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Hmaideh A, Tarnas MC, Zakaria W, Rifai AO, Ibrahem M, Hashoom Y, Ghazal N, Abbara A. Geographical Origin, WASH Access, and Clinical Descriptions for Patients Admitted to a Cholera Treatment Center in Northwest Syria between October and December 2022. Avicenna J Med 2023; 13:223-229. [PMID: 38144910 PMCID: PMC10736181 DOI: 10.1055/s-0043-1776045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
Background On September 10, 2022, a cholera outbreak was declared in Syria for the first time in over a decade of protracted conflict. As of May 20, 2023, 132,782 suspected cases had been reported, primarily in northwest and northeast Syria. We aim to provide a detailed description of water sources and clinical status of a patient cohort seen at a cholera treatment center (CTC) in northwest Syria. Methods We retrospectively identified patients with confirmed cholera who presented to the CTC in Idlib governorate between October 8 and December 18, 2022. Data were obtained from clinical case records and analyzed in R v4.0.4. Results Ninety-four patients (55.3% men) were treated at the CTC. Thirty-five patients were severely dehydrated (Plan C treatment), 54 had some dehydration (Plan B), and 5 had no dehydration (Plan A). Most patients were between 11 and 20 years old ( n = 25, 26.6%) or 31 and 40 years old ( n = 19, 20.2%). Note that 70.2% ( n = 66) of patients were seen in November 2022 and most were from Harim district ( n = 44, 46.8%). Public wells ( n = 46, 48.9%) and water trucking ( n = 41, 43.6%) were the most commonly used water sources. Note that 76.6% ( n = 72) did not have access to chlorine-treated water. Forty-seven patients (50%) had more than five water, sanitation, and hygiene (WASH)-related cholera risk factors. Following treatment, six patients were transferred to another treatment center, three died (case fatality rate: 3.2%), and the remainder were discharged. Conclusion Most patients reported WASH-related risk factors for cholera, reflecting the poor state of WASH in northwest Syria after over a decade of conflict. This relates to the direct and indirect impacts of urban and periurban violence as well as the underfunded humanitarian response. Strengthening WASH and health promotion are important components to control the outbreak.
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Affiliation(s)
- Ahmad Hmaideh
- Syrian Board of Medical Specialties, Syria
- Syria Public Health Network, United Kingdom
| | - Maia C. Tarnas
- Department of Population Health and Disease Prevention, University of California Irvine, Irvine, California, United States
| | | | - Ahmad Oussama Rifai
- Syrian Board of Medical Specialties, Syria
- The Virtual Nephrologist, Florida, United States
| | | | | | | | - Aula Abbara
- Syrian Board of Medical Specialties, Syria
- Syria Public Health Network, United Kingdom
- Department of Infectious Diseases, Imperial College, London, United Kingdom
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Rifai AO, Rembetski EM, Stutts LC, Mazurek ZD, Yeh JL, Rifai K, Bear RA, Maquiera AJ, Rydell DJ. Retrospective analysis of operative time and time to discharge for laparoscopic vs robotic approaches to appendectomy and cholecystectomy. J Robot Surg 2023; 17:2187-2193. [PMID: 37271758 PMCID: PMC10492745 DOI: 10.1007/s11701-023-01632-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Abstract
Robotic-assisted appendectomies and cholecystectomies are believed to increase cost compared to the gold standard laparoscopic approach. Two equally qualified surgeons performed both approaches over 2 years to evaluate intraoperative duration, time to discharge, conversion to open procedure, and readmission within 30 days. 110 laparoscopic, 81 robotic-assisted appendectomies; and 105 laparoscopic and 165 robotic-assisted cholecystectomies were performed. Intraoperative time; laparoscopic appendectomy was 1.402 vs 1.3615 h for robotic-assisted (P value = 0.304); laparoscopic cholecystectomy was 1.692 vs 1.634 h for robotic-assisted (P value = 0.196). Time to discharge, was 38.26 for laparoscopic vs 28.349 h for robotic-assisted appendectomy (P value = 0.010), and 35.95 for laparoscopic vs 28.46 h for robotic-assisted cholecystectomy (P value = 0.002). Intraoperative conversion to open; only laparoscopic procedures were converted, one appendectomy and nine cholecystectomies. None in the robotic-assisted procedures. Readmissions, none in the appendectomy group and three in the cholecystectomy group. One laparoscopic and two robotic-assisted cholecystectomy patients were readmitted. Intraoperative times for robotic appendectomy and cholecystectomy were not longer than laparoscopic approach. Robotic approach shortened the time to discharge and the likelihood for conversion to open procedure.
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Affiliation(s)
- Ahmad Oussama Rifai
- The Education and Research Department, The Virtual Nephrologist, INC, PO Box 1750, Lynn Haven, FL, 32444-5950, USA.
| | - Emily M Rembetski
- ACOM, Research Department, Alabama College of Osteopathic Medicine, 445 Health Sciences Boulevard, Dothan, AL, 36303, USA
| | - Larry Collins Stutts
- ACOM, Research Department, Alabama College of Osteopathic Medicine, 445 Health Sciences Boulevard, Dothan, AL, 36303, USA
| | - Zachary D Mazurek
- ACOM, Research Department, Alabama College of Osteopathic Medicine, 445 Health Sciences Boulevard, Dothan, AL, 36303, USA
| | - Jenifer L Yeh
- ACOM, Research Department, Alabama College of Osteopathic Medicine, 445 Health Sciences Boulevard, Dothan, AL, 36303, USA
| | - Kareem Rifai
- ACOM, Research Department, Alabama College of Osteopathic Medicine, 445 Health Sciences Boulevard, Dothan, AL, 36303, USA
| | - Ryan A Bear
- ACOM, Research Department, Alabama College of Osteopathic Medicine, 445 Health Sciences Boulevard, Dothan, AL, 36303, USA
| | | | - David J Rydell
- Envision Physician Services, HCA Florida Gulf Coast Hospital, 449 west 23rd stree, Panama City, FL, 32405, USA
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Alasfar S, Zakaria W, Nasan KH, Zanabli AR, Al-Saghir F, Rifai AO, Luycks V, Murad L, Kaysi S, Al-Makki A, Sekkarie M. Dealing with dramatic health care problems during times of natural disaster and armed conflict. Kidney Int 2023:S0085-2538(23)00336-8. [PMID: 37187288 DOI: 10.1016/j.kint.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Sami Alasfar
- Department of Medicine, Division of Nephrology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
| | - Wasim Zakaria
- Syrian Board of Medical Specialties, Idlib, Northwest Syria
| | - Khaled Haj Nasan
- Department of Medicine, Dr. Muhammad Waseemm Maaz Hospital, Azaz, Northwest Syria
| | - Abdul R Zanabli
- Charleston Nephrology Hypertension and Transplant, South Charleston, West Virginia, USA
| | - Fahd Al-Saghir
- Departmemt of Medicine, Wayne State University, Detroit, Michigan, USA; Michigan Kidney Consultants LLC, Pontiac, Michigan, USA
| | - Ahmad Oussama Rifai
- Syrian Board of Medical Specialties, Idlib, Northwest Syria; The Virtual Nephrologist INC, Lynn Haven, Florida, USA
| | - Valerie Luycks
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Lina Murad
- Syrian Board of Medical Specialties, Idlib, Northwest Syria; Metropolitan Access Center, Colmar Manor, Maryland, USA
| | - Saleh Kaysi
- Department of Medicine, Division of Nephrology, Brugmann University Hospital, Brussels, Belgium
| | - Akram Al-Makki
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine-West Lafayette, Lafayette IN
| | - Mohamed Sekkarie
- Nephrology and Hypertension Associates, Bluefield, West Virginia, USA
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Rifai AO, Denig KM, Caza T, Webb SM, Rifai S, Khan S, Dahan S, Alamin S. Antitubular Basement Membrane Antibody Disease Associated with Nivolumab Infusion and Concomitant Acute Pyelonephritis Leading to Acute Kidney Injury : a Case Report and Literature Review. Case Rep Nephrol 2023; 2023:6681756. [PMID: 37051373 PMCID: PMC10085645 DOI: 10.1155/2023/6681756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
Antitubular basement membrane (anti-TBM) antibody disease is an extremely rare disorder. It may be idiopathic or secondary to exposure of the proximal tubular basement membrane, triggered by tubular injury due to acute pyelonephritis, acute allergic interstitial nephritis, or kidney allograft rejection. The histopathology of anti-TBM antibody disease is characterized by strong linear deposits of IgG with complement C3 along the proximal tubular cell basement membranes. The staining is restricted to proximal tubules. Currently, a kidney biopsy with these pathognomonic findings is the only diagnostic method. Serological testing and titers for anti-TBM antibodies are not clinically standardized. Our patient had pyelonephritis and possibly acute allergic interstitial nephritis as a result of nivolumab infusion. The kidney biopsy demonstrated dense interstitial infiltrates of neutrophil-rich interstitial inflammation, neutrophilic casts, and neutrophilic tubulitis consistent with acute pyelonephritis, as well as areas of mixed inflammation with lymphocytic tubulitis suggesting concurrent acute interstitial nephritis. The presence of linear IgG staining along proximal but not distal tubular basement membranes was diagnostic of anti-TBM antibody disease, favored to be due to both triggers. The patient was treated with discontinuation of nivolumab, intravenous antibiotics, and corticosteroids and was supported with hemodialysis. After 6 weeks, the patient’s kidney function recovered enough to discontinue hemodialysis and had significant renal improvement.
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Affiliation(s)
| | - Kristin M. Denig
- Hypertension Kidney and Dialysis Specialists, Panama City, FL, USA
| | | | - Shana M. Webb
- Hypertension Kidney and Dialysis Specialists, Panama City, FL, USA
| | - Sarah Rifai
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Sarah Khan
- Hypertension Kidney and Dialysis Specialists, Panama City, FL, USA
| | - Sally Dahan
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Samaa Alamin
- University of Medical Sciences and Technology, Sudan (UMST), P.O. Box 12810, Khartoum, Sudan
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Healey KD, Rifai SM, Rifai AO, Edmond M, Baker DS, Rifai K. Edwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Factors. Am J Case Rep 2021; 22:e934347. [PMID: 34873141 PMCID: PMC8667629 DOI: 10.12659/ajcr.934347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient: Female, 59-year-old
Final Diagnosis: Sepsis
Symptoms: Acute kidney injury • pancytopenia • respiratory deterioration • sepsis
Medication: —
Clinical Procedure: Mechanical ventilation
Specialty: Critical Care Medicine • Infectious Diseases
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Affiliation(s)
- Kevin D Healey
- Department of Research and Education, Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
| | - Sami M Rifai
- Department of Research and Education, Hypertension Kidney and Dialysis Specialists, Panama City, FL, USA
| | - Ahmad Oussama Rifai
- Department of Education and Publications, The Virtual Nephrologist, Inc., Lynn Haven, FL, USA
| | - Masha Edmond
- Gulf Coast Regional Medical Center, Panama City, FL, USA
| | - Daniel S Baker
- Gulf Coast Regional Medical Center, Panama City, FL, USA
| | - Kareem Rifai
- Department of Research and Education, Alabama College of Osteopathic Medicine, Dothan, AL, USA
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Sekkarie M, Hiracham P, Soudan K, Rifai AO. Hemodialysis Machines Capable of Performing Isolated Ultrafiltration in the Absence of Adequate Water Supply Are Needed During Disasters. Kidney Int Rep 2021; 6:1480-1481. [PMID: 34013130 PMCID: PMC8116769 DOI: 10.1016/j.ekir.2021.03.875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mohamed Sekkarie
- Nephrology and Hypertension Associates, Bluefield, West Virginia, USA
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Mirzai S, Wolf SB, Mili S, Rifai AO. Successful external cephalic version in a patient with uterus didelphys and fetal malpresentation. BMJ Case Rep 2019; 12:12/11/e230965. [PMID: 31748355 DOI: 10.1136/bcr-2019-230965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Müllerian anomalies are congenital malformations of the female reproductive organs that occur when the müllerian ducts develop abnormally. Different types of müllerian anomalies have different pregnancy outcomes. Breech presentation is a common occurrence in pregnant women with uterus didelphys, and caesarean section is the traditional mode of delivery under such circumstances. Here, we present the case of a 29-year-old woman (gravida 2, para 1) with her fetus in a frank breech presentation. The patient had a known history of uterus didelphys and previous vaginal delivery. She elected to undergo external cephalic version (ECV) at 37 weeks with a trial of labour at 39 weeks as opposed to planned cesarean delivery. The version was successful, and the fetus was subsequently delivered vaginally without complications. This case demonstrates ECV as a possible option in women with uterus didelphys, provided the risks of the procedure are carefully weighed and individualised to each patient.
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Affiliation(s)
- Saeid Mirzai
- Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | | | - Saima Mili
- Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
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Mirzai S, Rifai AO, Webb S, Rifai K, Reiner A. Probable Clostridium septicum pneumocephalus in a user of natural remedies with newly diagnosed diabetes mellitus type 1. IDCases 2019; 17:e00581. [PMID: 31312601 PMCID: PMC6610224 DOI: 10.1016/j.idcr.2019.e00581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 11/16/2022] Open
Abstract
Clostridium septicum encephalitis is a rare cause of spontaneous, non-traumatic pneumocephalus. Systemic infections with this organism have a fulminant course, likely leading to death within 48 hours, and are commonly associated with hematological or colonic malignancies. The effectiveness of an antibacterial regimen is unknown because of a lack of studies. The best prognosis is observed in patients undergoing early surgical intervention for localized intracranial processes. Here we describe a case of rapidly developing C. septicum sepsis as a result of bacteremia and hematogenous spread, resulting in encephalitis and pneumocephalus in a patient without a diagnosed malignancy. The patient presented to the emergency department with diabetic ketoacidosis, which led to the diagnosis of new-onset type 1 diabetes mellitus. There are currently 19 reported cases of C. septicum central nervous system infections in the literature, with 12 of them having pneumocephalus. Natural remedies, such as drinking kombucha tea and performing coffee enemas, that were used by our patient may have played a role in the dissemination of C. septicum. In survivors of this fulminant illness, colonic and hematologic malignancies should be excluded because of their association with such infections. Type 1 diabetes mellitus, drinking kombucha tea, and performing coffee enemas may be newly recognized risk factors associated with the dissemination of C. septicum.
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Affiliation(s)
- Saeid Mirzai
- OMS III, Alabama College of Osteopathic Medicine, ACOM, 445 Health Sciences Blvd, Dothan, AL, 36303, USA
| | | | - Shana Webb
- Hypertension Kidney and Dialysis Specialists, 2507 Harrison Ave Unit 101, Panama City, FL, 32405, USA
| | - Kareem Rifai
- OMS I, Alabama College of Osteopathic Medicine, ACOM, 445 Health Sciences Blvd, Dothan, AL, 36303, USA
| | - Amanda Reiner
- OMS III, Alabama College of Osteopathic Medicine, ACOM, 445 Health Sciences Blvd, Dothan, AL, 36303, USA
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Isreb MA, Kaysi S, Rifai AO, Al Kukhun H, Al-Adwan SAS, Kass-Hout TA, Sekkarie MA. The Effect of War on Syrian Refugees With End-Stage Renal Disease. Kidney Int Rep 2017; 2:960-963. [PMID: 29270503 PMCID: PMC5733747 DOI: 10.1016/j.ekir.2017.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/04/2017] [Accepted: 05/19/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Majd A. Isreb
- Peace Health Medical Group, Longview, Washington, USA
| | | | | | | | | | | | - Mohamed A. Sekkarie
- Nephrologist, Nephrology and Hypertension Associates, Bluefield, West Virginia, USA
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