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Article: Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center.

Akeel, Nouf

2021 Volume 13, Issue 9, Page(s) e18170

Abstract: Objectives Although inguinal hernia (IH) repair is low-risk surgery, older patients are occasionally offered watchful waiting because of their functional status and comorbidities. This study reviewed the surgical outcomes of IH repair in older patients ... ...

Abstract	Objectives Although inguinal hernia (IH) repair is low-risk surgery, older patients are occasionally offered watchful waiting because of their functional status and comorbidities. This study reviewed the surgical outcomes of IH repair in older patients in comparison with outcomes in younger patients. Methods This retrospective study included all patients who had IH repair from 2010 to 2020. The primary outcomes of interest were postoperative complications and recurrence. Results A total of 262 patients underwent IH repair during the study period; 40% were ≥60 years old. One patient had a recurrence. Among the 8% of patients who had postoperative complications, groin pain was the most common one (1.9%). Female patients had a significantly higher rate of complications than male patients did (38.5% female versus 6.4% male,
Language	English
Publishing date	2021-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.18170
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Article ; Online: What are the outcomes in patients referred to a tertiary referral centre for Crohn's rectovaginal fistula surgery?

Sapci, Ipek / Zutshi, Massarat / Akeel, Nouf / Hull, Tracy

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2023 Volume 25, Issue 8, Page(s) 1653–1657

Abstract: Aim: Rectovaginal fistulas in patients with Crohn's disease are challenging to manage, and surgical treatment remains the best option for achieving permanent closure of the fistula. Biologicals are now used routinely for patients with Crohn's disease. ... ...

Abstract	Aim: Rectovaginal fistulas in patients with Crohn's disease are challenging to manage, and surgical treatment remains the best option for achieving permanent closure of the fistula. Biologicals are now used routinely for patients with Crohn's disease. The aim of this study was to investigate the surgical procedures used by us to treat rectovaginal fistula in patients with Crohn's disease in the era of biologicals. Method: Patients with Crohn's disease who underwent surgery for a rectovaginal fistula between 2010 and 2020 were included in this retrospective study and were identified from a prospectively maintained institutional database. Collected variables included demographics, perioperative and operative variables and data regarding medications used. Success of the procedure was defined as no symptoms at least 6 months after definitive repair and/or stoma closure. Results: Twenty patients (out of 80 referred for evaluation) underwent surgery with intent to close the fistula and had at least 6 months of follow-up. Mean age was 44 ± 12 years with a median follow-up duration of 33 months (range 6-130 months). Forty per cent of the patients had a history of at least two surgeries to close the fistula. The overall healing rate was 70% (14/20). The most performed procedure was a transanal rectal advancement flap (7/20), with a success rate of 85%. Conclusion: Rectovaginal fistula in Crohn's disease is difficult to cure; according to our results almost half of these patients have multiple surgeries due to recurrence. Multiple procedures may be offered for this challenging problem in motivated patients. Perioperative diversion should be strongly considered.
MeSH term(s)	Female ; Humans ; Infant ; Child, Preschool ; Child ; Rectovaginal Fistula/etiology ; Rectovaginal Fistula/surgery ; Crohn Disease/complications ; Crohn Disease/surgery ; Retrospective Studies ; Tertiary Care Centers ; Treatment Outcome ; Rectal Fistula/etiology ; Rectal Fistula/surgery
Language	English
Publishing date	2023-07-17
Publishing country	England
Document type	Journal Article
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.16660
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Article: Gastrointestinal Perforation With an Intraluminal Stent and Bevacizumab use in Advanced Metastatic Colorectal Cancer.

Akeel, Nouf / Toonsi, Wafaa A

Cureus

2021 Volume 13, Issue 1, Page(s) e12831

Abstract: Intestinal obstruction is a common acute presentation of advanced rectal cancer, which could be managed with surgical or non-surgical techniques including metallic stenting. Bevacizumab has been gaining popularity in the treatment of advanced colorectal ... ...

Abstract	Intestinal obstruction is a common acute presentation of advanced rectal cancer, which could be managed with surgical or non-surgical techniques including metallic stenting. Bevacizumab has been gaining popularity in the treatment of advanced colorectal cancer (CRC) in combination with different chemotherapeutic agents, to improve the overall survival rate; however, data regarding the adverse effects of bevacizumab in combination with other treatment modalities have been insufficient. Herein, we present a case of a 37-year-old man diagnosed with advanced rectal cancer with concurrent liver and lung metastases. He was started on Xelox (capecitabine plus oxaliplatin) chemotherapy in combination with bevacizumab for palliative care. He developed an episode of bowel obstruction, which was managed with emergent placement of a metallic stent. Soon after that, the patient presented emergently with signs and symptoms of intestinal perforation. He underwent emergent surgical intervention with stoma creation and a complicated hospital course. Despite the oncological benefits of bevacizumab for treating metastatic CRC, complications can occur resulting in a devastating outcome, with intestinal perforation being the most serious rare complication.
Language	English
Publishing date	2021-01-21
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.12831
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Article: Serum Level and Genetic Polymorphism of Mannose-Binding Lectin in Infants with Neonatal Sepsis at Zagazig University Hospitals.

El-Behedy, Eman M / Akeel, Nagwa / El-Maghraby, Hanaa M / Shawky, Amal

The Egyptian journal of immunology

2019 Volume 26, Issue 1, Page(s) 91–99

Abstract: Immature immune system in neonates is considered a risk factor for neonatal infections and sepsis. Mannose-binding lectin (MBL) is one of the innate immune system components that could recognize a wide variety of pathogens and initiate an immune response ...

Abstract	Immature immune system in neonates is considered a risk factor for neonatal infections and sepsis. Mannose-binding lectin (MBL) is one of the innate immune system components that could recognize a wide variety of pathogens and initiate an immune response against them. Objectives of this study were to assess the correlation between serum level of MBL and MBL2 gene polymorphism and incidence of neonatal sepsis. Isolation of bacteria from neonatal blood culture was carried out by conventional methods then, serum level of MBL was measured by ELISA and MBL2 gene polymorphism was determined by PCR-RFLP. Out of 50 neonates with sepsis enrolled in this study, 44 (88%) neonates had MBL deficiency and 6 (12%) had normal serum level with a very high statistically significant difference (P=0.00001). Genotype BB was more frequent in neonatal sepsis (56%) followed by genotype AB (32%) then genotype AA (12%) and it was more prevalent in preterm (63.2%) than in full term (33.3%) with a high statistically significant difference (P=0.001). Patients with BB genotype had the lowest MBL level in serum compared to other genotypes with a very high significant difference (P=0.001). In conclusion, low serum level of MBL and genotype BB might be significantly associated with development of sepsis among neonates.
MeSH term(s)	Genotype ; Hospitals, University ; Humans ; Infant, Newborn ; Infant, Premature ; Mannose-Binding Lectin/blood ; Mannose-Binding Lectin/genetics ; Neonatal Sepsis/blood ; Polymorphism, Genetic
Chemical Substances	MBL2 protein, human ; Mannose-Binding Lectin
Language	English
Publishing date	2019-07-22
Publishing country	Egypt
Document type	Journal Article
ISSN	1110-4902
ISSN	1110-4902
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Article ; Online: What Is the Best Surgical Treatment of Pouch-Vaginal Fistulas?

Sapci, Ipek / Akeel, Nouf / DeLeon, Michelle F / Stocchi, Luca / Hull, Tracy

Diseases of the colon and rectum

2019 Volume 62, Issue 5, Page(s) 595–599

Abstract: Background: Pouch-vaginal fistula is a debilitating condition with no single best surgical treatment described. Closure of these fistulas can be incredibly difficult, and transanal, transabdominal, and transvaginal approaches have been reported with ... ...

Abstract	Background: Pouch-vaginal fistula is a debilitating condition with no single best surgical treatment described. Closure of these fistulas can be incredibly difficult, and transanal, transabdominal, and transvaginal approaches have been reported with varying success rates. Recurrence is a major problem and could eventually result in repeat redo pouch or permanent diversion. Objective: The aim of our study was to investigate healing rates for procedures done for pouch-vaginal fistula closure. Design: This is a retrospective analysis of a prospectively maintained database complemented by chart review. Settings: This study reports data of a tertiary referral center. Patients: Patients who underwent surgery for pouch-vaginal fistula from 2010 to 2017 were identified. Patients who underwent surgery with intent to close the fistula were included, and patients who had inadequate follow-up to verify fistula status were excluded. Interventions: Patients included underwent surgery to close pouch-vaginal fistula. Main outcome measures: Success of the surgery was the main outcome measure. Success was defined as procedures with no reported recurrence of fistula on last follow-up. Results: A total of 70 patients underwent surgery with an intent to close the pouch-vaginal fistula, 65 of whom had undergone index IPAA for ulcerative colitis, but 13 of these patients later had the diagnosis changed to Crohn's disease. Thirty-nine patients (56%) had a fistula originating from anal transition zone to dentate line to the vagina (not at the pouch anastomosis). In the total group of 70 patients, our successful closure rate was 39 (56%) of 70. Procedures with the highest success rates were perineal ileal pouch advancement flap and redo IPAA (61% and 69%). Limitations: The retrospective nature and small number of cases are the limitations of the study. Conclusions: Although numerous procedures may be used in an attempt to close pouch-vaginal fistula, pouch advancement and redo pouch were the most successful in closing the fistula. See Video Abstract at http://links.lww.com/DCR/A841.
MeSH term(s)	Adenomatous Polyposis Coli/surgery ; Adult ; Anastomosis, Surgical ; Colitis, Ulcerative/surgery ; Colonic Pouches ; Crohn Disease/surgery ; Databases, Factual ; Digestive System Surgical Procedures/methods ; Female ; Humans ; Intestinal Fistula/surgery ; Middle Aged ; Postoperative Complications/surgery ; Proctocolectomy, Restorative ; Reconstructive Surgical Procedures/methods ; Reoperation ; Retrospective Studies ; Surgical Flaps ; Treatment Outcome ; Vaginal Fistula/surgery ; Young Adult
Language	English
Publishing date	2019-01-07
Publishing country	United States
Document type	Journal Article ; Video-Audio Media
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000001313
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Article: Outcomes of Cytoreduction and Oxaliplatin-Based Hyperthermic Intraperitoneal Chemotherapy in Patients With Peritoneal Carcinomatosis From Colorectal Cancer.

Alhumaid, Moayad / Sait, Salma / Fallatah, Emad / AlSayegh, Nasser / Farsi, Ali / Nassif, Mohammed / Farsi, Nada J / Akeel, Nouf / Samkari, Ali / Shabkah, Alaa A / Trabulsi, Nora

Cureus

2021 Volume 13, Issue 10, Page(s) e18670

Abstract: Among patients with metastatic colorectal cancer, 25% have isolated peritoneal carcinomatosis. We performed a systematic review and meta-analysis to assess the disease-free survival (DFS) and overall survival (OS) of patients undergoing hyperthermic ... ...

Abstract	Among patients with metastatic colorectal cancer, 25% have isolated peritoneal carcinomatosis. We performed a systematic review and meta-analysis to assess the disease-free survival (DFS) and overall survival (OS) of patients undergoing hyperthermic intraperitoneal chemotherapy with oxaliplatin. Eleven studies were included in the final assessment. Pooled three- and five-year OS rates were 58.60% and 42.19%, respectively. The estimated pooled three- and five-year DFS rates were 23.47% and 14.26%, respectively.
Language	English
Publishing date	2021-10-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.18670
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Article ; Online: Clinically Node Negative, Pathologically Node Positive Rectal Cancer Patients Who Did Not Receive Neoadjuvant Therapy.

Akeel, Nouf / Lan, Nan / Stocchi, Luca / Costedio, Meagan M / Dietz, David W / Gorgun, Emre / Kalady, Matthew F / Karagkounis, Georgios / Kessler, Hermann / Remzi, Feza H

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2016 Volume 21, Issue 1, Page(s) 49–55

Abstract: Purpose: Neoadjuvant chemoradiotherapy is the preferred standard of care for clinical stages II-III rectal cancer. It is uncertain whether clinically node negative (cN-) tumors found to be pathologically stage III could be optimally treated with surgery ...

Abstract	Purpose: Neoadjuvant chemoradiotherapy is the preferred standard of care for clinical stages II-III rectal cancer. It is uncertain whether clinically node negative (cN-) tumors found to be pathologically stage III could be optimally treated with surgery alone and avoid adjuvant treatments. The aim of our study was to define the outcomes of such patients. Methods: Patients undergoing radical surgery using total mesorectal excision (TME) techniques for rectal cancer (≤12 cm from the anal verge) with curative intent during 2000-2012 and found to have stage III disease on final pathology were identified from a prospectively maintained database. Patients were staged with abdominopelvic CT, transrectal endoscopic ultrasound, and/or pelvic MRI. Exclusion criteria were cN+ without neoadjuvant chemoradiotherapy, hereditary colorectal syndromes, inflammatory bowel diseases, lack of preoperative nodal staging, intraoperative radiotherapy, and follow-up <3 years. We compared cN-/pN+ patients according to the postoperative treatment received (group 1 if no further treatment, group 2 if any postoperative treatments), using ypN+ patients (neoadjuvant chemoradiotherapy + surgery) as controls (group 3). Oncological outcomes evaluated included overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), local recurrence (LR), and distant recurrence (DR). Results: Out of 218 patients included in the study, 77 cN- patients underwent initial surgery with a pN+ surgical specimen. Eighteen of these patients received no postoperative treatment due to associated comorbidity, patient preference, or postoperative complications while the remaining 59 (group 2) patients received chemoradiotherapy (n = 21) or chemotherapy alone (n = 38), respectively, and group 3 included 141 patients. Distal, radial resection margins and TME grading when available were comparable among groups. cN-/pN+ patients treated with surgery alone were associated with significantly poorer cancer outcomes compared with cN-/pN+ patients who received any form of adjuvant therapy and to ypN+ patients. Conclusion: TME surgery is not sufficient to optimize outcomes among rectal cancer patients believed to be node negative and found to be stage III based on specimen pathology.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Anal Canal/surgery ; Chemoradiotherapy, Adjuvant ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Rectal Neoplasms/mortality ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Rectal Neoplasms/therapy ; Survival Analysis ; Treatment Outcome
Language	English
Publishing date	2016-10-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-016-3301-1
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Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) 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: Effect of intravenous iron saccharate on the requirements of erythropoietin in hemodialysis patients.

Shaheen, Faissal Am / Souqiyyeh, Muhammad Ziad / Akeel, Nabeela

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia

2002 Volume 13, Issue 2, Page(s) 131–140

Abstract: We attempt in this study to evaluate the effect of intravenous iron saccharate (i.v. Sach) on the erythropoietin (EPO) requirements during the initial phase of replacement therapy with recombinant human erythropoietin (r-HuEPO) in adult chronic ... ...

Abstract	We attempt in this study to evaluate the effect of intravenous iron saccharate (i.v. Sach) on the erythropoietin (EPO) requirements during the initial phase of replacement therapy with recombinant human erythropoietin (r-HuEPO) in adult chronic hemodialysis (HD) patients. We evaluated 96 study patients who completed 12 weeks of treatment with EPO. There were 69 (72%) males and 27 (28%) females with a mean age of 44 +/- 10 years (range 24 to74 years). The patients were initiated on EPO at 50 units/kg body weight subcutaneously post-dialysis two to three times weekly. Intravenous iron was administered to maintain the ferritin levels and transferrin saturation ratio within normal range. There were 36 (37.5%) patients who received i.v. Sach at doses of 100 mg at the end of dialysis two or three times per week during the whole study period (total dose 2400-3600 mg). Of the 96 study patients, 91 (94.8%) responded to the EPO. The mean hemoglobin (Hb) at entry to the study was 72 +/- 84 g/L (range 52-88 g/L). There was a significant increase of the mean Hb to 108 +/- 10 g/L (range 70-120 grams/L) at the end of the study (P< 0.0001). The mean total weekly dose per kg per patient per week of EPO was 149 +/- 11 (range 100-225) units/kg/week and decreased significantly to 141 +/- 24 units/kg/week at the end of the study (P< 0.0006). The study patients were stratified by the baseline ferritin and transferrin saturation (TSAT) into three sub-groups: group I: patients with TSAT < 0.2 and ferritin < 100 ng/ml; group II: patients with TSAT> 0.2 and ferritin < 100 ng/ml; group III: patients with TSAT> 0.2 and ferritin> 100 ng/ml. There were 19 patients in group I (13 received i.v. Sach), 26 in group II (16 received i.v. Sach) and 44 in group III (seven received i.v. Sach). There was a group of seven patients who had TSAT < 0.2 and ferritin> 100 ng/ml, however, none received i.v. Sach and they were not included in the stratification. There was no significant difference in the mean Hb between patients who received and those who did not receive i.v. Sach in the sub-groups studied. However, there was a significant decrease in the mean weekly dose of EPO in the patients who received i.v. Sach. We conclude that routine use of i.v. iron supplementation in chronic HD patients receiving recombinant EPO may be beneficial in the initial phase of treatment in attaining the target Hb with lower doses of EPO, regardless of the status of the iron indices.
Language	English
Publishing date	2002-04
Publishing country	Saudi Arabia
Document type	Journal Article
ZDB-ID	1379955-1
ISSN	1319-2442
ISSN	1319-2442
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Article: Dose and lipid lowering effect of tinzaparin sodium: a single center experience.

Badawi, Laila / Akeel, Nabeela / Shaheen, Faissal Am / Al Ahmadi, Salwa

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia

2005 Volume 16, Issue 2, Page(s) 161–165

Abstract: The administration of an anticoagulant is essential to prevent clotting of blood in the extra corporeal circuit during a hemodialysis (HD) session. Unfractionated heparin (UFH) has been used for this purpose over many decades with satisfactory results. ... ...

Abstract	The administration of an anticoagulant is essential to prevent clotting of blood in the extra corporeal circuit during a hemodialysis (HD) session. Unfractionated heparin (UFH) has been used for this purpose over many decades with satisfactory results. However, UFH has many unwanted side effects such as risk of bleeding, thrombocytopenia, paradoxical thrombosis as well as disturbances of blood lipids. Over the last few years, low molecular weight heparin (LMWH.) has been introduced in medical practice. We performed this prospective study at the Jeddah Kidney Center, Jeddah, Saudi Arabia to evaluate the efficacy of LMWH. We compared the changes in lipid profile during the period of administration of LMWH with the changes observed during the administration of UFH. A total of 30 patients were involved in this prospective study. During the first part of the study, which was carried out for 12 weeks, all the study patients received UFH as anticoagulant during the HD sessions. During the second part of the study, which was conducted over the subsequent 12 weeks, the same patients were given LMWH as anticoagulant during the HD sessions. During the HD sessions using Tinzaparin, no significant problems were observed and HD was performed efficiently. The total cholesterol level was reduced during the administration of LMWH while the triglyceride levels showed a rise during this period. Our study suggests that LMWH is a safe and effective substitute for UFH for anticoagulation during HD sessions. Studies on larger cohorts and for longer periods of time are required to validate our observation.
Language	English
Publishing date	2005-04
Publishing country	Saudi Arabia
Document type	Journal Article
ZDB-ID	1379955-1
ISSN	1319-2442
ISSN	1319-2442
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Article: Darbepoetin use for the treatment of anemia in hemodialysis patients in Saudi Arabia.

Shaheen, Faissal A M / Akeel, Nabila / Alfi, Adnan / Harbi, Ali / Tarif, Nauman / Souqiyyeh, Mohammad Ziad

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia

2006 Volume 17, Issue 3, Page(s) 365–372

Abstract: Erythropoietin replacing proteins have improved patient outcomes and quality of life. Darbepoetin has a 3-fold longer half-life than recombinant human erythropoietin (rHuEPO). In this study, we investigate the efficacy and safety of the conversion of ... ...

Abstract	Erythropoietin replacing proteins have improved patient outcomes and quality of life. Darbepoetin has a 3-fold longer half-life than recombinant human erythropoietin (rHuEPO). In this study, we investigate the efficacy and safety of the conversion of stable hemodialysis patients from the current short-acting r-HuEPO (EPO alfa or beta) to the long-acting darbepoetin. In addition, we verified the appropriateness of the current ratio of conversion of the short acting to the long-acting erythropoietin in an open label prospective multi-center study. The study design included 12 weeks darbepoetin administration. The conversion ratio was 200 IU of short acting r-HuEPO to 1 microgram of darbepoetin. We adjusted the dose of darbepoetin to maintain hemoglobin levels between 110-120 g/L. There were 33 patients who satisfied the entry criteria. The study was conducted from January-June, 2005. The study patients included 18 men and 15 women, the mean age was 50.4 +/- 12.3 years and the mean duration on HD was 323 +/- 51.9 days. There was a significant decrease in the mean dose of darbepoetin from 37.3 +/- 12.9 ug/week at week 1 of the study to 20.8 +/- 16.6 ug/week by the end of week 12 (p < 0.00003) while the hemoglobin level was maintained within the previously defined range. The initial conversion ratio from short-acting erythropoietin to darbepoetin was 200 IU to 1 microgram. However, at the end of week 12, the mean dose of darbepoetin decreased to an equivalent conversion ratio to 361 IU: 1 microgram. This may reflect great savings in the cost of treatment. Our experience with darbepoetin reveals that darbepoetin is effective and safe for the treatment of anemia in hemodialysis patients and has a more convenient dosing schedule than short-acting erythropoietin. The darbepoetin dosage decreases over time and savings are expected to greater with darbepoetin more than with short-acting erythropoietin with time.
MeSH term(s)	Anemia/blood ; Anemia/drug therapy ; Anemia/epidemiology ; Darbepoetin alfa ; Dose-Response Relationship, Drug ; Erythropoietin/administration & dosage ; Erythropoietin/analogs & derivatives ; Erythropoietin/therapeutic use ; Female ; Follow-Up Studies ; Hemoglobins/metabolism ; Humans ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Renal Dialysis/adverse effects ; Saudi Arabia/epidemiology ; Treatment Outcome
Chemical Substances	Hemoglobins ; Erythropoietin (11096-26-7) ; Darbepoetin alfa (15UQ94PT4P)
Language	English
Publishing date	2006-09
Publishing country	Saudi Arabia
Document type	Clinical Trial ; Comparative Study ; Journal Article ; Multicenter Study
ZDB-ID	1379955-1
ISSN	1319-2442
ISSN	1319-2442
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