In the past three years, Lebanon, a country located in the Middle East, has faced a severe financ... more In the past three years, Lebanon, a country located in the Middle East, has faced a severe financial crisis. This crisis had many effects on several sectors in Lebanon, including the healthcare sector. The authors expected an increase in the rate of complicated appendicitis after the crisis due to the shortage of medical supplies. The aim of the study was to compare the rate of complicated acute appendicitis before and after the Lebanese crisis. Methods The study included two groups of patients with acute appendicitis. The first group included patients admitted in the period between November 2018 and November 2019 (before the crisis). The second group included patients admitted between November 2020 and November 2021 (during the crisis). The data were collected retrospectively and analyzed using SPSS software (version 25.00) (SPSS Inc., Chicago, IL). Ethical approval was obtained and the study was registered at Al Zahraa hospital, University Medical Center in Beirut, Lebanon. Results The study included 49 patients in the first group (before the crisis) and 46 patients in the second group (after the crisis). The percentage of complicated appendicitis has increased from 22.4% before the crisis to 28.3% during the crisis. The study showed a statistically significant difference between the two groups in the white blood cell count (10,831 versus 7180 cu.mm, respectively, p=0.006), the operating time (59.9 versus 79.0 minutes, respectively; p=0.004), the need to obtain an intra-peritoneal swab for bacterial culture (83.7% versus 58.7%, respectively; p=0.007), and the need for intra-abdominal abscess drainage (6.1% versus 28.3%, respectively; p=0.004). There were no significant differences in the demographics, the duration of postoperative antibiotic use, the duration of stay in the hospital, and the postoperative complications in the first month following surgery. Conclusion Due to the decreased financial income, the high cost of medical care during the Lebanese crisis, and the delay of patients' presentation to the hospital, the rate of complicated appendicitis increased during the crisis.
Tumors of the ampulla of Vater are uncommon lesions accounting for only 0.5% of the gastrointesti... more Tumors of the ampulla of Vater are uncommon lesions accounting for only 0.5% of the gastrointestinal tumors. A total of three techniques for ampullary tumors (AT) exist: endoscopic papillectomy (EP), surgical transduodenal ampullectomy (TDA), and partial pancreatoduodenectomy (PD). Scarce articles report the outcomes of TDA. Two Arabic men presented to the hospital with epigastric pain and were subsequently diagnosed with AT. The TDA was performed a few days after the diagnosis. The first patient underwent a partial gastrectomy on the eleventh postoperative day. The second patient underwent endoscopic pyloric re-opening on the eleventh postoperative day to relieve gastric obstruction. Both patients started tolerating food and were discharged home. Further randomized controlled studies assessing long-term complications, efficacy, and efficiency of TDA are now warranted.
Amyloidosis was initially described by Nicolaes Fonteyn in 1639. It is caused by the deposition o... more Amyloidosis was initially described by Nicolaes Fonteyn in 1639. It is caused by the deposition of soluble immunoglobulin light chains as insoluble fibrils and can affect any organ including the heart, nervous system, dermis and subcutaneous tissue, kidneys and liver. This is a rare case of cardiac amyloidosis occurring with multiple myeloma and pleural effusion. A 65-year-old Arab woman, nonsmoker, nonalcoholic, known to have hypothyroidism and multiple myeloma, presented to the hospital with dyspnea and basilar crackles. Workup was done to exclude leukemia. Cardiac echography showed features of amyloidosis. Cardiac amyloidosis occurring with multiple myeloma and pleural effusion is rare. However, it is stated that 10–15% of amyloidosis patients might develop multiple myeloma (MM).
Multivariate electricity consumption series clustering can reflect trends of power consumption ch... more Multivariate electricity consumption series clustering can reflect trends of power consumption changes in the past time period, which can provide reliable guidance for electricity production. However, there are some abnormal series in the past multivariate electricity consumption series data, while outliers will affect the discovery of electricity consumption trends in different time periods. To address this problem, we propose a robust graph factorization model for multivariate electricity consumption clustering (RGF-MEC), which performs graph factorization and outlier discovery simultaneously. RGF-MEC first obtains a similarity graph by calculating distance among multivariate electricity consumption series data and then performs robust matrix factorization on the similarity graph. Meanwhile, the similarity graph is decomposed into a class-related embedding and a spectral embedding, where the class-related embedding directly reveals the final clustering results. Experimental result...
Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...
Background Staple line leak is one of the most challenging complications following laparoscopic s... more Background Staple line leak is one of the most challenging complications following laparoscopic sleeve gastrectomy, with a rate reaching near 1%. Its management often implicates a multidisciplinary approach and experienced bariatric and metabolic surgeons. The literature is abundant on various approaches to treat single staple line leak with variable results. But what to do in front of an intra-op incidental finding of double gastric fistulae? Methods In this article, we describe a new successful surgical treatment option of double Baltazar technique for a patient who was found to have two gastric fistulae post-sleeve gastrectomy. We aim to demonstrate that this approach is safe and effective and can help avoid major side effects of traditional treatment options for such complications. Results The patient presented 20 days following a laparoscopic sleeve gastrectomy in a severe septic condition and was found to have a gastric leak. During surgical repair, unlike the usual single proximal fistula findings, another opening was identified more distally. Decision was made to proceed with a double fistulo-jejunostomy. It was a feasible technique, with no intra-op complications. Post-operatively, the patient had a successful recover, with no residual leak. Conclusions Double Baltazar technique is a successful and feasible treatment option for patients presenting with two gastric fistulae following sleeve gastrectomy. This is the first case report describing this new technique, and its success should encourage more similar trials and avoid more aggressive surgical options such as total gastrectomy or gastric bypass.
Attached is a reprint from the May 15, 1995, FEDERAL REGISTER (60 FR 25888) which announces that ... more Attached is a reprint from the May 15, 1995, FEDERAL REGISTER (60 FR 25888) which announces that the Secretary of Commerce has approved FIPS PUB 146-2. This revision supersedes FIPS PUB 146-1. This revision includes references to specifications that Federal agencies may use in acquiring data communications protocols based on open, voluntary standards.
Unusual clinical course Background: The global burden of Taenia saginata (T. saginata), the beef ... more Unusual clinical course Background: The global burden of Taenia saginata (T. saginata), the beef tapeworm, includes economic loss, and its pathogenicity is considered mild. T. saginata can infect the human definitive host when people ingest larval cysts from raw or undercooked beef, as cattle are the intermediate host. This report is of a case of gastric perforation and pneumoperitoneum with regurgitation of T. saginata in a 27-year-old Lebanese man, and includes a review of previous cases of gastrointestinal perforation due to T. saginata. Case Report: We report a rare case of stomach perforation caused by T. saginata, in which the tapeworm was subsequently expelled orally. A computerized tomography (CT) scan was done, revealing pneumoperitoneum and abdominal fluid, which was consistent with evidence of a perforated hollow viscus. Three days after exploratory laparoscopy, the patient vomited a 3-meter tapeworm and the diagnosis was subsequently made. On the fourth day, a CT scan of the abdomen with oral contrast was performed and showed no leakage. A clear fluid diet was started on the fifth day. The patient was discharged home on the seventh postoperative day in good condition. One week after the discharge, the patient was examined; he was in a good condition and symptoms were completely relieved 1 week after worm expulsion. Conclusions: This report shows that in countries or societies where eating raw beef is common, a diagnosis of infestation with T. saginata should be considered in patients who present with gastrointestinal symptoms.
Advances in Obesity, Weight Management & Control, 2018
An “aberrant pancreas” is a rare congenital anomaly, described for the first time by Schultz in 1... more An “aberrant pancreas” is a rare congenital anomaly, described for the first time by Schultz in 1729, but no been histologically confirmed until 1859, by Klob.1 The ectopic pancreatic tissue is located outside the anatomic location of the pancreas, without any vascular or ductal continuity with the main gland, and it may be found in multiple areas in the abdominal cavity, mainly along the proximal gastro-intestinal tract, or within the spleen, liver and even in the biliary ducts and gallbladder.2
Atypical Bullous Pemphigoid After Linagliptin Intake
Patient: Female, 77-year-old Final Diagnosis: Atypical bullous pemphigoid Symptoms: Bullous skin ... more Patient: Female, 77-year-old Final Diagnosis: Atypical bullous pemphigoid Symptoms: Bullous skin lesions Medication: — Clinical Procedure: — Specialty: Dermatology Objective: Unusual clinical course Background: Bullous pemphigoid is a common pruritic skin lesion reported in elderly patients. It is caused by an immuno-logic reaction between autoantibodies and hemidesmosome proteins of epithelial cells. The disease is characterized by a symmetrical blister distribution on the body. Diagnosis should be suspected in elderly patients presenting with a tense blister on normal-appearing skin or on an erythematous base. In the literature, several forms of typical bullous pemphigoid after treatment with linagliptin have been reported. However, this is the first reported case of atypical nonbullous pemphigoid after linagliptin intake. Case Report: A 77-year-old woman presented with multiple erythematous papules and nodules on the upper extremities and trunk. The patient was being treated with...
Jejunal diverticula (JD) are a rare medical entity. They are often unnoticed, until complications... more Jejunal diverticula (JD) are a rare medical entity. They are often unnoticed, until complications occur. We report herein three cases of such diverticula, analyzed retrospectively, and depicting some of these complications: small bowel obstruction due to enterolith in a giant diverticulum treated surgically, incidental intraoperative finding on an anastomotic jejunal limb affecting the surgical plan and diverticulitis with anemia. In all three cases, the diagnosis of JD was unexpected, which illustrates the importance of being familiar with this disease for adequate management.
The greater omentum is a common location for metastatic tumors. On the other hand, the primary tu... more The greater omentum is a common location for metastatic tumors. On the other hand, the primary tumors of the omentum are rare. Intra-abdominal rhabdomyosarcoma (RMS) is extremely rare in adults. Few cases have been reported in the literature and the most of them were in the pediatric population. Omental rhabdomyosarcoma (RMS) in an adult, is an even rarer case that deserve the presentation. We are reporting a case of intra-abdominal rhabdomyosarcoma in a 54-year-old lady who presented with constipation and increasing abdominal girth. Investigations revealed disseminated omental rhabdomyosarcoma. We decided to start chemotherapy, but unfortunately she passed away on the tenth day of treatment.
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Papers by Samer Dbouk