D Oueidat

Bio: D Oueidat is an academic researcher from American University of Beirut. The author has contributed to research in topics: Public health & Colitis. The author has an hindex of 4, co-authored 5 publications receiving 51 citations.

Obesity in Lebanon: A National Problem

Abstract: Obesity is a major health problem, because of its relationship with serious medical illnesses and significant economic consequences. This article explores various factors and variables affecting the prevalence of obesity in Lebanon, to focus public health initiatives and medical interventions in the management of obesity. This study interviewed 593 subjects, of more than 20 years, from all governorates of Lebanon. The interview covered personal and demographic data, awareness, knowledge, attitude and practices towards obesity including diet and physical activity. Males’ and females’ percentages were 51.6% and 48.4%, respectively, and a young population profile was with 52.8% less than 40 years of age. The BMI index showed that 52.77% were obese with 70.6% males and 34.27% females. The great majority were educated. TV was the most used media outlet, 79.61% watching daily between 1 - 4 hours. Obesity was considered as the most important health problem by 27.6% and ranking the 5th after cancer, cardiovascular, smoking and HIV/AIDS. About two thirds considered it a risk factor for hypertension and type 2 diabetes mellitus and 80.27% for cardiovascular diseases. Interventions should include changes in diet habits whereby, approximately one third (33.5%) drink carbonated beverages on a daily basis and 50.76% eat fast food, with a lack of awareness about daily calories intake by 75.38%. About half of the population (56.32%) walks daily for 20 minutes. Most people favored behavioral and lifestyle modifications in management rather than medications and surgery (67.79%). This study provides baseline data regarding several aspects of an obesogenic environment, a major risk factor for several diseases including hypertension, diabetes and other non-communicable diseases. After describing the factors and variables affecting the prevalence of obesity, some suggestions for appropriate interventions are included, with the hope of reducing the health burden of obesity in Lebanon.

25 years’ experience in the management of pilonidal sinus disease

Abstract: Pilonidal sinus disease is a common medical condition that accounts for almost 15% of anal suppurations with high morbidity. Its management is subject to many variations. In this study, a 25-year experience from 1984 to 2009 of treating pilonidal sinus disease is being reported. A total of 252 patients were included in the study. They were treated by phenol injection, excision and primary closure, or excision and packing. Data showed that excision with packing had the highest cure rate (85%), followed by excision and primary closure (65%), and then phenol (55%). As for the healing duration, the shortest was for excision and primary closure, followed by the phenol injection. However, excision and packing had the least recurrence rate (12%), compared to phenol and excision with primary closure 26.5% and 23%, respectively. The authors recommended excision and packing. However, hospital stay, missed days of work, recurrence rates, and the surgeon’s familiarity with the techniques were important factors in the choice of treatment modality.

Estrogens control inflammation in experimental colitis.

Abstract: There is now a wealth of experimental evidence indicating that the deficit in endogenous estrogen facilitates the onset of inflammation that can be antagonized by estrogen replacement therapy. This work investigated the role of estrogen in the control of intestinal inflammation in a panel of colitis models, focusing on the morphological changes, the activity of mast cells, the expression of cytokines (IL-1beta, IL-6, and TNF-alpha), fibronectin and reactive oxygen species. Two hundred adult male rats were divided into 4 groups: colitis was induced in Group I and Group II but only the latter was treated with estrogen; Group III received estrogen only, and Group IV saline. Colitis was induced in 4 models using: iodoacetamide; iodoacetamide + enteropathogenic E. coli; 2, 4, 6-Trinitrobenzene sulfonic acid; and dextran sulfate sodium salt. Macroscopic and microscopic evaluations of abdominal structures as well as molecular analysis were made on days 7, 14, 28 and 56. There was a significant improvement in the health condition of the estrogen-treated rats: the inflammation scores were reduced by at least 10-15%, the number of mast cells in the colon decreased by 30%, fibronectin expression was only 50% and reactive oxygen species decreased by 30%. In addition, there was a significant decrease in TNF-alpha, IL-6 and IL-1beta expression by about 25%. In conclusion, there was an improvement in the inflammatory status in all estrogen-treated groups through the duration of the experiment at all-time points. In addition, there was less tissue necrosis as depicted by less fibronectin and a marked antioxidant effect.

Estrogens control inflammation in experimental colitis

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A 30 year experience in the management of anal fistula

Abstract: Anal fistula has been recognized for centuries, and yet, its treatment remains a challenge for surgeons till today. In this study, a 30 year experience of treating anal fistula is being reported and discussed in light of the various recognized management methods. A total of 320 patients were treated by fistulotomy, fistulectomy, fistula plugging or seton technique. Data showed that fistula plugging carried the highest failure rate (89%) seconded by fistulectomy (37%), seton procedure (24.5%) and fistulotomy (15.6%). High transsphincteric fistulas were more likely to predict failure compared to low transsphincteric, intersphincteric and subcutaneous fistulas (37.5% versus 9.5%, 7.3% and 0%, respectively). In conclusion, the scales seem to support fistulotomy. However, no standardized algorithm exists to guide the care of patients and the choice of operation is based on patient-related factors, the patient’s surgical history, and the surgeon’s experience and familiarity with the various techniques for treating anal fistula. © EuroMediterranean Biomedical Journal 2017

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence.

Abstract: We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.

Effects of Estrogen on the Gastrointestinal Tract.

Abstract: Estrogen is a kind of steroid compound that has extensive biologic activities. The effect of estrogen is pleiotropic, affecting multiple systems in the body. There is accumulating evidence that estrogen has important effects on the gastrointestinal tract. Longer exposure to estrogen may decrease the risk of gastric cancer. Use of the anti-estrogen drug tamoxifen might increase the risk of gastric adenocarcinoma. Estrogen receptor β may serve as a target for colorectal cancer prevention. In addition, estrogen has been reported to be closely related to the mucosal barrier, gastrointestinal function and intestinal inflammation. However, the role of estrogen in the gastrointestinal tract has not been systematically summarized. In this review, we aim to provide an overview of the role of estrogen in the gastrointestinal tract and evaluate it from various aspects, including estrogen receptors, the mucosal barrier, intestinal inflammation and gastrointestinal tract tumors, which may provide the basis for the development of therapeutic strategies to manage gastrointestinal diseases.

The Role of Mast Cells in Alzheimer's Disease.

Abstract: Immunity and inflammation are deeply involved in Alzheimer's disease. The most important properties of pathological Alzheimer's disease are the extracellular deposits of amyloid â-protein plaque aggregates along with other unknown mutated proteins, which are implicated in immunity and inflammation. Mast cells are found in the brain of all mammalian species and in the periphery, and their biological mediators, including cytokines/chemokines, arachidonic acid products and stored enzymes, play an import role in Alzheimer's disease. Cytokines/chemokines, which are generated mostly by microglia and astrocytes in Alzheimer's disease, contribute to nearly every aspect of neuroinflammation and amyloid â-protein plaque aggregates may induce in mast cells the release of a plethora of mediators, including pro-inflammatory cytokines/chemokines such as interleukin-1, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor-alpha, vascular endothelial growth factor, transforming growth factor beta, CXCL8 and CCL2-3-4. These proinflammatory cytokines/chemokines are prominent mediators of neuroinflammation in brain disorders such as Alzheimer's disease, and their inhibition may be associated with improved recovery. In this review, we summarize the current knowledge regarding the roles of mast cell mediators (stored and de novo synthesis) in the pathogenesis of Alzheimer's disease.

Impact of geography and surgical approach on recurrence in global pilonidal sinus disease.

Abstract: Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.

Mast Cell Serotonin Immunoregulatory Effects Impacting on Neuronal Function: Implications for Neurodegenerative and Psychiatric Disorders

Abstract: Mast cells (MCs) are derived from hemopoietic precursor cells, undergo their maturation in peripheral tissues, and play a significant role in both the innate and adaptive immune response. Cross-linking of the FceRI on MCs initiates activation of several cytoplasmic protein tyrosine kinases which rapidly lead to phosphorylation and recruitment of adaptor molecules. These effects trigger the release of preformed mediators stored in the cytoplasmic granules, including histamine, serotonin and tryptase, as well as newly synthesized mediators, such as cytokines/chemokines, prostaglandins, leukotrienes, and growth factors. Serotonin (5-HT) is a bioactive monoamine, which has seven specific cell surface membrane bound receptors which are coupled to G-proteins, plays an important role in the central and peripheral nervous system, and is one of the key mediators in signaling between nervous and immune systems. Serotonin is not stored in all MC types but is implicated in MC adhesion, chemotaxis, tumorigenesis, and tissue regeneration through smooth muscle differentiation of stromal cells. Recent evidence indicates that serotonin has immunoregulatory actions that may be important in neuropsychiatric conditions. Chemokines, RANTES/CCL5, MCP-1/CCL2, and related molecules, constitute the C-C class of chemokine supergene family, play a role in regulating T helper-cell cytokine production and MC trafficking, and are involved in histamine and serotonin generation and MC functions. Pro-inflammatory cytokines such as interleukin-1-β and tumor necrosis factor which mediate MC response, are capable of activating p38 MAPK, and might increase serotonin generation through p38 MAPK activation. Here, we review the relationship between MCs and serotonin and its role in inflammatory diseases and neuroimmune interactions.