Objective: For the first time, we reported experiences with an intestinal rehabilitation unit (IRU) from a country without home parenteral nutrition (HPN). Methods:We included patients with a diagnosis of intestinal failure (IF) since the establishment of our IRU from February 2018 to February 2020. We further report on our protocols for management of enterocutaneous fistulas (ECFs), short-bowel syndrome (SBS), chronic intestinal pseudo-obstruction and motility disorders.Results: Among a total of 349 patients who have been admitted, 100 patients had IF and were included . Mean (SD) age of patients was 46.3 ± 16.1 years. Most common cause of IF was ECFs (32%), SBS (24%), and SBS + fistula (22%). Most common causes of SBS were mesenteric ischemia (63.3%) and repeated surgery (22.4%). Median (interquartile range [IQR]) duration of parenteral nutrition (PN) for patients was 32 (18-60) days. The most common reconstructive surgery performed was resection and anastomosis (75.4%), followed by serial transverse enteroplasty procedure (10.5%) and closure of ostoma (7%). Patients were hospitalized for a median (IQR) of 33 (17.5-61) days. Most common complications were sepsis (45%), catheter infections (43%), and catheter thrombosis (20%), respectively. At the final follow-up, 61% stopped receiving PN, 23% became candidates for transplantation, and 16% died. Conclusion:Considering that most countries lack facilities for HPN, by establishing IRUs using specific treatment protocols and autologous gastrointestinal reconstruction techniques will provide a means to manage patients with IF, thus decreasing death rates and number of patients who require intestinal transplantations due to IF.

Background: The outcome of patients with triple-negative breast cancer (TNBC) is highly dependent on demographic factors and ethnicity. We aimed to evaluate the clinicopathological determinants of prognosis among women with TNBC using data from one of the largest breast cancer (BC) registries. Methods: A total of 6145 patients with BC from our referral center were evaluated from 1995 to 2018, among whom 523 had TNBC. The baseline, menstrual and reproductive, treatment and pathology related characteristics were evaluated. Results: Among TNBC patients, the rate of stage 3 and 4 BC (29.9% vs. 14.4% and 7.8% vs. 0% for stage 3 and 4, respectively; P < 0.001), invasive ductal carcinoma (90.7% vs. 75.6%; P = 0.004), nodal involvement (46.7% vs. 33.4%; P = 0.026), mastectomy (57.3% vs. 37.8%; P = 0.001) and axillary node dissection (76.7% vs. 59.8%; P = 0.019) was significantly higher in the group that developed recurrence. Disease-free-survival was 80.6% (157.76 ± 9.48 months) and overall-survival was 90.1% (182.73 ± 3.28 months). For death, stage 3 BC (compared to stages 0 and 1 as base) showed a higher risk of earlier death (adjusted HR: 4.191, 95% CI = 1.392-12.621; P = 0.011). For recurrence, stage 3 BC (adjusted HR: 1.044, 95% CI = 1.209-6.673; P = 0.017) (compared to stages 0 and 1 as base) showed significantly higher risk for developing earlier recurrence. Moreover, those who had invasive ductal carcinoma (compared to other types of BCs) had a higher risk for developing earlier recurrence (adjusted HR: 3.307, 95% CI = 1.191-0.724; P = 0.012). Conclusion: BC stage plays a significant role in both earlier recurrence and earlier mortality among patients with TNBC.

Introduction: To date, in the Middle East no center has yet to establish an intestinal rehabilitation unit specializing in care for patients with intestinal failure.In this study we report our experiences with an intestinal rehabilitation unit (IRU) in a country without home parenteral nutrition (HPN). Methods: Our IRU was first set up in February 2018. All patients diagnosed with intestinal failure (IF) up to February 2020 have been included in this report. Results: In total, 349 individuals referred to our IRU for treatment. One hundred individuals were diagnosed with IF, among which 68% of patients were males. The mean (SD) age of patients was 46.3 ± 16.1 years. In our series the most prevalent causes for IF included ECF (32%), SBS (24%, which included mesenteric ischemia and repeated surgery as the most common causes of SBS), SBS+fistula (22%), post-operative prolonged ileus (7%), advanced cancer (6%) and chronic intestinal pseudo obstruction (5%), respectively. The median (IQR) amount of days patients received parenteral nutrition (PN) was 32 (18, 60) days. Regarding autologous gastrointestinal reconstruction, resection and anastomosis was performed in 75.4% of patients, serial transverse enteroplasty procedure (STEP) was done in 10.5% and closure of ostoma was done in 7% of patients. In total, six patients had isolated ITxs and three had multivisceral transplantations. Median (IQR) hospitalization time and length of ICU stay were 33 (17.5, 61) and 3 (0, 5.6) days, respectively. Based on the Clavien-Dindo classification, 29%, 26%, 18%, 9% and 2% developed complications grades 1, 2, 3A, 4 and 5, respectively. Overall, 45% of patients developed sepsis, 43% developed catheter infections, 20% catheter thrombosis and 18% developed sludge or gall stones. During the study period, 61% became off PN, 23% of them became candidates for ITx and 16% died, respectively. Conclusion: Establishing an IRU and applying reconstruction techniques, especially in countries without facilities for HPN, will aid in the management of patients with IF and will decrease the number of deaths and number of candidates for ITx.