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Article: Reply to: Comment on "The role of graft reperfusion sequence in the development of non-anastomotic biliary strictures following orthotopic liver transplantation: A meta-analysis".

Bekheit, Mohamed

Hepatobiliary & pancreatic diseases international : HBPD INT

2019 Volume 18, Issue 4, Page(s) 402

MeSH term(s)	Cholestasis ; Constriction, Pathologic ; Humans ; Liver Transplantation
Language	English
Publishing date	2019-06-11
Publishing country	Singapore
Document type	Letter ; Comment
ZDB-ID	2241386-8
ISSN	1499-3872
ISSN	1499-3872
DOI	10.1016/j.hbpd.2019.06.003
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Article: Chronomodulated Administration of Chemotherapy in Advanced Colorectal Cancer: A Systematic Review and Meta-Analysis.

Nassar, Ahmed / Abdelhamid, Amir / Ramsay, George / Bekheit, Mohamed

Cureus

2023 Volume 15, Issue 3, Page(s) e36522

Abstract: In this systematic review, the efficacy and safety of chronomodulated chemotherapy, defined as the delivery of chemotherapy timed according to the human circadian rhythm, were assessed and compared to continuous infusion chemotherapy for patients with ... ...

Abstract	In this systematic review, the efficacy and safety of chronomodulated chemotherapy, defined as the delivery of chemotherapy timed according to the human circadian rhythm, were assessed and compared to continuous infusion chemotherapy for patients with advanced colorectal cancer. Electronic English-language studies published until October 2020 were searched. Randomised controlled trials (RCTs) comparing chronomodulated chemotherapy with non-chronomodulated (conventional) chemotherapy for the management of advanced colorectal cancer were included. The main outcomes were the objective response rate (ORR) and system-specific and overall toxicity related to chemotherapy. Electronic databases including Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Review were searched. In total, seven RCTs including 1,137 patients were analysed. Males represented 684 (60%) of the study population. The median age was 60.5 (range = 47.2-64) years. There was no significant difference between chronomodulated and conventional chemotherapy in ORR (risk ratio (RR) = 1.15; 95% confidence interval (CI) = 0.87-1.53). Similarly, there was no significant difference in gastrointestinal toxicity under the random effect model (RR = 1.02; 95% CI = 0.68-1.51). No significant difference was found regarding neurological and skin toxicities (RR = 0.64, 95% CI = 0.32-1.270 and RR = 2.11, 95% CI = 0.33-13.32, respectively). However, patients who received chronomodulated chemotherapy had less haematological toxicity (RR = 0.36, 95% CI = 0.27-0.48). In conclusion, there was no overall difference in ORR or haematologic toxicity between chronomodulated and non-chronomodulated chemotherapy used for patients with advanced colorectal cancer. Chronomodulated chemotherapy can be considered in patients at high risk of haematological toxicities.
Language	English
Publishing date	2023-03-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.36522
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Article ; Online: Causes of death after emergency general surgical admission: population cohort study of mortality.

Ramsay, G / Wohlgemut, J M / Bekheit, M / Watson, A J M / Jansen, J O

BJS open

2022 Volume 5, Issue 2

Abstract: Background: A substantial number of patients treated in emergency general surgery (EGS) services die within a year of discharge. The aim of this study was to analyse causes of death and their relationship to discharge diagnoses, in patients who died ... ...

Abstract	Background: A substantial number of patients treated in emergency general surgery (EGS) services die within a year of discharge. The aim of this study was to analyse causes of death and their relationship to discharge diagnoses, in patients who died within 1 year of discharge from an EGS service in Scotland. Methods: This was a population cohort study of all patients with an EGS admission in Scotland, UK, in the year before death. Patients admitted to EGS services between January 2008 and December 2017 were included. Data regarding patient admissions were obtained from the Information Services Division in Scotland, and cross-referenced to death certificate data, obtained from the National Records of Scotland. Results: Of 507 308 patients admitted to EGS services, 7917 died while in hospital, and 52 094 within 1 year of discharge. For the latter, the median survival time was 67 (i.q.r. 21-168) days after EGS discharge. Malignancy accounted for 48 per cent of deaths and was the predominant cause of death in patients aged over 35 years. The cause of death was directly related to the discharge diagnosis in 56.5 per cent of patients. Symptom-based discharge diagnoses were often associated with a malignancy not diagnosed on admission. Conclusion: When analysed by subsequent cause of death, EGS is a cancer-based specialty. Adequate follow-up and close links with oncology and palliative care services merit development.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cause of Death/trends ; Comorbidity ; Cross-Sectional Studies ; Emergencies ; Emergency Service, Hospital/standards ; Emergency Service, Hospital/statistics & numerical data ; Female ; General Surgery/statistics & numerical data ; General Surgery/trends ; Hospital Mortality/trends ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Patient Discharge/statistics & numerical data ; Retrospective Studies ; Scotland/epidemiology ; Young Adult
Language	English
Publishing date	2022-01-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrab021
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Article ; Online: Comprehensive assessment of the management of acute cholecystitis in Scotland: population-wide cohort study.

Bekheit, Mohamed / Rajan, Sendhil / Wohlgemut, Jared M / Watson, Angus J M / Ramsay, George

BJS open

2023 Volume 7, Issue 4

Abstract: Background: Acute cholecystitis is one of the most common diagnoses presenting to emergency general surgery and is managed either operatively or conservatively. However, operative rates vary widely across the world. This real-world population analysis ... ...

Abstract	Background: Acute cholecystitis is one of the most common diagnoses presenting to emergency general surgery and is managed either operatively or conservatively. However, operative rates vary widely across the world. This real-world population analysis aimed to describe the current clinical management and outcomes of patients with acute cholecystitis across Scotland, UK. Methods: This was a national cohort study using data obtained from Information Services Division, Scotland. All adult patients with the admission diagnostic code for acute cholecystitis were included. Data were used to identify all patients admitted to Scottish hospitals between 1997 and 2019 and outcomes tracked for inpatients or after discharge through the unique patient identifier. This was linked to death data, including date of death. Results: A total of 47 558 patients were diagnosed with 58 824 episodes of acute cholecystitis (with 27.2 per cent of patients experiencing more than one episode) in 46 Scottish hospitals. Median age was 58 years (interquartile range (i.q.r.) 43-71), 64.4 per cent were female, and most (76.1 per cent) had no comorbidities. A total of 28 741 (60.4 per cent) patients had an operative intervention during the index admission. Patients who had an operation during their index admission had a lower risk of 90-day mortality compared with non-operative management (OR 0.62, 95% c.i. 0.55-0.70). Conclusion: In this study, 60 per cent of patients had an index cholecystectomy. Patients who underwent surgery had a better survival rate compared with those managed conservatively, further advocating for an operative approach in this cohort.
MeSH term(s)	Adult ; Female ; Humans ; Male ; Middle Aged ; Cholecystectomy/standards ; Cholecystectomy/statistics & numerical data ; Cholecystitis, Acute/diagnosis ; Cholecystitis, Acute/mortality ; Cholecystitis, Acute/surgery ; Cholecystitis, Acute/therapy ; Cohort Studies ; Hospitalization/statistics & numerical data ; Scotland ; Aged ; Disease Management ; Survival Rate
Language	English
Publishing date	2023-08-14
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrad073
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Article: Post-hepatectomy liver failure: A timeline centered review.

Bekheit, Mohamed / Grundy, Lisa / Salih, Ahmed Ka / Bucur, Petru / Vibert, Eric / Ghazanfar, Mudassar

Hepatobiliary & pancreatic diseases international : HBPD INT

2023 Volume 22, Issue 6, Page(s) 554–569

Abstract: Background: Post-hepatectomy liver failure (PHLF) is a leading cause of postoperative mortality after liver surgery. Due to its significant impact, it is imperative to understand the risk stratification and preventative strategies for PHLF. The main ... ...

Abstract	Background: Post-hepatectomy liver failure (PHLF) is a leading cause of postoperative mortality after liver surgery. Due to its significant impact, it is imperative to understand the risk stratification and preventative strategies for PHLF. The main objective of this review is to highlight the role of these strategies in a timeline centered way around curative resection. Data sources: This review includes studies on both humans and animals, where they addressed PHLF. A literature search was conducted across the Cochrane Library, Embase, MEDLINE/PubMed, and Web of Knowledge electronic databases for English language studies published between July 1997 and June 2020. Studies presented in other languages were equally considered. The quality of included publications was assessed using Downs and Black's checklist. The results were presented in qualitative summaries owing to the lack of studies qualifying for quantitative analysis. Results: This systematic review with 245 studies, provides insight into the current prediction, prevention, diagnosis, and management options for PHLF. This review highlighted that liver volume manipulation is the most frequently studied preventive measure against PHLF in clinical practice, with modest improvement in the treatment strategies over the past decade. Conclusions: Remnant liver volume manipulation is the most consistent preventive measure against PHLF.
MeSH term(s)	Humans ; Hepatectomy/adverse effects ; Liver Neoplasms/surgery ; Liver Failure/diagnosis ; Liver Failure/etiology ; Liver Failure/prevention & control ; Liver Function Tests ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Retrospective Studies
Language	English
Publishing date	2023-03-16
Publishing country	Singapore
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	2241386-8
ISSN	1499-3872
ISSN	1499-3872
DOI	10.1016/j.hbpd.2023.03.001
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Article ; Online: Meta-analysis of laparoscopic transcystic

Bekheit, M / Smith, R / Ramsay, G / Soggiu, F / Ghazanfar, M / Ahmed, I

BJS open

2019 Volume 3, Issue 3, Page(s) 242–251

Abstract: Background: It is not clear whether laparoscopic transcystic exploration (LTCE) laparoscopic choledochotomy (LCD) is superior in the management of choledocholithiasis. In this meta-analysis, the success of LTCE : Methods: Cochrane Central Register of ...

Abstract	Background: It is not clear whether laparoscopic transcystic exploration (LTCE) laparoscopic choledochotomy (LCD) is superior in the management of choledocholithiasis. In this meta-analysis, the success of LTCE Methods: Cochrane Central Register of Controlled Trials, Web of Science, Trip, PubMed, Ovid and Embase databases were searched systematically for relevant literature up to May 2017. Studies that compared the success rate of LTCE and LCD in patients with choledocholithiasis were included. PRISMA guidelines were followed. Multiple independent reviewers contributed on a cloud-based platform. Random-effects model was used to calculate odds ratios (ORs) or standardized mean differences (MDs) with 95 per cent confidence intervals. An Results: Of 3533 screened articles, 25 studies comprising 4224 patients were included. LTCE achieved a lower duct clearance rate than LCD (OR 0.38, 95 per cent c.i. 0·24 to 0·59). It was associated with a shorter duration of surgery (MD -0·86, 95 per cent c.i. -0·97 to -0·77), lower bile leak (OR 0·46, 0·23 to 0·93) and shorter hospital stay (MD -0·78, -1·14 to -0·42) than LCD. There was no statistically significant difference in conversion, stricture formation or reintervention rate. Conclusion: LCD has a higher rate of successful duct clearance, but is associated with a longer duration of surgery and hospital stay, and a higher bile leak rate.
MeSH term(s)	Adult ; Aged ; Anastomotic Leak/epidemiology ; Choledocholithiasis/surgery ; Common Bile Duct/surgery ; Cystic Duct/surgery ; Female ; Humans ; Laparoscopy/methods ; Laparoscopy/trends ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/epidemiology
Language	English
Publishing date	2019-01-23
Publishing country	England
Document type	Comparative Study ; Journal Article ; Meta-Analysis ; Systematic Review
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1002/bjs5.50132
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Article ; Online: Feedback Given to Surgeons Is a Useful Tool for Quality Improvement: Demystifying the "Sensitizing Surgeons to Their Outcome Has No Measurable Short-term Benefit".

Bekheit, Mohamed / Ahmed, Irfan

Annals of surgery

2017 Volume 269, Issue 1, Page(s) e12–e13

MeSH term(s)	Feedback ; Humans ; Quality Improvement ; Surgeons
Language	English
Publishing date	2017-10-10
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000002992
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Article: Timing of urinary catheter removal after colorectal surgery with pelvic dissection: A systematic review and meta-analysis.

McIntosh, Stuart / Hunter, Ross / Scrimgeour, Duncan / Bekheit, Mohammed / Stevenson, Lynn / Ramsay, George

Annals of medicine and surgery (2012)

2021 Volume 73, Page(s) 103148

Abstract: Background: Urinary catheters are routinely placed before colorectal surgery. Enhanced recovery after surgery (ERAS) recommends their removal as soon as possible. However, premature removal risks urinary retention, and delayed removal increases risk of ... ...

Abstract	Background: Urinary catheters are routinely placed before colorectal surgery. Enhanced recovery after surgery (ERAS) recommends their removal as soon as possible. However, premature removal risks urinary retention, and delayed removal increases risk of urinary tract infections (UTIs). This meta-analysis aims to synthesise the published literature on the optimal timing of urinary catheter removal following colorectal surgery with pelvic dissection. Materials and methods: The protocol for this meta-analysis is registered on PROSPERO (CRD42019150030).Pubmed, Ovid and Web of Science databases were searched (January 2020). Primary outcomes included urinary retention and catheter associated UTI. The intervention was removal of urinary catheter following colorectal surgery with pelvic dissection on postoperative days 1-2 (early); 3-4 (intermediate); or 5+ (late). Meta-analysis was performed using Comprehensive meta-analysis V2. Results: Eight papers were analysed. 883 patients had early catheter removal, 236 intermediate and 204 late. Early catheter removal was associated with increased risk of urinary retention when compared to late removal RR = 2.352 95% CI = 1.370-4.038 (p = 0.002). No significant difference in urinary retention was found between early and intermediate or intermediate and late catheter removal groups. Early catheter removal was associated with reduced risk of UTIs compared to late removal RR = 0.498, 95% CI 0.306-0.811, (p = 0.005). No significant difference in UTIs was found between early and intermediate or intermediate and late catheter removal groups. Conclusions: Removal of urinary catheters on postoperative day 3-4 provides a balance between minimising the risks of urinary retention and UTIs. This analysis can be used to finesse future ERAS protocols concerning catheter removal in colorectal surgery involving pelvic dissection.
Language	English
Publishing date	2021-12-13
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1016/j.amsu.2021.103148
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Article ; Online: The value of liquid biopsy in the diagnosis and staging of hepatocellular carcinoma: a systematic review.

Tan, Poh / Grundy, Lisa / Makary, Peter / Eng, Khem Hua / Ramsay, George / Bekheit, Mohamed

Translational gastroenterology and hepatology

2021 Volume 6, Page(s) 54

Abstract: Background: Blood-borne tumour markers in the form of circulating tumour cells (CTCs) are of intense research interest in the diagnostic and prognostic work-up of hepatocellular carcinoma (HCC).: Methods: This is a meta-analysis. Using a PICO ... ...

Abstract	Background: Blood-borne tumour markers in the form of circulating tumour cells (CTCs) are of intense research interest in the diagnostic and prognostic work-up of hepatocellular carcinoma (HCC). Methods: This is a meta-analysis. Using a PICO strategy, adults with HCC was the population, with the individual CTCs as the intervention and comparators. The primary outcome was the sensitivity and specificity of HCC detection with tumour specific single gene methylation alteration. Secondary outcomes were the comparison using specific assay methods and the effect of early Results: The review included 36 studies, with a total of 5,853 patients. Here, we found that AFP has the highest overall diagnostic performance. The average Youden index amongst all CTC was 0.46 with a mode and median of 0.5 with highest of 0.87 and lowest of 0.01. Conclusions: The available literature provides weak evidence that there is potential in the use of CTC, however the lack of a standardised procedure in the study of CTC contribute to the lack of consensus of use. Future research should include large scaled, standardized studies for the diagnostic accuracy of CTCs.
Language	English
Publishing date	2021-10-25
Publishing country	China
Document type	Journal Article
ISSN	2415-1289
ISSN (online)	2415-1289
DOI	10.21037/tgh.2020.01.11
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Article ; Online: Emergency general surgery: impact of distance and rurality on mortality.

Wohlgemut, Jared M / Ramsay, George / Bekheit, Mohamed / Scott, Neil W / Watson, Angus J M / Jansen, Jan O

BJS open

2022 Volume 6, Issue 2

Abstract: Background: There is debate about whether the distance from hospital, or rurality, impacts outcomes in patients admitted under emergency general surgery (EGS). The aim of this study was to determine whether distance from hospital, or rurality, affects ... ...

Abstract	Background: There is debate about whether the distance from hospital, or rurality, impacts outcomes in patients admitted under emergency general surgery (EGS). The aim of this study was to determine whether distance from hospital, or rurality, affects the mortality of emergency surgical patients admitted in Scotland. Methods: This was a retrospective population-level cohort study, including all EGS patients in Scotland aged 16 years or older admitted between 1998 and 2018. A multiple logistic regression model was created with inpatient mortality as the dependent variable, and distance from hospital (in quartiles) as the independent variable of interest, adjusting for age, sex, co-morbidity, deprivation, admission origin, diagnosis category, operative category, and year of admission. A second multiple logistic regression model was created with a six-fold Scottish Urban Rural Classification (SURC) as the independent variable of interest. Subgroup analyses evaluated patients who required operations, emergency laparotomy, and inter-hospital transfer. Results: Data included 1 572 196 EGS admissions. Those living in the farthest distance quartile from hospital had lower odds of mortality than those in the closest quartile (OR 0.829, 95 per cent c.i. 0.798 to 0.861). Patients from the most rural areas (SURC 6) had higher odds of survival than those from the most urban (SURC 1) areas (OR 0.800, 95 per cent c.i. 0.755 to 0.848). Subgroup analysis showed that these effects were not observed for patients who required emergency laparotomy or transfer. Conclusion: EGS patients who live some distance from a hospital, or in rural areas, have lower odds of mortality, after adjusting for multiple covariates. Rural and distant patients undergoing emergency laparotomy have no survival advantage, and transferred patients have higher mortality.
MeSH term(s)	Cohort Studies ; Hospital Mortality ; Hospitalization ; Hospitals ; Humans ; Retrospective Studies
Language	English
Publishing date	2022-04-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrac032
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