GREGORY NICOLAS
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- Case Report: Stage VI Morel-Lavallee Lesion with a Large Challenging Defect(2021) NICOLAS, Gregory; ABBAS, Laielly; PRADO, Ariadne; TAKEMURA, Rafael Eiki; WADA, Alexandre; GOMEZ, David Souza; GEMPERLI, RolfMorel-Lavallee lesion (MLL) is a closed degloving soft-tissue injury that results in the accumulation of a hemolymphatic fluid between the skin/superficial fascia and the deep fascia. This is a rare injury that may be challenging to diagnose, and necessitates early identification and treatment to achieve the best outcomes. We report the case of a 45-year-old male patient who was referred to our institution for large wound closure after undergoing debridement of a misdiagnosed MLL that became complicated by infection and sepsis. The patient was retrospectively diagnosed with a Stage VI MLL and had to undergo 4 operations with skin grafting and vacuum-assisted closure therapy playing an essential role in achieving tissue closure. This case was presented as a reminder of this rare diagnosis, and the importance of considering it when faced with a patient presenting with a relevant clinical picture post trauma. An early diagnosis is important because early intervention can prevent complications and lead to better outcomes. The misdiagnosis in the case of our patient and delayed treatment led to an aggressive debridement with a large wound that was challenging to close.
- The efficacy of cryotherapy in reducing edema and ecchymosis in patients who underwent rhinoplasty: A narrative review(2023) JARDAK, Mira Nawfal; SAAD, Elio Assaad; JALLOUL, Rawan; EMMANUEL, Nancy; NICOLAS, Gregory; MENENDEZ, Juan PabloObjective: The aim of this article was to showcase current literature on the efficacy of different postoperative and intraoperative cryotherapy techniques in reducing edema, ecchymosis, and pain in patients who have undergone rhinoplasty. Background: Rhinoplasty has some unfavorable postoperative temporary side effects, such as edema, ecchymosis, and pain, which hinder the patients' daily activities. Several interventions have been proposed in the literature, including cryotherapy, which refers to cold application to the desired facial area in patients who have undergone rhinoplasty. Methods: Specific keywords were used, and PubMed, Scopus, and Embase databases were searched. Two extensive selection rounds were performed to finally include 27 articles; the first round was based on the title and abstract, while the second was based on the full article. Discussion: The articles were split into postoperative and intraoperative categories based on the time cryotherapy was administered during the surgery. They were then subdivided depending on the specific cryotherapy technique used, and a detailed description of the method of application and improvement in patients' edema, ecchymosis, and pain was noted. Articles that compared different cryotherapy techniques were also compared with articles that discussed previously used techniques. Conclusion: Cryotherapy has shown promising outcomes in reducing edema, ecchymosis, and pain after rhinoplasty and bleeding. It is crucial to build further studies upon these outcomes and develop guidelines for surgeons to effectively use these cryotherapy techniques in their practice. & COPY; 2023 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.
- Gluteoplasty With Lumbar Gluteal Flap Associated With Liposuction and Fat Grafting: A Safe Technique for Massive Weight Loss Patients(2024) ALVES, Helio Ricardo Nogueira; NICOLAS, GregoryBackground Weight loss leads to excessive flaccidity, volume loss, and tissue descent in the gluteal region. Translated autologous flaps during lower body lifting have been utilized in patients; they address sagging tissue and the lack of volume. However, sometimes use of these autologous flaps does not provide adequate gluteal projection, and a second procedure with fat injection may be required.Objectives The authors describe their technique of a lower body lift with a lumbosacral flap in association with liposuction and lipofilling for gluteoplasty.Methods A prospective series of 23 post-bariatric surgery individuals who underwent a lower body lift with lumbosacral flap gluteal augmentation, liposuction, and lipofilling between January 2021 and September 2022 were described. The satisfaction rate and complications were assessed 6 months postoperatively with a validated questionnaire (BODY-Q scale).Results The patients had a mean age of 38.18 (range, 28-56 years) and median body mass index of 26. Four patients with dehiscence were diagnosed and treated conservatively. All wound breakdowns were observed in the paramedian plane of the torsoplasty. No reoperations were performed. The mean satisfaction percentage of the BODY-Q scale transformed score was 97.5.Conclusions A technique for a lower body lift with buttock augmentation combined with liposuction and fat grafting was presented. In future studies other techniques to maximize gluteal contouring should be investigated.
- Os desafios no tratamento de paciente grande queimado e politraumatizado com trombose arterial em membro inferior durante a pandemia de COVID-19: relato de caso(2021) TAKEMURA, RAFAEL EIKI; NICOLAS, GREGORY; WADA, ALEXANDRE; GOMEZ, DAVID DE SOUZA; GEMPERLI, ROLF■ ABSTRACT Introduction: The COVID-19 pandemic spread rapidly worldwide, bringing the need for emergency actions to control the disease at the collective and individual level. Thus, the Division of Plastic Surgery and Burns of the largest hospital complex in Latin America was physically aimed at the infected. In this context, we find the challenges of treating a large burned and polytraumatized patient, who presented arterial thrombosis in the lower limb, a rare complication associated with the thermal burn. All treatment was performed in a hospital not specialized in trauma care. Case Report: Case Report: Male patient, 18 years old, without comorbidities, with predominantly third-degree burns of 50% of body surface burned and severe neurotrauma. He presented arterial thrombosis in his right leg 24 hours after the burn. The patient underwent limb amputation and serial surgical interventions for debridement and skin grafting. Despite the prevention protocols, the patient was infected by COVID-19 during hospitalization. Conclusion: This case focuses on a rare complication related to burn injury, which does not yet have diagnostic criteria and defined prophylactic measures. Besides, the COVID-19 pandemic has impacted various health services areas, and it is essential to share knowledge during this pandemic by seeking adaptations to the crisis situation.
- Surgical treatment of sacral pressure wounds in patients with COVID-19: A case series(2023) FERREIRA, Joao; NICOLAS, Gregory; VALENTE, Daniel; MILCHESKI, Dimas; SALIBA, Marita; GEMPERLI, Rolf
- Computational Intelligence: A Step Forward in Cancer Biomarker Discovery and Therapeutic Target Prediction(2022) SIDDIQUI, M. F.; MOUNA, A.; NICOLAS, G.; RAHAT, S. A. A.; MITALIPOVA, A.; EMMANUEL, N.; TASHMATOVA, N.Computational intelligence (CI) is one of the most popular and advanced fields that mimics human intelligence and transforms numerous aspects of the healthcare industry. For the past two decades, CI has grown extensively and reached a new height in clinical research on cancer. The subfields of artificial intelligence, like deep learning and machine learning, are also applied to tackle various scientific problems. Cancer is one of the most aggressive and dreaded diseases, which every year costs more than 10 million lives globally, and it is expected that these tolls may reach 16.4 million by 2040. Hence, meticulous prognosis and early diagnosis of this disease are very significant to increase the chance of patient survival. In recent years, breakthroughs in various AI-based stratagems for precision oncology, digital pathology, and next-generation sequencing (NSG) are driving the need for new prognostic and predictive assays that facilitate the stratification and selection of patients for treatment. This chapter briefly includes the applications of CI and its subfields in cancer biomarkers and therapeutic target prediction. However, we explore how these applications have assisted in solving biomedical problems with unprecedented accuracy and deep learning. We also demonstrated how these data could be run on natural and mathematical algorithms to derive a classification of cancer genomes, identify potential biomarkers, therapeutic targets, drugs, and draw scientifically sound conclusions based on them. By providing a fresh viewpoint on how computational tools might aid enhance cancer detection, this chapter can help make significant advances in the medical disciplines and scientific community. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd 2022.
- Surgical treatment of sacral pressure injury in ambulating patients during the COVID-19 pandemic: A prospective cohort with complications analysis and elaboration of a surgical treatment protocol(2024) NICOLAS, Gregory; FERREIRA, Joao; VALENTE, Daniel; ABBAS, Laielly; SALIBA, Marita; MILCHESKI, Dimas; MONTEIRO JUNIOR, Araldo; GEMPERLI, RolfBackground: The sudden increase of intensive care unit patients during the coronavirus pandemic led to an increase in the incidence of sacral pressure lesions. Despite being ambulating patients, in many cases the lesions were deep (Grade III and IV ), mainly due to the long -term intubation and being bedridden during the pandemic. Most of these wounds necessitated surgical repair. Objectives: To measure the success and the rate of complications in reconstructions of grade III and IV hospital acquired sacral pressure lesions in ambulating patients after hospitalization for COVID -19. Developing a well -established protocol for surgical treatment of hospital acquired sacral pressure lesions during the COVID -19 pandemic. Methods: Prospective cohort involving ambulating patients with grades III and IV sacral pressure lesions developed after hospitalization for COVID -19 from May 2020 to August 2020 (4 months ). All of them were submitted to reconstruction with fasciocutaneous flaps. Demographics, comorbidities, and preoperative laboratory tests were compared and multivariable -adjusted logistic regression was made in order to identify risk factors for complications. Results: Thirty -eight patients were submitted to fasciocutaneous flaps to repair sacral pressure lesions with a total complication rate of 36.0%. Hemoglobin levels lower than 9.0 mg/dl ( p = 0,01 ), leukocyte levels higher than 11.000/mm 3 ( p = 0,1 ) , and C Reactive protein levels higher than 142 mg/ dl ( p = 0,06 ) at the time of reconstruction and bilateral flaps were independent factors for com - plications. Conclusion: Specific preoperative laboratory tests and surgical techniques were associated with a statistically significant increased complication risk. It was established a protocol for surgical treatment of hospital - acquired sacral pressure lesions to diminish these risks, focusing on ambulating patients during the COVID - 19 pandemic. (c) 2023 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.
- Pediatric Oncology, Palliative Care and Low- or Middle- Income Countries: A Call for Action(2023) SIDDIQUI, Mohd Faizan; NOHRA, Lea; SALEH, Mustafa; THAKKAR, Keval; TRIVEDI, Rishika; MOUJALLY, Sophie Nicolas; DEEB, Hadeel; NICOLAS, Gregory; EMMANUEL, NancyPediatric oncology, which includes cancer screening and therapy in children, poses significant challenges in low- and middle-income countries (LMICs). Palliative care improves children's and their families' quality of life. In LMICs, palliative care resources are scarce, resulting in poor symptom management, psychological support, and spiritual care. All relevant English-language articles on pediatric palliative oncology were searched in PubMed, Google Scholar, Scopus, and Medline databases using the following keywords: ""Pediatric Oncology,"" ""Pediatric Palliative Oncology,"" ""Pediatric Palliative Care,"" ""Palliative Care,"" ""Child Cancer,"" and ""Lower- and Middle-Income Countries."" This study highlights the significance of incorporating palliative care early in therapy and the recommendations may improve the competence of information provided by medical professionals to patients and families. LMICs have the potential to improve overall treatment and outcomes for child cancer patients and their families by prioritizing the integration of palliative care, guaranteeing a compassionate and dignified attitude toward the disease.