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Bharadwaj S, Gohel T, Deen OJ, DeChicco R, Shatnawei A. Fish oil-based lipid emulsion: current updates on a promising novel therapy for the management of parenteral nutrition-associated liver disease. Gastroenterol Rep (Oxf) 2015; 3:110-4. [PMID: 25858884 PMCID: PMC4423466 DOI: 10.1093/gastro/gov011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/09/2015] [Indexed: 01/16/2023] Open
Abstract
Intestinal failure is characterized by loss of enteral function to absorb necessary nutrients and water to sustain life. Parenteral nutrition (PN) is a lifesaving therapeutic modality for patients with intestinal failure. Lifelong PN is also needed for patients who have short bowel syndrome due to extensive resection or a dysmotility disorder with malabsorption. However, prolonged PN is associated with short-term and long-term complications. Parenteral nutrition-associated liver disease (PNALD) is one of the long-term complications associated with the use of an intravenous lipid emulsion to prevent essential fatty acid deficiency in these patients. PNALD affects 30-60% of the adult population on long-term PN. Further, PNALD is one of the indications for isolated liver or combined liver and intestinal transplantation. There is no consensus on how to manage PNALD, but fish oil-based lipid emulsion (FOBLE) has been suggested to play an important role both in its prevention and reversal. There is significant improvement in liver function in those who received FOBLE as lipid supplement compared with those who received soy-based lipid emulsion. Studies have also demonstrated that FOBLE reverses hepatic steatosis and reduces markers of inflammation in patients on long-term PN. Future prospective studies with larger sample sizes are needed to further strengthen the positive role of FOBLE in PNALD.
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Review |
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Hamilton C, Dasari V, Shatnawei A, Lopez R, Steiger E, Seidner D. Hypocaloric home parenteral nutrition and nutrition parameters in patients following bariatric surgery. Nutr Clin Pract 2012; 26:577-82. [PMID: 21947640 DOI: 10.1177/0884533611416125] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Surgical intervention is considered an acceptable treatment for morbid obesity. Complications following bariatric surgery procedures (BSPs) may necessitate home parenteral nutrition (HPN). No studies have been published on patients receiving HPN following BSP complications. The study aim was to determine if hypocaloric HPN has an effect on body mass index (BMI), albumin, and HPN complications. METHODS A historic cohort of patients was identified from a clinical database. Obese patients (BMI ≥35 kg/m(2)) who underwent BSP and received HPN for an anastomotic leak/fistula or bowel obstruction were included. Comparisons for start and end of therapy were made for calorie and protein intake, BMI, white blood cell count, and serum albumin level. Readmissions and metabolic and infectious complications were recorded. Obese patients received hypocaloric feeds to promote weight loss and protein for wound healing. RESULTS Twenty-three patients were included for an average study length of 1.5 months. Patients received an average of 1.2 g of protein and a median of 13.6 kcal per kg actual body weight (ABW) per day. BMI decreased by 7.1% ± 5.2%, from a median of 39.8 to 37.1, and serum albumin increased by 12.5%, from 2.8 ± 0.5 to 3.2 ± 0.6 g/dL. Readmissions occurred in 52.2% of patients with 40.0% of complications related to HPN. CONCLUSIONS Hypocaloric HPN is efficacious in maintaining adequate nutrition while allowing for weight loss in morbidly obese patients following complications of bariatric surgery. Frequency of HPN complications was comparable to those reported in the literature.
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Journal Article |
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Shatnawei A, Habib M, Hamilton C, Steiger E, Kirby DF, Speerhas R, Quintini C. The Association Between Home Parenteral Nutrition and Patients With FAP‐Associated Intra‐Abdominal Desmoids. JPEN J Parenter Enteral Nutr 2013; 37:683-8. [DOI: 10.1177/0148607112471860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bharadwaj S, Tandon P, Rivas JM, Furman A, Moccia L, Ratliff A, Shatnawei A, Steiger E, Kirby DF. Update on the management of intestinal failure. Cleve Clin J Med 2016; 83:841-848. [DOI: 10.3949/ccjm.83a.15045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Bharadwaj S, Gohel TD, Deen OJ, Coughlin KL, Corrigan ML, Fisher J, Lopez R, Shatnawei A, Kirby DF. Prevalence and Predictors of Vitamin D Deficiency and Response to Oral Supplementation in Patients Receiving Long-Term Home Parenteral Nutrition. Nutr Clin Pract 2014; 29:681-5. [DOI: 10.1177/0884533614539178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Unlu O, Roach EC, Okoh A, Olayan M, Yilmaz B, Uzunaslan D, Shatnawei A. Skin cancer in immunosuppressed transplant patients: Vigilance matters. World J Hepatol 2015; 7:717-720. [PMID: 25866609 PMCID: PMC4389000 DOI: 10.4254/wjh.v7.i4.717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/27/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation (LT) is a widely-accepted, definitive therapy of irreversible liver diseases including hepatitis C, alcoholic liver disease and metabolic liver disease. After transplantation, patients generally use a variety of immunosuppressive medications for the rest of their lives to prevent rejection of transplanted liver. Mortality after LT is mainly caused by recurrence of alcoholic hepatitis which is mostly seen in the patients who resume heavy drinking. On the other hand, de-novo malignancies after LT are not seldom. Skin cancers make up 13.5% of the de-novo malignancies seen in these patients. Malignancies tend to affect survival earlier in the course with a 53% risk of death at 5 years after diagnosis. We aimed to report a case who underwent LT secondary to alcoholic liver disease and developed squamous cell carcinoma of the skin eighteen years after transplantation. In summary, transplant recipients are recommended to be educated on self examination for skin cancer; health care providers should be further suspicious during routine dermatological examinations of the transplant patients and biopsies of possible lesions for skin cancer is warranted even many years after transplantation.
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Case Report |
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Shatnawei A, Hamilton C, Quintini C, Steiger E, Kirby DF. Use of home parenteral nutrition in patients with intra-abdominal desmoid tumors. Nutr Clin Pract 2010; 25:290-5. [PMID: 20581324 DOI: 10.1177/0884533610368706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Fistulae, small bowel obstruction (SBO), and malabsorption are complications of intra-abdominal desmoid (IAD) tumors that require home parenteral nutrition (HPN). HPN outcomes in patients with IAD tumors have not been previously reported. The aim of this study was to compare some of the nutrition parameters and complications of HPN in patients with IAD with a control group of patients on HPN. METHODS This was a case-control study of patients and randomly selected controls who required HPN because of fistulae, SBO, or malabsorption and were managed by the Cleveland Clinic Nutrition Support Team between 1990 and 2008. Variables included demographics, indications, number of episodes, duration of HPN, number of admissions and complications related to HPN, and nutrition parameters. Univariable and multivariable logistic regression analyses were used. RESULTS Eighteen of 1615 HPN patients (1.1%) had IAD. For the study, 58 patients were included: 14 with IAD and 44 controls. Four IAD patients did not have complete medical records. IAD patients had longer duration of HPN (P = .015), were younger (P = .028), and were more likely to receive HPN for malabsorption (P < .001). Body mass index (BMI), serum albumin level, protein intake provided at the beginning of HPN, energy intake provided at the start and end of HPN, mortality, and complications were comparable between groups. At the end of HPN, IAD patients received significantly more protein and had lower serum albumin levels compared with controls. CONCLUSIONS HPN for IAD patients maintained BMI but did not increase serum albumin concentration despite receiving more protein than controls. IAD patients did not have increased HPN-related complications.
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Journal Article |
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Rice G, Hassan M, Kaddoura R, Shatnawei A. Establishing A Home Enteral Nutrition (Hen) Service – A United Arab Emirates (Uae) Experience. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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El Nekidy WS, Shatnawei A, Abdelsalam MM, Hassan M, Dajani RZ, Salem N, St John TJL, Rahman N, Hamed F, Mallat J. Hypertriglyceridemia in Critically Ill Patients With SARS-CoV-2 Infection. Ann Pharmacother 2022; 56:637-644. [PMID: 34470517 DOI: 10.1177/10600280211038302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with SARS-CoV-2 infection could develop severe disease requiring critical care admission. Case reports indicated high incidence of hypertriglyceridemia (HTG) in critically ill patients infected with SARS-CoV-2, which might be related to the drugs. OBJECTIVE We sought to determine the risk factors associated with HTG in this population and to investigate the relationship between HTG and lipase. METHODS A retrospective observational study was conducted at our hospital between March 1 and June 30, 2020. Patients were included if they were ≥18 years old, admitted to the intensive care unit (ICU), tested positive for SARS-CoV-2, and had triglycerides (TG) checked during their hospital stay. RESULTS Of the 111 critically ill patients, 103 patients were included. Males comprised 88.3% of the sample. The median TG at baseline was 197.4 (IQR: 139.8-283) mg/dL. The lipase median level at baseline was 23.00 (IQR: 0.00-69.50) IU/L. The results of the mixed-effects logistic regression analysis indicated that patient-level variables, favipiravir use, blood glucose level, and propofol use were significantly associated with HTG. There was no relationship between lipase and TG levels over time. Furthermore, TG concentrations over time showed a similar trend to inflammatory markers. CONCLUSION AND RELEVANCE The incidence of clinically significant HTG was high and was associated with propofol and favipiravir use. HTG might reflect the high inflammatory state in these patients. Clinicians should look at the full picture before changing therapies based only on HTG. Our findings need to be replicated in a larger prospective study.
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Observational Study |
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Unlu O, Okoh A, Yilmaz B, Roach EC, Olayan M, Shatnawei A. Endoluminal Bariatric Interventions: Where do we stand? Where are we going? Acta Gastroenterol Belg 2015; 78:415-423. [PMID: 26712053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Obesity is an epidemic leading to high morbidity, mortality, and therefore health-related costs. Thus, there is a huge need for development of safe and effective treatments. Even though success rates of conservative methods are highly limited, the surgical approaches lead to major complications in as many as 25% of the patients. In this study, we aimed to review the currently available, less-invasive, endoscopic bariatric techniques which provides an option to reduce the risks of the patients and the medical costs. METHODS A systematic literature review through Pubmed and Medline was performed to find the studies on this topic, and all controlled clinical trials, case reports, and case series were reviewed. RESULTS Endoluminal bariatric interventions include restrictive, malabsorptive approaches, and other techniques including transpyloric shuttle, botulinum toxin, gastric pacing and vagal nerve stimulation. Restrictive procedures act by limiting the gastric volume and leading to early satiety, while malabsorptive procedures create a malabsorption state. Transpyloric shuttle is a device decreasing the rate of gastric emptying. Botox injection causes a delay in gastric emptying, and vagal nerve stimulation modulates eating behavior. CONCLUSION Endoluminal bariatric techniques can become the primary choice of therapy in the near future for bariatric care.
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Review |
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Roach EC, Olayan M, Unlu O, Saygin C, Shatnawei A. Schwachman-Diamond syndrome: Increased risk for autoimmune diseases? Clin Res Hepatol Gastroenterol 2015; 39:e49-50. [PMID: 25636239 DOI: 10.1016/j.clinre.2014.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/17/2014] [Indexed: 02/04/2023]
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Case Reports |
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Masannat Y, Masannat Y, Shatnawei A. Gallstone ileus: a review. THE MOUNT SINAI JOURNAL OF MEDICINE, NEW YORK 2006; 73:1132-4. [PMID: 17285212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This article aims to review gallstone ileus in the literature addressing the pathophysiology, clinical presentation, radiological findings and treatment options of the condition. A literature search was done on gallstone ileus, for the period 1966-2005. Gallstone ileus is a disease of the elderly, causing up to one fourth of non-strangulation intestinal obstructions in patients older than 65 years of age. It is often missed or diagnosed late. The presentation is that of intestinal obstruction preceded by biliary complaints. Radiological features on plain X-rays include features of intestinal obstruction and pneumobilia, and an aberrant gallstone. Treatment depends on the site of the impacted stone, but surgery is needed in many cases. Gallstone ileus is a rare complication of a common condition. Because it primarily affects the elderly, mortality and morbidity are high, although they have improved over the years. Early diagnosis and treatment improve the outcome.
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Review |
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Shatnawei A, AlNababteh AH, Govender RD, Al-Shamsi S, AlJarrah A, Al-Rifai RH. Mode of presentation and performance of serology assays for diagnosing celiac disease: A single-center study in the United Arab Emirates. Front Nutr 2023; 10:1107017. [PMID: 37090770 PMCID: PMC10113562 DOI: 10.3389/fnut.2023.1107017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/21/2023] [Indexed: 04/09/2023] Open
Abstract
ObjectiveTo characterize patients with celiac disease (CD), examines the clinical spectrum of CD, and evaluate the performance of serologic tests used for CD screening, in the United Arab Emirates (UAE).MethodsMedical charts of patients received at the Digestive Diseases Institute of Cleveland Clinic Abu Dhabi from January 2015 to December 2020 were reviewed. Patients who were screened for four serologic biomarkers (anti-tissue transglutaminase IgA [Anti-tTG-IgA], anti-tissue transglutaminase IgG [Anti-TtG-IgG], anti-deamidated gliadin peptide IgG [Anti-DGP-IgG], and anti-deamidated gliadin peptide IgA [Anti-DGP-IgA]) were included. Histopathology was performed on patients with the seropositive test. Marsh score > 1 considered to confirm CD. Characteristics of the Anti-tTG-IgA seropositive patients were described and that correlated with histopathologically confirmed CD were explored.ResultsOf the 6,239 patients, 1.4, 2.9, 4.7, and 4.9%, were seropositive to Anti-tTG-IgG, Anti-TtG-IgA, Anti-DGP-IgA, and Anti-DGP-IgG, respectively. Overall, 7.7% were seropositive to either of the four biomarkers. Of the biopsy-screened 300 patients, 38.7% (1.9% of the total serologically screened) were confirmed with CD. The mean age of Anti-TtG-IgA seropositive patients was 32.1 ± 10.3 SD years, 72% of them were females, and 93.4% were Emirati. In those patients, overweight (28.7%) and obesity (24.7%) were common while 5.8% of patients were underweight. Anemia prevalence was 46.7%, 21.3% had Gastroesophageal reflux disease (GERD), 7.7% with autoimmune thyroid disease, 5.5% (type 1), and 3.3% (type 2) were diabetic. Vitamin D deficiency was observed in 47.8% of the Anti-TtG IgA seropositive patients. Twelve (10.3%) histopathologically confirmed CD patients were seronegative to Anti-TtG-IgA but seropositive to anti-DGP-IgA and/or Anti-DGP-IgG. Body mass index, GERD, autoimmune thyroid disease, type 1 diabetes, asthma, hemoglobin, and vitamin D concentration, were all correlated with biopsy-confirmed CD (P < 0.05). Compared to the gold-standard biopsy test, Anti-TtG-IgA had the highest sensitivity (89.7%) and specificity (83.7%).ConclusionThree and two of every 100 patients were serologically (anti-tTG-IgA positive) and histopathologically diagnosed with CD, respectively. Although Anti-TtG-IgA is the most sensitive, specific, and commonly used test, one of every ten histopathologically confirmed patients and Anti-tTG-IgA seronegative were seropositive to Anti-DGP. To avoid missing patients with CD, a comprehensive serological investigation covering DGP-IgG/IgA is warranted.
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Shatnawei A, Dasari V, Dumot J, Kirby DF. Two Cases of Gastric and Esophageal Amyloidosis. Gastroenterol Hepatol (N Y) 2009; 5:571-574. [PMID: 37967401 PMCID: PMC2886404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
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Case Reports |
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Dugum M, Hanouneh I, Shatnawei A. New-onset gastrointestinal polyposis. Gastroenterology 2013; 145:e9-e10. [PMID: 23978436 DOI: 10.1053/j.gastro.2013.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 06/11/2013] [Accepted: 06/14/2013] [Indexed: 12/02/2022]
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Case Reports |
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