Medical Specialties Commons^™

Exploring The Efficacy Of Various Minimally Invasive Surgery (Mis) Techniques In Spinal Fusion For Degenerative Spondylolisthesis: A Systematic Review, Yolanda V. Gutierrez, Blake Martin, Joshua Nwose, Alyssa A. Sepulveda, Ronald Shaju, Aamir Ahmad, Robert H. Ablove

School of Medicine Publications

Degenerative spondylolisthesis is a common etiology of low back pain characterized by the anterior displacement of one vertebral body relative to the one below it. A key contributing factor is intervertebral disc degeneration, which compromises spinal stability. In patients with a lack of neurological issues, conservative treatment is recommended. If conservative treatment is ineffective, surgery is deemed the next step, involving decompression and fusion of the vertebrae. Over the past several decades, minimally invasive surgical (MIS) techniques have been developed and refined. This systematic review aims to compare different types of MIS techniques for the treatment of degenerative spondylolisthesis to …

Beyond The Bone: A Misdiagnosis Of Paget’S Disease Reveals Polyostotic Mazabraud Syndrome, Michael Higham, Stephanie Campbell, Amanda Killeen

School of Podiatric Medicine Publications

Introduction: Mazabraud Syndrome is a rare benign condition characterized by polyostotic fibrous dysplasia and intramuscular myxomas. Due to its overlapping radiographic features, it is frequently misdiagnosed. We present a case where Mazabraud Syndrome was misdiagnosed as Paget’s disease for nearly 6 decades.

Case Presentation: A 59-year-old woman presented to the podiatry clinic with complaints of numbness and sharp pain of the left foot while in stance. Her surgical history is positive for numerous lower extremity myxomas excised over her lifetime, beginning in adolescence, and now with non-mobile soft tissue mass at the porta pedis of the left foot for 1 …

Histotripsy: A Novel Non-Invasive Ultrasound Technology For Precision Thrombolysis In Acute Ischemic Stroke Management, Ameer E. Hassan, Thomas Dreyer, Yousef Khalili

School of Medicine Publications

BackgroundStroke remains a major cause of morbidity and mortality worldwide. Traditional treatments for ischemic stroke such as mechanical thrombectomy and pharmacological thrombolysis are often less effective or inaccessible for certain patient populations, particularly those with delayed hospital arrival, contraindications to thrombolytics, or in regions with limited access to endovascular care. This study investigates the feasibility of using histotripsy, a non-invasive ultrasound technology, to precisely liquefy thrombi in an artificial experimental setup.MethodsClot analogs were introduced into sample tubes, and focused ultrasound was applied using optimized parameters, including pulses per burst, repetition rates, and output amplitudes. These parameters were systematically adjusted to …

Demographic And Clinical Characteristics Of Patients With Benign Bone Tumors: Evidence Of Bimodal Age Distribution In A Hispanic Population, Blake Martin, Mohammad Khalil, Juan Lopez-Alvarenga, Michael Sander

School of Medicine Publications

Background

As far as researchers know, there's no way to prevent BBTs from forming. Although these tumors generally do not metastasize, they can still be dangerous as they may grow and compress healthy tissues and lead to poor outcomes. The principal objective was to evaluate the demographic and clinical characteristics linked to BBTs in individuals from the Rio Grande Valley. We hypothesized that older age and males would have greater frequency of BBTs.

Methods

This was a retrospective chart review and IRB approval was obtained prior to starting this study. We obtained medical charts for individuals who had been diagnosed …

Impact Of Metabolically Healthy Obesity On Post Percutaneous Coronary Intervention Outcomes In Patients With Acute Myocardial Infarction: A Nationwide Propensity Matched Analysis, Rupak Desai, Adhvithi Pingili, Arankesh Mahadevan, Vishal Reddy Bejugam, Hafeezuddin Ahmed, Vamsikalayan Borra, Adil Sarvar Mohammed, Gayatri Bondi, Shobana Krishnamurthy, Nithya Borra

School of Medicine Publications

Background

Obesity paradox in post-percutaneous coronary intervention (PCI) outcomes among acute myocardial infarction (AMI) patients is a known controversy. However, these studies included patients who had diabetes, hypertension, or hyperlipidemia. We studied relationship between metabolically healthy obesity (MHO—without diabetes, hypertension, or hyperlipidemia) and in-hospital post-PCI outcomes among AMI patients.

Methods

We extracted data from National Inpatient Sample 2020 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for admissions of AMI patients who underwent PCI. We then identified patients with diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity index and Clinical Classifications Software and excluded them. Then, using Elixhauser …

A Flea-Borne Mystery: Unraveling Murine Typhus In A Patient With Unexplained Encephalopathy, Jose J. Loayza Pintado, Jorge A. Aboytes, Cesar Uribe

School of Medicine Publications

Murine typhus is a flea-borne rickettsial infection caused by Rickettsia typhi, commonly seen in endemic regions like Southern California and Texas. While it typically presents with fever, rash, and headache, neurological symptoms such as altered mental status are rare. We present a case of a 66-year-old male in southern Texas with alcohol use disorder who developed progressive confusion, decreased appetite, and subjective fevers. He was found to have severe hyponatremia, acute kidney injury, and atrial fibrillation with rapid ventricular response. Despite supportive care and empiric antibiotics for a urinary tract infection, his encephalopathy persisted. Further history revealed exposure to …

How Far Does It Go? An Analysis On The Extent Of Spinal Cord Injury In Post-Traumatic Patients, Sravani Mannuru, Sarvani Uppati, Kelsey Baker

Research Colloquium

Background: Spinal cord injury causes debilitating functional loss in post-trauma patients. Previous studies have showed that an area of edema (tissue damage and swelling) occurs at the level of spinal damage and may be related to the amount of functional loss in the patient and their associated recovery potential. We hypothesized that the extent of the injury is greater than previously studied and may better explain functional loss and recovery potential.

Methods: We retrospectively analyzed five T2-weighted MRI spinal cord images from post-trauma patients ages 32-67. Patients had a clinically diagnosed spinal cord injury that affected the cervical …

Vegf In Diabetic Retinopathy And Age-Related Macular Degeneration, Andrew Callan, Justin Z. Heckman, Giani Tah, Samantha Lopez, Laura Valdez, Andrew Tsin

School of Medicine Publications

Vascular endothelial growth factor (VEGF) plays a key role in angiogenesis throughout the human body, influencing countless physiological and pathological processes, including tumor growth, preeclampsia, and retinal diseases such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). In DR, VEGF promotes retinal neovascularization and intraretinal fluid accumulation, leading to complications like diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Regular intravitreal anti-VEGF injections are commonly used to manage PDR and DME, though repeated treatments are often required, and efficacy can be limited. AMD, a major cause of vision loss in older adults, is characterized by either dry or …

Various Bone Disorders Affecting The Medically Underserved South Texas Region, Blake Martin, Manoj Peiris, Michael Sander

School of Medicine Publications

Bone disorders can have a devastating impact on an individual’s quality of life. The main objective of our study was to analyze various demographic disparities between various bone disorders in the demographically unique Rio Grande Valley region. We hypothesized that osteoporosis would be the most prevalent condition and that the demographics between the various conditions would vary depending on age, sex, BMI, and ethnicity but not on marital status. This was a retrospective chart review using the University of Texas Rio Grande Valley UTHealth electronic database from January 1, 2017, to January 1, 2024. Any relevant individuals seen at a …

Addressing Glenoid Defects With Distal Clavicle Autograft In Revision Total Shoulder Arthroplasty, Ryan Bialaszewski, Ross Chapel, Frank Gerold

School of Medicine Publications

No abstract provided.

Rectosigmoid Intussusception Due To A Nonmalignant Etiology: An Extremely Rare Cause Of Acute Lower Gastrointestinal Bleeding In An Elderly Patient, Kashif Ali, Samra Sohail, Grecia Dominguez Rivera, Valeska Balderas

School of Medicine Publications

An intussusception at the rectosigmoid junction with acute gastrointestinal bleeding is exceedingly rare. We present a case of an 88-year-old man who presented in the emergency department with bilateral lower quadrant abdominal pain and frank rectal bleeding for 2 days. A computed tomography abdomen pelvis angiogram with contrast showed a target sign, and a flexible sigmoidoscopy showed congested bowel, ischemia, frank blood, and intussusception at the rectosigmoid junction. He underwent an exploratory laparotomy with the removal of the affected part. The pathology and the peritoneal fluid cytology results came out negative for dysplasia and malignancy.

Manganese-Induced Precocious Puberty Alters Mammary Epithelial Cell Proliferation In Female Rats, Alina M. Hamilton, Vinod K. Srivastava, Jill K. Hiney, William L. Dees, Robert K. Dearth

School of Integrative Biological & Chemical Sciences Faculty Publications

Precocious puberty (PP) is an established breast cancer risk factor. In the normal mammary gland, hormone receptor-positive (HR+) cells rarely proliferate. In breast cancer, proliferating epithelial cells are often HR+. It is not known if PP can modify this population of proliferating HR+ cells. Previously, we established a manganese-induced precocious puberty (MnPP) model to study the effects of PP on mammary gland development in female rats. Here, we characterized the distribution of HR+ proliferating mammary epithelial cells in prepubertal and adult rodents, in association with precocious puberty. Female rats were exposed daily to 10 mg/kg manganese chloride or saline (control) …

Diabetic Foot Ulcer Healing Time With Silver Alginate Dressing: A Scoping Review, Srilalitha Lanka, Merlin Sajeev, Jessica Sima, Amanda Killeen

School of Podiatric Medicine - Student Research

Introduction: Diabetic foot ulcers (DFUs) are slow-healing wounds that can lead to serious complications. Choosing the right dressing is important for improving healing. Silver alginate dressings are commonly used because they help fight infection and may promote faster recovery. This scoping review examines existing research on the effect of silver alginate dressings on DFU healing time.

Method: A literature search was conducted using Google Scholar and PubMed with the search terms: ““Diabetic foot ulcer” AND "wound healing" AND “silver Dressing” AND "alginate"” and “Diabetic foot ulcer AND wound healing AND silver Dressing AND alginate”, respectively. Articles published between 2005 and …

From Likes To Insights: Perceptions Of Peripheral Nerve Surgery On Tiktok, Madeleine G. Mehaffey, Nicholas Obias, James Hughes, John Gouin

School of Podiatric Medicine - Student Research

Introduction: Peripheral nerve surgery is a therapeutic modality for many diagnoses, such as nerve compression syndromes, peripheral neuropathy, and neuroma. In response to the increasing number of people seeking health information on social media, this study explores public perceptions of peripheral nerve surgery on the social media platform TikTok (1). Conclusions from this study may provide insight to medical personnel looking to use social media to improve patient education.

Methods: A new TikTok account was used to search “Peripheral Nerve Surgery.” The top 25 posts, including sponsored advertisements, were analyzed based on number of likes and comments, relevance, type, authorship, …

Evaluation Of Wound Dehiscence Rate Between Total Ankle Replacement (Tar) And Ankle Arthrodesis (Aa): A Systematic Review And Meta-Analysis, Asad Mustafa, Sarah Weisbrodt, Naohiro Shibuya

School of Podiatric Medicine - Student Research

Introduction

Total ankle replacement (TAR) and ankle arthrodesis (AA) are surgical interventions used for patients with degenerative ankle arthritis. Historically, AA has been the standard treatment for ankle arthritis; however, in recent years, TAR has become just as popular, if not more so. The TARVA study, a randomized controlled trial examining the outcomes of each procedure for a population with end-stage osteoarthritis, reports similar results between the two procedures, except that TAR may have a higher incidence of wound dehiscence. TAR typically requires a larger incision than AA, which may influence patient selection for the procedure. However, data from the …

Unveiling The Potential Of Urolithin A In Cancer Therapy: Mechanistic Insights To Future Perspectives Of Nanomedicine, Vinita Karumuru, Anupam Dhasmana, Narsimha Mamidi, Subhash Chauhan, Murali Yallapu

School of Medicine Publications

Cancer remains a leading global health challenge, with high mortality rates persisting despite significant advancements in therapeutic interventions. Major obstacles, including systemic toxicity, therapy resistance, metastasis, and relapses, emphasize the urgent need for safer, more effective, and readily accessible treatment strategies. Among emerging alternatives, natural bioactive compounds have gained considerable attention because of their diverse therapeutic potential and lower toxicity profiles. Urolithin A (UA), a metabolite derived from ellagic acid through gut microbiota metabolism, has emerged as a compelling anticancer agent. UA has multiple mechanisms of action, including the regulation of autophagy, enhancement of mitochondrial function, and inhibition of tumor …

First Endovascular Flow Diversion Treatment For A Supergiant Brain Aneurysm (>110 Mm) In Ethiopia, Wondwossen G. Tekle, Eskedar Kebede Belayneh, Kaleab Tesfaye Eticha, Tariku Assefa Soboka, Michael Yirgalem Teka, Hilina Agonafir Mengistu, Yonatan Wudeneh Mekonnen, Fikru Tsehayneh Kelemu, Bereketeab Ethiopia Bogale, Eden Enyew Zeleke

School of Medicine Publications

In late 2022, a 65‐year‐old woman presented to us with a 3‐day history of ischemic stroke resulting in left facial droop and left‐sided weakness. She had a known giant right internal carotid artery (ICA) aneurysm since 2015 that kept on growing and causing her a myriad of neurologic signs and symptoms including recurrent severe headaches, debilitating tinnitus, right‐sided vision loss (2020), proptosis, ophthalmoplegia, ptosis, and hearing loss. She had allodynia in the right trigeminal nerve distribution, complete right facial palsy, new left lower facial palsy and left hemiparesis (3/5 strength). Unfortunately, local treatment options were unavailable at that time, and …

Diabetic Foot Ulcer Recurrence In Hispanic Americans: A Growing Concern, Daniela Lizbeth Avilez, Amanda Killeen

School of Podiatric Medicine - Student Research

Background: Diabetic foot ulcers (DFUs) represent a critical public health concern among Hispanic populations, contributing significantly to healthcare disparities and an elevated risk of amputations. Although Hispanic Americans account for 11.7% of the U.S. population with diabetes, they experience disproportionately higher rates of DFUs and amputations compared to non-Hispanic White individuals. Additionally, Hispanic adults exhibit lower rates of attempted revascularization, which exacerbates their susceptibility to severe complications. As the Hispanic population continues to grow, particularly in Texas, addressing DFU recurrence is crucial for improving clinical outcomes and reducing health inequities. This review evaluates evidence on DFU recurrence within Hispanic populations. …

Small-Molecule Mitotic Inhibitors As Anticancer Agents: Discovery, Classification, Mechanisms Of Action, And Clinical Trials, Yazmin Salinas, Subhash Chauhan, Debasish Bandyopadhyay

School of Medicine Publications

Despite decades of research, cancer continues to be a disease of great concern to millions of people around the world. It has been responsible for a total of 609,820 deaths in the U.S. alone in 2023. Over the years, many drugs have been developed to remove or reduce the disease’s impact, all with varying mechanisms of action and side effects. One class of these drugs is small-molecule mitotic inhibitors. These drugs inhibit cancer cell mitosis or self-replication, impeding cell proliferation and eventually leading to cell death. In this paper, small-molecule mitotic inhibitors are discussed and classified through their discovery, underlying …

The Multiple Roles Of 5-Lo In Tissue Regeneration – Insights From Translational Animal Models Utilizing Pharmacological And Genetic Approaches, Roel Navarro, Nidhin John, Claudia Biguetti

School of Podiatric Medicine - Student Research

Inflammation following tissue injury is a natural physiological response, where its course, duration, and intensity help determine whether it promotes beneficial or detrimental outcomes in tissue healing. Arachidonic acid (AA) serves as a substrate for5-lipoxygenase (5-LO) pathway, which synthesizes metabolites such as leukotrienes that influence both acute and chronic inflammatory response.  AA and its product's inhibitors are currently used to treat hypersensitivity reactions. However, literature suggests potential therapeutic efficacy in tissue healing.

Wound Dehiscence Rate Between Chevron Osteotomy Procedure Vs. Lapidus For Correction Of Hallux Valgus Deformity, Isabella V. Strash, Abelardo Osuna, Madelaine Adkins

School of Podiatric Medicine - Student Research

Format: Scientific

Length of follow-up: n/a

Level of Evidence: Cross-Sectional Study (Level III)

Classification: Surgery

Purpose: Distal metatarsal osteotomies, like the chevron procedure, were once preferred for their stability and faster recovery in hallux valgus correction. However, recent advancements have increased the use of proximal procedures, such as the lapidus. This study aims to compare complications between distal and proximal hallux valgus surgeries.

Methodology & Procedure: Data was downloaded from the TriNetX Research Network on February 2, 2023 using CPT codes 28296 (chevron) and 28297 (lapidus). Inclusion criteria consisted of patients between 18 and 60 years of age and required …

Trends In Resident Cataract Surgery Complication Rates Under A Single Experienced Supervising Attending, Simran Ohri, Jason A. Zehden, Dipen Kumar, Roma Pegany, Zhidong Zhang, Kenneth Cohen, Alice Y. Zhang

Teaching and Learning Faculty Publications

Purpose: To evaluate resident surgical complication rates under the supervision of an experienced attending surgeon over five years.

Setting: A single academic medical center at University of North Carolina at Chapel Hill, Chapel Hill, NC.

Design: Retrospective chart review.

Methods: Retrospective review of the first 30e50 cases performed by five classes of residents supervised by a single experienced attending surgeon with over twenty years of experience as a surgical educator. Data was collected from Accreditation Council for Graduate Medical Education (ACGME) surgical logs and operative notes. Preoperative risk factors, operative technique, and intraoperative complication rates were analyzed.

Results: A total …

Successful Limb Salvage In A Severe Diabetic Foot Infection: A Case Study Of Aggressive Surgical Intervention And Grafting Technique, Stephanie N. Campbell, Amanda Killeen, Michael Sobolevsky

Research Symposium

Background: Severe necrotizing diabetic foot infections are known to have high morbidity, high amputation risk, and high complication rates. Efforts at preserving the limb require significant surgical efforts and lengthy wound care. This process is more complicated in patients with significant housing instability.

Case Presentation: A 53-year-old male with uncontrolled diabetes (A1c 7.9%), housing insecurity, food insecurity presented with severe necrotizing diabetic foot infection with ascending cellulitis, infectious hemorrhagic bullae, multi-compartment abscesses of the foot and anterior leg. It is known that patients with diabetes are at increased risk of both amputation and surgical interventions than patients without diabetes. This …

Integrative Analysis Of Transcriptomics And Clinical Data Of Slc1a5 In Cervical Cancer, Veronica O'Brien, Vivek Kashyap, Bhuvnesh Sharma, Murali Yallapu, Everardo Cobos, Subhash Chuahan

Research Symposium

Background: Cervical cancer is the fourth most common cancer in adult females globally and the second most common cancer in females between the ages of 15 and 44. The alanine-serine- cysteine transporter 2, ASCT2 (solute carrier family 1 member 5, SLC1A5), is a major transporter of the amino acid, glutamine. SLC1A5 expression is associated with the progression of multiple types of tumors, including liver, lung, breast, colon and head and neck cancer. However, the biological significance of SLC1A5 cervical cancer has not been systematically and comprehensively investigated. Using deep data mining and transcriptomics analyses, in this study, we investigated the …

Long-Term Neurocognitive And Behavioral Outcomes In Survivors Of Pediatric Brain Tumors: A Systematic Review, Tori Sayers, Megan W. Szobody, Nina Mourao, Blake C. Martin, Sriya Gullapalli, Kory Punch, Tirath Patel, Murali Yallapu, Bharathi Shrikanth Gadad

Research Symposium

Background: Pediatric populations have an increased susceptibility for brain tumors and suffer from neurocognitive impairment due to the neoplasm itself, and side effect of subsequent treatments. This causes many patients to experience a subpar quality of life (QoL), affecting academic endeavors, social interaction and mental well-being. Increasing our understanding of the long-term effects associated with brain tumors and the side effects from our current treatment methodology will help us formulate better treatment protocols and improve survivors’ QoL. This review aims to investigate different long-term neurocognitive and behavioral outcomes in pediatric brain tumor survivors, as well as evaluate how various treatment …

Case Report: Oral Contraceptives-Induced Cholestasis, Aura Calderon, Taiwo Ajani, Nayiri Derian, Catherine Matos, Ivan Mogollon, Andres Suarez

Research Symposium

Background: Oral contraceptives represent one of the most prevalently utilized pharmacological interventions for contraception, renowned for their safety and efficacy. However, their advantageous safety profile, these pharmaceuticals are intermittently correlated with infrequent yet significant hepatobiliary complications, including drug-induced cholestasis and hyperbilirubinemia1. The estrogenic constituents of oral contraceptives are recognized for their capacity to disrupt bile acid transport within the hepatic system, culminating in intrahepatic cholestasis2. This phenomenon is particularly alarming in individuals possessing inherent genetic susceptibilities, such as Dubin-Johnson Syndrome, wherein bilirubin metabolism and excretion are already adversely affected3. The identification and comprehension of these adverse effects are imperative for …

Investing In Limb Preservation: A Case Report In Avoiding Bilateral Amputation In A Vasculopathy Patient, Stephanie N. Campbell, Craig J. Verdin, Heather V. Tran, Nikita Gambhir

Research Symposium

Background: Limb salvage and prosthetics play vital roles in restoring function and mobility for patients with severe injuries or metabolic conditions. Limb salvage involves surgical techniques aimed at preserving a limb rather than resorting to amputation, while prosthetics provide artificial devices to replace lost limbs. Key considerations for limb salvage include restoring a functional foot, maintaining patient independence, minimizing hospitalizations, and avoiding bilateral lower limb amputations.

Case Presentation: The patient, already at single-limb status, presented with a necrotic heel ulcer, exposed calcaneus, and necrotic Achilles tendon. After vascular optimization, the risks and benefits of final aggressive measures were discussed, leading …

The Effect Of Co-Morbid Chronic Illnesses On The Outcomes Of Traumatic Intracranial Hemorrhage In The Rio Grande Valley: A Retrospective Analysis, Sowmya Duddu, Julia Paz, Andrea Argenal, Sonya Bhatia, Nina Mourao, Tori Sayers, Manoj Peiris, Kelsey Baker, Bharathi S. Gadad

Research Symposium

Introduction: Intracranial hemorrhage is bleeding occurring in or around the brain. The severity can range from mild to fatal with a variety of lasting symptoms. The severity and outcome depends on a number of factors such as the location, treatment, and pre-existing patient conditions. Previous studies have been done observing comorbidities in patients, such as hypertension or diabetes, and their role in intracranial hemorrhages. The purpose of this project is to identify how pre-existing health conditions, such as diabetes, hypertension, blood disorders, and more, influence the type and severity of intracranial hemorrhages.

Methods: A retrospective analysis was conducted …

Incidence Of Myocardial Infarction And Neurodegenerative Disease Co-Occurrence In The Rio Grande Valley: A Five-Year Retrospective Analysis, Sowmya Duddu, Maria Sophia Malbas, Allison Mcadams, Julia Paz, Miguel Quintanilla, Karina Zamora, Hansapani Rodrigo, Kelsey Baker

Research Symposium

Introduction: Neurodegenerative Diseases (NDDs) are a group of disorders leading to the degeneration of neurons causing varying degrees of functional loss. NDDs lead to a loss of independence for the patients and an emotional burden for the patients’ families or caretakers. Previous studies have shown that the prevalence of neurodegenerative diseases such as Alzheimer’s Disease or Vascular Dementia is high in the Rio Grande Valley. Due to the severity of these diseases, research is currently being done to determine the factors that correlate with the development of neurodegenerative diseases and whether there is a causative effect. The purpose of …

Who Leaves Orthopedics? Analyzing Attrition Among Texas Orthopedic Surgeons, Sean Corcoran, Anesu Karen Murambadoro, Paul Bonilla, Victoria Elizondo, Tori Sayers, Daniela Ramos, Mark Manickath

Research Symposium

Background: Nationally, attrition rates in surgical specialties have been reported to be as high as 20-26%. As of 2019, women comprised only 6.5% of the 29,613 orthopedic surgeons. Female residents showed significantly higher overall attrition rates compared to males (5.96% vs. 2.79%, p < 0.001), with unintended attrition nearly twice as high (2.09% vs. 1.01%, p < 0.001). Attrition can result from a wide array of variables, including sex, ethnicity, education, and background. The aim of this study was to evaluate the demographic and educational factors associated with career longevity beyond training among orthopedic surgeons, with a focus on identifying patterns of attrition in underrepresented groups.

Methods: Data from the Texas Medical Board Physician Database as of September 2024 was evaluated using Microsoft Excel. To determine length of practice, the date of license issuance was subtracted from the date of license expiration. Surgeons with license expirations after 2024 were excluded to maintain a focus on physicians that are no longer practicing. Entries …