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Article ; Online: Brunner's gland hamartomas: Not always benign.

Shmais, Manar / Mousawi, Ahmad / Mourad, Fadi / Sharara, Ala I

Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology

2024 Volume 25, Issue 1, Page(s) 70–73

Abstract: Brunner's gland hamartoma (BGH) is a rare, benign tumor of the duodenum. It is mostly asymptomatic and usually found incidentally on routine esophagogastroduodenoscopy (EGD). However, some BGHs present with major complications including anemia, bleeding, ...

Abstract	Brunner's gland hamartoma (BGH) is a rare, benign tumor of the duodenum. It is mostly asymptomatic and usually found incidentally on routine esophagogastroduodenoscopy (EGD). However, some BGHs present with major complications including anemia, bleeding, obstruction, or dysplasia, requiring management and resection of these lesions. Herein, we present two cases of large BGHs of the duodenum, one presenting as severe gastrointestinal bleeding and the other, noted on EGD for iron deficiency anemia, found to have high grade dysplasia. This literature review discusses the rare serious complications of BGH, including iron deficiency anemia, overt gastrointestinal bleeding, and malignant potential.
MeSH term(s)	Humans ; Brunner Glands/pathology ; Duodenal Diseases/diagnosis ; Duodenal Diseases/surgery ; Duodenal Diseases/complications ; Anemia, Iron-Deficiency/diagnosis ; Anemia, Iron-Deficiency/etiology ; Hamartoma/diagnosis ; Hamartoma/surgery ; Gastrointestinal Hemorrhage/etiology
Language	English
Publishing date	2024-01-30
Publishing country	Egypt
Document type	Review ; Case Reports
ZDB-ID	2502114-X
ISSN	2090-2387 ; 1687-1979
ISSN (online)	2090-2387
ISSN	1687-1979
DOI	10.1016/j.ajg.2023.12.003
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Article ; Online: Management of acute diarrhea in the emergency department of a tertiary care university medical center.

Jabak, Suha J / Kawam, Lamees / El Mokahal, Ali / Sharara, Ala I

The Journal of international medical research

2022 Volume 50, Issue 8, Page(s) 3000605221115385

Abstract: Objectives: To examine the management of acute diarrhea in the emergency department (ED) of a large university medical center.: Methods: Retrospective cross-sectional study over a 10-month period of adult patients (age ≥18 years) presenting to the ED ...

Abstract	Objectives: To examine the management of acute diarrhea in the emergency department (ED) of a large university medical center. Methods: Retrospective cross-sectional study over a 10-month period of adult patients (age ≥18 years) presenting to the ED with acute diarrhea. Results: Data for 780 patients were reviewed; 101 met the exclusion criteria. Of the 679 patients with acute community-acquired diarrhea, 582 (85.7%) were discharged home and constituted the study cohort of mostly healthy adults (mean age: 32.5 ± 14.5 years). The rate of antibiotic prescription at discharge was 26%. Inappropriate use of antibiotics occurred in 28% of the patients. The presence of fever (odds ratio (OR) = 3.52), leukocytosis (OR = 1.72), and older age (OR = 1.16) were predictors of antibiotic prescription. Patients with dehydration, comorbidities, or bloody diarrhea were more likely to receive antibiotics. Microbiological studies and cross-sectional imaging were ordered in 12.4% and 11.7% of the patients, respectively, but provided very low yield (<10% for both) resulting in significantly higher visit charges. Inappropriately prescribed antibiotics at discharge resulted in higher charges in the ED compared with no antibiotic prescription. Conclusion: Acute diarrhea management in our ED is suboptimal and does not adhere to practice guidelines, resulting in unnecessary antibiotic prescriptions, investigations, and cost.
MeSH term(s)	Academic Medical Centers ; Adolescent ; Adult ; Anti-Bacterial Agents/therapeutic use ; Cross-Sectional Studies ; Diarrhea/drug therapy ; Emergency Service, Hospital ; Humans ; Middle Aged ; Retrospective Studies ; Tertiary Healthcare ; Young Adult
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-08-02
Publishing country	England
Document type	Journal Article
ZDB-ID	184023-x
ISSN	1473-2300 ; 0300-0605 ; 0142-2596
ISSN (online)	1473-2300
ISSN	0300-0605 ; 0142-2596
DOI	10.1177/03000605221115385
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Zs.A 925: Show issues

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Jg. 1995 - 2021: Lesesall (1.OG)
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Article ; Online: Smoking Is Not an Independent Risk Factor for Surgery in Patients with Crohn's Disease on Biologic Therapy.

Halablab, Saleem M / Alrazim, Ayman / Sadaka, Christian / Slika, Hasan / Adra, Nour / Ghusn, Wissam / Shmais, Manar / Sharara, Ala I

Inflammatory intestinal diseases

2023 Volume 8, Issue 1, Page(s) 34–40

Abstract: Introduction: The development and course of inflammatory bowel disease appear to be influenced by environmental factors. Particularly, smoking has been shown to assume a harmful role in Crohn's disease (CD) and a protective role in ulcerative colitis. ... ...

Abstract	Introduction: The development and course of inflammatory bowel disease appear to be influenced by environmental factors. Particularly, smoking has been shown to assume a harmful role in Crohn's disease (CD) and a protective role in ulcerative colitis. This study aims to examine the effect of smoking on need for surgery in patients with moderate to severe CD receiving biologic therapy. Methods: This was a retrospective study of adult patients with CD at a University Medical Center over a 20-year period. Results: A total of 251 patients were included (mean age 36.0 ± 15.0; 70.1% males; current, former, and nonsmokers: 44.2%, 11.6%, and 43.8%, respectively). Mean duration on biologics was 5.0 ± 3.1 years (>2/3 received anti-TNFs, followed by ustekinumab in 25.9%) and a third of patients (29.5%) received more than one biologic. Disease-related surgeries (abdominal, perianal, or both) occurred in 97 patients (38.6%): 50 patients had surgeries prior to starting biologics only, 41 had some surgeries after, and 6 had insufficient information. There was no significant difference in surgeries between ever-smokers (current or previous) versus nonsmokers in the overall study group. On logistic regression, the odds of having any CD surgery were higher in patients with longer disease duration (OR = 1.05, 95% CI = 1.01, 1.09) and in those receiving more than one biologic (OR = 2.31, 95% CI = 1.16, 4.59). However, among patients who had surgery prior to biologic therapy, smokers were more likely to have perianal surgery compared to nonsmokers (OR = 10.6, 95% CI = 2.0, 57.4; Conclusion: In biologic-naive CD patients requiring surgery, smoking is an independent predictor of perianal surgery. Smoking, however, is not an independent risk factor for surgery in this cohort after starting biologics. The risk of surgery in those patients is primarily associated with disease duration and the use of more than one biologic.
Language	English
Publishing date	2023-04-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2817967-5
ISSN	2296-9365 ; 2296-9365
ISSN (online)	2296-9365
ISSN	2296-9365
DOI	10.1159/000530689
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Article ; Online: A comparative clinical and histopathological pilot study of different fractional CO

Rasheed, Ahmad I / Shawki, Sylvia R / Mostafa, Rabab G / Sharara, Manal A

Journal of cosmetic dermatology

2020 Volume 20, Issue 1, Page(s) 116–123

Abstract: Background: Atrophic scars cause significant patient morbidity. Fractional photothermolysis is one of the most effective treatment options used to resurface scars of different etiologies.: Aims: To assess the efficacy and safety of different ... ...

Abstract	Background: Atrophic scars cause significant patient morbidity. Fractional photothermolysis is one of the most effective treatment options used to resurface scars of different etiologies. Aims: To assess the efficacy and safety of different fractional ablative CO Methods: A prospective pilot study of 20 adult male patients (skin types Π- Ⅳ, aged 18-45) with post-traumatic atrophic linear scars were divided into 2 groups each comprising 10 patients receiving different fractional CO Results: The study showed statistically significant reduction in average scar volume in both groups (P < .01), with reduction in depth more obvious than reduction in width or length in both groups. There was a highly significant difference in overall scar improvement represented by scar volume between both groups (P < .01) with an average reduction in scar volume of 42.85% in group (a) compared with 35.29% in group (b). Also, there was a highly statistically significant increase in both epidermal and papillary and reticular dermis thickness in both groups after treatment. However, the difference between both groups was nonsignificant. Side effects were mild, well tolerated, and transient. Conclusion: Fractional CO
MeSH term(s)	Adolescent ; Adult ; Carbon Dioxide ; Cicatrix/etiology ; Cicatrix/pathology ; Humans ; Lasers, Gas/adverse effects ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Treatment Outcome ; Young Adult
Chemical Substances	Carbon Dioxide (142M471B3J)
Language	English
Publishing date	2020-05-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2280551-5
ISSN	1473-2165 ; 1473-2130
ISSN (online)	1473-2165
ISSN	1473-2130
DOI	10.1111/jocd.13489
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Zs.A 6539: Show issues

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Article ; Online: 2008 financial crisis versus 2020 economic fallout: how COVID-19 might influence fertility treatment and live births.

Gromski, Piotr S / Smith, Andrew D A C / Lawlor, Deborah A / Sharara, Fady I / Nelson, Scott M

Reproductive biomedicine online

2021 Volume 42, Issue 6, Page(s) 1087–1096

Abstract: Research question: The economic and reproductive medicine response to the coronavirus disease 2019 (COVID-19) pandemic in the USA has reduced the affordability and accessibility of fertility care. What is the impact of the 2008 financial recession and ... ...

Abstract	Research question: The economic and reproductive medicine response to the coronavirus disease 2019 (COVID-19) pandemic in the USA has reduced the affordability and accessibility of fertility care. What is the impact of the 2008 financial recession and the COVID-19 recession on fertility treatments and cumulative live births? Design: The study examined annual US natality, Centers for Disease Control and Prevention IVF cycle activity and live birth data from 1999 to 2018 encompassing 3,286,349 treatment cycles, to estimate the age-stratified reduction in IVF cycles undertaken after the 2008 financial recession, with forward quantitative modelling of IVF cycle activity and cumulative live births for 2020 to 2023. Results: The financial recession of 2008 caused a 4-year plateau in fertility treatments with a predicted 53,026 (95% confidence interval [CI] 49,581 to 56,471) fewer IVF cycles and 16,872 (95% CI 16,713 to 17,031) fewer live births. A similar scale of economic recession would cause 67,386 (95% CI 61,686 to 73,086) fewer IVF cycles between 2020 and 2023, with women younger than 35 years overall undertaking 22,504 (95% CI 14,320 to 30,690) fewer cycles, compared with 4445 (95% CI 3144 to 5749) fewer cycles in women over the age of 40 years. This equates to overall 25,143 (95% CI 22,408 to 27,877) fewer predicted live births from IVF, of which only 490 (95% CI 381 to 601) are anticipated to occur in women over the age of 40 years. Conclusions: The COVID-19 recession could have a profound impact on US IVF live birth rates in young women, further aggravating pre-existing declines in total fertility rates.
MeSH term(s)	Adult ; Birth Rate ; COVID-19/economics ; Female ; Fertility/physiology ; Humans ; Live Birth ; Pandemics ; Pregnancy ; Reproductive Techniques, Assisted/economics
Language	English
Publishing date	2021-03-23
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2113823-0
ISSN	1472-6491 ; 1472-6483
ISSN (online)	1472-6491
ISSN	1472-6483
DOI	10.1016/j.rbmo.2021.03.017
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Zs.A 5792: Show issues

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bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Prevalence and characteristics of post-gastroscopy gastric cancer: A retrospective study from an academic medical center.

Abi Doumeth, Sarah / Bou Daher, Halim / El Mokahal, Ali / Tawil, Ayman / Sharara, Ala I

Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology

2021 Volume 22, Issue 3, Page(s) 193–198

Abstract: Background and study aims: Gastric cancer is diagnosed by endoscopy but false negative rates of up to 10% in the west and 40% in Asia have been reported. In Lebanon, little is known about the rates of post-gastroscopy gastric cancer (PGGC), defined as ... ...

Abstract	Background and study aims: Gastric cancer is diagnosed by endoscopy but false negative rates of up to 10% in the west and 40% in Asia have been reported. In Lebanon, little is known about the rates of post-gastroscopy gastric cancer (PGGC), defined as the proportion of patients diagnosed with gastric cancer with a negative previous examination within 2 years of diagnosis. We aimed to examine the rate of PGGC and its risk factors, clinico-pathologic and endoscopic characteristics at a University medical Center. Patients and methods: Retrospective analysis of patients with histologically proven gastric malignancy over the last 14 years. Patients with history of upper endoscopy preceding the index diagnostic endoscopy by 6 to 24 months were included. Results: 18,976 patients underwent upper endoscopy and gastric cancer was diagnosed in 323 (1.7%). Of those, only 4 (1.2%) had a preceding endoscopy within 6 to 24 months of diagnosis: 3 adenocarcinoma and one MALT lymphoma. Upon review of the initial endoscopy, a mucosal abnormality had been noted in all 4 patients and biopsies taken in 3 were negative for cancer. The mean time to cancer diagnosis was 8 months (range 6-13 months). Conclusion: A small proportion of gastric carcinomas are missed on endoscopy in this study. Patients with endoscopic evidence of mucosal abnormalities and negative biopsies should undergo repeat examination with multiple biopsies. Proper endoscopic technique, lesion recognition and adoption of performance improvement measures are important to optimize endoscopic practice.
MeSH term(s)	Academic Medical Centers ; Gastroscopy ; Humans ; Prevalence ; Retrospective Studies ; Stomach Neoplasms/diagnosis ; Stomach Neoplasms/epidemiology
Language	English
Publishing date	2021-06-02
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2502114-X
ISSN	2090-2387 ; 1687-1979
ISSN (online)	2090-2387
ISSN	1687-1979
DOI	10.1016/j.ajg.2021.02.001
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Article ; Online: Positive predictive value of fecal immunochemical test for high-risk colonic adenomas and carcinoma: A health maintenance organization cohort screening study in Lebanon.

Chehab, Hamed / BouDaher, Halim / Mokahal, Ali El / ElHaddad, Aline / Rimmani, Hussein / Hamadeh, Ghassan / Tawil, Ayman / Sharara, Ala I

Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology

2021 Volume 22, Issue 2, Page(s) 174–176

Abstract: Background and study aims: Fecal Immunochemical Test (FIT) is one of the leading modalities for colorectal cancer screening. Studies show that FIT is highly sensitive for the detection of colorectal cancer (CRC) but not similarly accurate for detection ... ...

Abstract	Background and study aims: Fecal Immunochemical Test (FIT) is one of the leading modalities for colorectal cancer screening. Studies show that FIT is highly sensitive for the detection of colorectal cancer (CRC) but not similarly accurate for detection of pre-cancerous advanced adenomas (AA). We studied the performance metrics of FIT for the detection of CRC and AA in ahealth maintenance organization (HMO) cohort screening program. Patients and methods: Retrospective cohort study of asymptomatic persons of screening age belonging to a HMO. Endoscopy and pathology reports of those who tested positive were used to calculate the positive predictive value (PPV) of FIT, and characterize endoscopic findings on colonoscopy. Results: Between 1995 and 2017, 3000 persons had screening fecal occult testing as part of their Employee Health Care plan. Of those, 150 had a positive qualitative FIT (cutoff 10 Âµg hemoglobin/g feces). All underwentcolonoscopy, and median time to colonoscopy was 27 days. 4 (2.6%) had carcinoma(2 stage IIIA and 2 stage IIIB), 106 (70.6%) had adenomas of which 40 (26.6% of the total cohort) had advanced adenomas (≥1 cm, villous features, or high-grade dysplasia) giving a PPV for AA and carcinoma of 29% and 3% respectively. When stratified by age, the PPV of AA; carcinoma was [50-59 (21.7%; 0.0%)], [60-69 (14.6%; 4.2%)], [70-79 (42.6%; 2.1%)], [80-89 (33.3%; 11.1%)]. Conclusion: The performance characteristics of FIT testing are acceptable for population screening in resource-limited settings. The resultsof this study are helpful when discussing expectations prior to colonoscopy in people with positive FIT.
MeSH term(s)	Adenoma ; Carcinoma ; Colonoscopy ; Colorectal Neoplasms ; Early Detection of Cancer ; Feces ; Health Maintenance Organizations ; Humans ; Lebanon ; Mass Screening ; Predictive Value of Tests ; Retrospective Studies
Language	English
Publishing date	2021-05-05
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2502114-X
ISSN	2090-2387 ; 1687-1979
ISSN (online)	2090-2387
ISSN	1687-1979
DOI	10.1016/j.ajg.2021.04.002
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Article: Current and Prospective Treatment of Adenomyosis.

Sharara, Fady I / Kheil, Mira H / Feki, Anis / Rahman, Sara / Klebanoff, Jordan S / Ayoubi, Jean Marc / Moawad, Gaby N

Journal of clinical medicine

2021 Volume 10, Issue 15

Abstract: 1) Background: Adenomyosis is a poorly understood entity which makes it difficult to standardize treatment. In this paper we review and compare the currently approved medical and surgical treatments of adenomyosis and present the evidence behind them. ( ... ...

Abstract	(1) Background: Adenomyosis is a poorly understood entity which makes it difficult to standardize treatment. In this paper we review and compare the currently approved medical and surgical treatments of adenomyosis and present the evidence behind them. (2) Methods: A PubMed search was conducted to identify papers related to the different treatments of adenomyosis. The search was limited to the English language. Articles were divided into medical and surgical treatments. (3) Results: Several treatment options have been studied and were found to be effective in the treatment of adenomyosis. (4) Conclusions: Further randomized controlled trials are needed to compare treatment modalities and establish a uniform treatment algorithm for adenomyosis.
Language	English
Publishing date	2021-07-30
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm10153410
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Article ; Online: Predictors of Sustained Response With Tofacitinib Therapy in Patients With Ulcerative Colitis.

Sandborn, William J / Armuzzi, Alessandro / Liguori, Giuseppina / Irving, Peter M / Sharara, Ala I / Mundayat, Rajiv / Lawendy, Nervin / Woolcott, John C / Danese, Silvio

Inflammatory bowel diseases

2021 Volume 28, Issue 9, Page(s) 1338–1347

Abstract: Background: Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis. We evaluate baseline characteristics as predictors of sustained response and remission in patients with ulcerative colitis receiving tofacitinib ... ...

Abstract	Background: Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis. We evaluate baseline characteristics as predictors of sustained response and remission in patients with ulcerative colitis receiving tofacitinib maintenance therapy. Methods: Patients with clinical response following OCTAVE Induction 1 and 2 entered OCTAVE Sustain and were rerandomized to receive tofacitinib 5 or 10 mg twice daily or placebo. Baseline characteristics were stratified by week 52 efficacy endpoints (remission, sustained remission, clinical response, sustained clinical response). Associations between baseline characteristics and efficacy endpoints were evaluated using logistic regression analyses. Results: Overall, 170 of 487 (34.9%) patients were in remission at week 52. In multivariable modeling, endoscopic subscore at baseline of OCTAVE Induction 1 and 2 (2 vs 3; odds ratio [OR], 1.60; 95% confidence interval [CI], 1.06-2.44]), partial Mayo score (<2 vs ≥2; OR, 1.92; 95% CI, 1.27-2.90), and age (per 10-years; OR, 1.19; 95% CI, 1.02-1.39) at baseline of OCTAVE Sustain (following 8 weeks' tofacitinib induction therapy) were associated with higher odds of remission at week 52. Oral corticosteroid use (OR, 0.63; 95% CI, 0.42-0.96) and C-reactive protein (per unit; OR, 0.94; 95% CI, 0.89-0.99) at baseline of OCTAVE Sustain were associated with reduced likelihood of remission at week 52. In general, opposite associations were observed for time to loss of response. Conclusion: Patients with greater clinical improvement after 8 weeks of tofacitinib induction therapy are more likely to maintain response or remission with tofacitinib regardless of dose received during maintenance, highlighting the importance of a robust response to induction therapy.
MeSH term(s)	Child ; Colitis, Ulcerative/chemically induced ; Colitis, Ulcerative/drug therapy ; Humans ; Piperidines/adverse effects ; Pyrimidines/adverse effects ; Pyrroles/adverse effects ; Remission Induction
Chemical Substances	Piperidines ; Pyrimidines ; Pyrroles ; tofacitinib (87LA6FU830)
Language	English
Publishing date	2021-12-03
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1340971-2
ISSN	1536-4844 ; 1078-0998
ISSN (online)	1536-4844
ISSN	1078-0998
DOI	10.1093/ibd/izab278
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Zs.A 4530: Show issues

Location:
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Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

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Article: Gastric Duplication Cyst Presenting as Massive Gastrointestinal Bleeding.

Youssef, Alexey / Ibrahim, Alexander / AlShehabi, Zuheir / Omran, Ammar / Sharara, Ala I

Pediatric gastroenterology, hepatology & nutrition

2019 Volume 22, Issue 2, Page(s) 189–192

Abstract: Gastric duplication cysts (GDCs) are rare congenital anomalies. Presentation of GDCs varies from an asymptomatic abdominal mass to fulminant or massive gastrointestinal (GI) bleeding. Herein, we describe a case of a GDC in a 10-month-old infant ... ...

Abstract	Gastric duplication cysts (GDCs) are rare congenital anomalies. Presentation of GDCs varies from an asymptomatic abdominal mass to fulminant or massive gastrointestinal (GI) bleeding. Herein, we describe a case of a GDC in a 10-month-old infant presenting with unexplained massive GI hemorrhage and hematemesis. An abdominal ultrasound was negative, while computerized tomography was, initially, inaccessible. Through a series of repeated esophagogastroduodenoscopies, we documented penetration of the GDC into the gastric cavity that was later confirmed by computerized tomography. The patient was treated successfully with surgical resection.
Language	English
Publishing date	2019-02-27
Publishing country	Korea (South)
Document type	Case Reports
ZDB-ID	3032413-0
ISSN	2234-8840 ; 2234-8646
ISSN (online)	2234-8840
ISSN	2234-8646
DOI	10.5223/pghn.2019.22.2.189
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