cells spread from the original tumor and enter the lymphatic system or bloodstream, infecting other body parts. Follicular thyroid cancer is also hard to treat, since it may spread to the bones and organs such as the lungs. It accounts for about 15 percent of all cases. Diagnosis for thyroid cancer may be through blood tests, biopsy, radioiodine scans, and imaging scans. Blood tests check whether the thyroid is functioning properly and hormone levels. A biopsy involves removing the suspect tissue and observing it in a laboratory for cancer cells. Radioiodine scans involve a patient swallowing a safe amount of radioactive iodine and using a special device to measure radioactivity in the thyroid gland. The areas that emit less radioactivity require more testing to ascertain if there is cancer. Last, imaging diagnosis techniques, including computed tomography (CT) scans and positron emission tomography (PET) scans, can be used to detect cancerous growths. Treatment depends on the tumor’s size and if it has spread. Common treatment methods include chemotherapy, hormone therapy, radiation therapy, radioiodine therapy, and surgery. Chemotherapy involves administering drugs to the patient that kill the cancerous cells. Hormone therapy stops the release of hormones that spread cancer or may cause it to recur. With radiation therapy, a machine emits targeted radiation that only kills the cancerous cells, while in radioiodine therapy, the patient takes a higher dose of radioactive iodine than that used in radioiodine scans to shrink and destroy the cancerous cells. Last, surgery involves physically removing the tumor. The surgeon may perform lobectomy, where they remove part of the thyroid gland, or thyroidectomy, where they remove all of the thyroid gland.

Karim Sarhane, MD

Karim Sarhane surgery
karim sarhane

A Look at Windsurfing

Karim Sarhane

Windsurfing, also known as boardsailing, is a water sport combining surfing and sailing using a craft called a sailboard to travel over water and glide over waves. The sailboard has a sail rig and a long board with fins attached to help steer it. The sail rig harnesses wind power to move the sailboard and rider. While the sailboard usually measures from six to nine feet in length, the sail rig will vary in size depending on the the windsurfer’s preferences and skills. The sport is done both recreationally and competitively. It dates back to the 1950s when Jim Drake and Hoyle Schweitzer thought of how they could combine their individual sports (surfing and sailing, respectively) into one, leading them to make several sailboard prototypes. They patented their first sailboard in 1968, and by the 1970s, Schweitzer was mass-producing them. It soon quickly spread in popularity in North America. By the late 1970s, it had spread to Europe and became as popular as in North America. In fact, today Europe is one of the leading regions in sailboard manufacturing. As a competitive sport, windsurfers compete in slalom races, regattas, and wave sailing events. In a slalom race, the windsurfer follows a winding course and must pass between pole pairs with flags. Regattas feature sailing, speedboat, and rowing races of various types. Wave sailing is a sport where the surfer rides into waves using special gear. A windsurfer may do the sport on various water bodies and conditions, including oceans, lakes, estuaries, harbors, and large rivers. Initially, windsurfers could only surf close to the shore at slow speeds. However, sailboards have advanced in design and functionality such that windsurfers can now go into deep waters. In fact, experienced windsurfers have successfully crossed the Atlantic Ocean, often reaching speeds of 40 knots using specialized sailboards. Wherever the windsurfer chooses to surf, there must be sufficient wind to drive the sailboard across the water. Importantly, the windsurfer must also follow the rules and regulations set for varying water surfaces, since some areas may be suitable for surfing but may be reserved for other activities such as swimming. Also, the individual will need to choose the right sailboard for the chosen body of water. For instance, due to stronger winds on oceans and lakes, the recommended sailboards have sturdier and heavier sails compared to those used in rivers and estuaries where the wind is not as strong. Specialized sailboards such as those used by experienced windsurfers may not be a good choice for beginners. This is because they are difficult to control due to their specific design features. There are also different windsurfing objectives. Freeriding is done mostly for recreation and is when an individual surfs just to enjoy the ride. Other objectives are often for competition. An example is focusing on speed to win a race, or maneuverability for slalom races. Another is where windsurfers ride waves, perform acrobatic skills, and perform other creative acts to display their skills. Judges award them points based on trick mastery and finesse. Windsurfing rules and regulations help avoid accidents on water. Among them, a windsurfer must maintain a three-mast distance from other surfers and swimmers. They should also never head to the waters when there are excessively strong winds or thunderstorms, and a windsurfer sailing downwind has the right of way over a surfer moving upwind. In addition, a windsurfer sailing perpendicular to the shore has the right of way over a surfer traveling parallel to the shore. Moreover, the surfer must keep the boom, the equipment that gives the sail structural support and that the individual grips onto to steer the sailboard, at shoulder height. When combined with bending the knees rather than the waist, they can then properly control the sailboard.

Karim Sarhane, MD

Body Contouring Has Minimal Sustained Weight Loss Impacts, Study Says

Karim Sarhane
Dr. Karim Sarhane

Body contouring helps patients who have experienced significant weight loss because of diet, post-pregnancy weight, and bariatric surgery tighten loose and saggy skin. A study published in the American Society of Plastic Surgeons’ June 2023 issue of the journal Plastic and Reconstructive Surgery reported that body contouring has long-term impacts on weight loss for people who have it after bariatric surgery. Those who undergo body contouring can immediately see improvements. Sometimes, skin condition improvements are immediately compared to non-surgical options that might take longer. Incidentally, most common body contouring procedures focus on the thighs, arms, back, belly and flanks, buttocks, neck, and skin. Most studies on the effectiveness of this procedure in encouraging long-term weight loss are mixed. This study, however, focused on 2,531 patients who underwent bariatric surgery from 2009 to 2012 and saw small gains in long-term weight loss. Researchers separated the patients into three groups. The first group of 350 patients had body contouring a median of two years after bariatric surgery. The second group comprised 364 patients who participated in a consultation about body contouring but did not follow through with the procedure. Finally, 1,817 patients neither had the surgery nor the consultation. Researchers found that those who had the body contouring did experience more sustained weight loss than those who did not have the procedure using body mass index (BMI) as a measure. BMI measures how much fat is in the body and is calculated by taking a person’s weight in kilograms and dividing it by their height in meters squared. The study found that those who underwent body contouring after a year had a lower average body mass index (BMI) than those who elected not to have the surgery. Seven years later, patients with the body contouring procedure saw their BMI reduced even further to 5kg/m2, on average. Interestingly, patients who sat for a body contouring consultation but did not undergo the procedure also saw positive impacts. One year after their bariatric procedure, their BMI was, on average, 1.5 kg/m2 lower compared to those who had no consultation. After seven years, their BMI was, on average, 2.3 kg/m2 lower than those who did not have a consultation. In addition, the study compared patients with body contouring with 259 patients in the consultation group who experienced enough weight loss to qualify for a consultation. After seven years, the study found that each group had a comparable BMI, with the body contouring procedure group having an average BMI of 31 kg/m2 compared to the consultation group with a BMI of 30 kg/m2. Incidentally, those who did not have the consultation or the contouring procedure had an average BMI of 35 kg/m2. However, the study mentioned that researchers found that the type of bariatric surgery and the patient’s race impacted weight loss long-term. Those who had sleeve gastrectomy (involving several small incisions in the upper abdomen) sustained a lower BMI than those who had gastric bypass surgery, with the former experiencing an eight percent difference in weight loss on average after seven years. Also, African American patients experienced a lower sustained weight loss than other racial groups. Ultimately, researchers concluded that while those who had the surgery or participated in a consultation saw improvement, the impact on body contouring was minimal. They also said that body contouring impacts were secondary to individual factors improving body weight loss outcomes.

Karim Sarhane, MD

Karim Sarhane

ACS Operation Giving Back Focuses on Africa

Karim Sarhane
Dr. Karim Sarhane

The American College of Surgeons (ACS) aims to improve surgical care globally. Its Operation Giving Back (OGB) initiative allows surgeons to volunteer their time in places where their skills are needed. In 2023, the ACS OGB program announced volunteer opportunities, including launching a fellowship allowing surgeons to travel to Hawassa University in Ethiopia. In August 2022, the OCG program, the Virginia Commonwealth University Health System Authority, the University of Utah School of Medicine, and Hawassa University College of Medicine and Health Sciences established the Academic Global Surgery Fellowship Program. This fellowship opportunity builds on an earlier effort launched by the OCG program and Hawassa University College of Medicine. The joint effort between the OCG and the Hawassa College of Medicine program began in 2018 in the College of Surgeons East, Central, and Southern Africa (COSECSA) region. This program has focused on improving surgical and clinical services, quality improvement programs, and research at Hawassa University Hospital in Ethiopia, a country with a population of over 18 million people. The Academic Global Surgery Fellowship Program will facilitate multidisciplinary and interdisciplinary partnerships focusing on research, education, and surgical training. University of Utah or Virginia Commonwealth University students were selected for the fellowship opportunity. These fellows received an appointment for one year, where they will be involved with research, conducting educational and quality improvement programs, sharing data and results with the medical community, generating academic research, and gaining from mentoring opportunities at Hawassa University Hospital. The fellowship fosters a lasting relationship between the US and Ethiopia programs. Fellows will travel to Ethiopia during the appointment period for three to six months and can participate in advocacy programs if they wish. All this work culminates in the fellow presenting their research at conferences and their conclusions in the end-of-year report. Dr. Girma Tefera, director of ACS OGB, stated that this fellowship is an opportunity for medical professionals entering surgical fields to participate in research and quality research at the Hawassa University Hospital. It also presents opportunities to close healthcare gaps and to give Africans access to quality surgical care. The launch of the fellowship program in 2022 was one of many works the OGB program was involved in Africa. In April 2023, the OGB program partnered with COSECSA to volunteer to oversee COSECSA fellowship oral exams, equivalent to the American Board of Surgery oral exam for certification. Medical residents can take the oral exams after completing at least five years of postgraduate training (six years for neurosurgery), meeting all COSECSA course requirements, and passing the COSECSA written exam. Upon completing all these requirements, graduates receive the Fellowship of College of Surgeons designation, recognized in all COSECSA member countries numbering 14. This joint effort is part of an overall initiative between ACS and COSECSA to improve healthcare in Sub-Saharan Africa. Outside of volunteering as examiners, the two organizations have joined efforts to spearhead the ACS-COSECSA Surgical Training Collaborative, one of its most extensive efforts. This ACS partnership is a part of the OGB initiative, which involved gathering ACS resources and that of multiple US hospital departments of surgery to increase the number of surgical trainees that train in Africa. The team established the first training site in Hawassa University Hospital in 2018. Since then, the collaboration has launched a second training hub at University Teaching Hospital in Lusaka, Zambia, in 2020.

Karim Sarhane, MD

Karim Sarhane