Afaf Felemban - Academia.edu (original) (raw)

Papers by Afaf Felemban

The incidence of venous thromboembolism and practice of deep venous thrombosis prophylaxis in hos... more The incidence of venous thromboembolism and practice of deep venous thrombosis prophylaxis in hospitalized cirrhotic patients

Advances in Reproductive Sciences, 2018

Uterine septum is a common congenital anomaly of the female reproductive tract [1]. The reported ... more Uterine septum is a common congenital anomaly of the female reproductive tract [1]. The reported population prevalence ranges from 0.4 to 5% in general for uterine abnormalities, and rates in women with recurrent miscarriage are significantly higher [2]. In a review of 22 studies with more than 573,000 women screened for these malformations, Nahum et al. reported the distribution of uterine anomalies as follows: bicornuate 3%, septate 34%, didelphic 11% arcuate 7%, unicornuate 5% and hypo/ aplastic, 4%. These anomalies may be discovered during routine pelvic examinations, cesarean deliveries, laparoscopies for tubal sterilization, or infertility evaluations [2]. In general, congenital uterine anomalies have commonly affected women with recurrent miscarriage. Septate uterus is caused when a resorption defect leads to a persistent complete or partial longitudinal uterine cavity septum. This might result in multiple complications, such as diminished fertility as well as increased risks...

Cureus, 2021

Introduction One of the major hardships faced by married couples is the inability to conceive a c... more Introduction One of the major hardships faced by married couples is the inability to conceive a child. This issue is becoming more prevalent given the increasing rate of infertility worldwide. Assisted reproductive technology (ART) has brought hope to infertile couples. We aim to estimate the live birth rate (LBR) and pregnancy rate in women with one ovary compared with those with two ovaries. Methods A retrospective cohort study of women who underwent ART at King Abdulaziz Medical City (Jan 2000 - Dec 2018) was conducted. Five cycles of patient data were collected. The LBR (both conditional and cumulative) was compared between women with one and two ovaries. Results The final analysis included 403 women. Of these, 9% (n = 37) had one ovary. The majority (59%, n = 233) had primary infertility. A male-associated factor accounted for 52% (n = 208) of the infertility cases. The total number of live births was 164; and the overall LBR from five cycles was estimated as 9%, 16%, 18%, 18%,...

Journal of Clinical Research and Reports, 2020

Unilateral ectopic twin is a rare condition with only a few cases of viable ectopic twins reporte... more Unilateral ectopic twin is a rare condition with only a few cases of viable ectopic twins reported. We report a 41 year- old, Gravida 6 Para 5 at 6 weeks gestation, presented to the Emergency Department with complaint of lower abdominal pain and vaginal spotting. Pelvic ultrasound showed twins with positive fetal heart beats in the right tube. Laparoscopic salpingectomy was performed to remove to fetus. Conclusion: viable ectopic pregnancy is a life threatening condition and can be diagnosed with ultrasound. Surgical removal is the standard treatment option.

Thrombosis Journal, 2011

Background: Cirrhotic patients are characterized by a decreased synthesis of coagulation and anti... more Background: Cirrhotic patients are characterized by a decreased synthesis of coagulation and anticoagulation factors. The coagulopathy of cirrhotic patients is considered to be auto-anticoagulation. Our aim was to determine the incidence and predictors of venous thromboembolism (VTE) and examine the practice of deep venous thrombosis (DVT) prophylaxis among hospitalized cirrhotic patients. Methods: A retrospective cohort study was performed in a tertiary teaching hospital. We included all adult patients admitted to the hospital with a diagnosis of liver cirrhosis from January 1, 2009 to December 31, 2009. We grouped our cohort patients in two groups, cirrhotic patients without VTE and cirrhotic with VTE. Results: Over one year, we included 226 cirrhotic patients, and the characteristics of both groups were similar regarding their clinical and laboratory parameters and their outcomes. Six patients (2.7%) developed VTE, and all of the VTEs were DVT. Hepatitis C was the most common (51%) underlying cause of liver cirrhosis, followed by hepatitis B (22%); 76% of the cirrhotic patients received neither pharmacological nor mechanical DVT prophylaxis. Conclusion: Cirrhotic patients are at risk for developing VTE. The utilization of DVT prophylaxis was suboptimal.

The Journal of the American Association of Gynecologic Laparoscopists, 2001

Fertility and Sterility, 2001

Fertility and Sterility, 2000

Journal of Gynecology Research Reviews & Reports, 2020

Objective: Conventional laparoscopic myomectomy (LM) has inherent limitations due to its rigid st... more Objective: Conventional laparoscopic myomectomy (LM) has inherent limitations due to its rigid structure. The robotic system is a newly developed technology equipped with a flexible EndoWrist that offers good performance in delicate motions. Our objective was to share our clinical experience in the management robotic myomectomy. Materials and Methods: From 2009 to 2018, 42 patients with symptomatic uterine myomas were evaluated who underwent robotic myomectomy. We recorded and analyzed the preoperative characteristics of the patients and the fibroids, the detailed surgical time, and several postoperative outcomes to evaluate the feasibility and efficacy of robotic-assisted LM (RALM) myomectomy. Results: A total of 42 patients were enrolled in this study. The median age of the patients was 37 years and the mean size of the largest fibroid was 20 *17 cm. RALM achieved satisfactory results, including a short postoperative hospital stay 3 days), no cases required laparotomy, and a low c...

Obstetrics and Gynecology Research

Objective: To compare the results of treating male immunological infertility using two different ... more Objective: To compare the results of treating male immunological infertility using two different treatment options. Intrauterine Insemination (IUI) versus In-virto Fertilisation (IVF).

Middle East Fertility Society Journal

Middle East Fertility Society Journal, 2015

Saudi medical journal, 2003

Isolated unilateral pleural effusion is uncommon presentation of ovarian hyper stimulation syndro... more Isolated unilateral pleural effusion is uncommon presentation of ovarian hyper stimulation syndrome. The pathogenesis of this syndrome involved an increased permeability of the ovarian capillaries and of the mesothelial vessels triggered by the release of vasoactive substances by the ovaries under human chorionic gonadotropin stimulation. Early recognition of this unusual presentation of ovarian hyperstimulation syndrome should allow for physicians to ensure a better and minimally invasive management of these potentially pregnant patients.

The Journal of the American Association of Gynecologic Laparoscopists, 2001

One of the newest treatments of uterine myoma is uterine artery embolization (UAE). 1,2 Its main ... more One of the newest treatments of uterine myoma is uterine artery embolization (UAE). 1,2 Its main purposes are to reduce myoma size and to treat excessive uterine bleeding. In a review of 119 cases, about 70% of women reported immediate cessation of menorrhagia and improvement of pain and pressure symptoms after the procedure. 1 At 6-month follow-up, total uterine volume decreased by 56% and the average diameter of the largest myoma decreased by 36%. After UAE, light spotting and passage of small amounts of necrotic myomatous tissue may occur. Case Report A 43-year-old gravida zero woman was referred to us with menorrhagia of 1 year's duration and uterine myoma. Pelvic examination revealed a 16-week uterus. Transvaginal ultrasound examination confirmed the presence of myomatous uterus containing five hypoechoic lesions of 3 to 4 cm. All myomas were reported to be intramural. The patient's hemoglobin was 76 g/dl. Transfemoral selective bilateral uterine artery catheterization was performed. The main arteries supplying the myomas were embolized with 350-to 500-µ polyvinyl alcohol particles until they were completely devascularized. The procedure was uneventful.

The Journal of the American Association of Gynecologic Laparoscopists, 2001

The association between endometriosis and pelvic pain is unclear. Endometriosis is often associat... more The association between endometriosis and pelvic pain is unclear. Endometriosis is often associated with pain, but it is also present in up to 15% of asymptomatic women. 1 In those with pelvic pain, it is thought that the disease can stimulate nerve endings, resulting in tender lesions on pelvic examination or on probing during laparoscopy under conscious sedation. 2,3 To identify nerve fibers, we reported immunocytochemistry staining with a monoclonal antibody to neurofilament. 4 We found no difference in the proportion and mean nerve score in adhesions due to previous intraabdominal infection, endometriosis, and previous intraabdominal surgery. In the present study we evaluated the histopathology and presence of nerve fibers in peritoneum of women with and without endometriosis. Materials and Methods The study population consisted of 40 women (age range 26-39 yrs) found to have stage 2 (mild) endometriosis during laparoscopic surgery between April 1998 and June 1999. These were women with classic appearance of endometriosis (powder burn spots). Indications for operation were infertility or pelvic pain. Endometriosis lesions were treated by excision.

The Journal of the American Association of Gynecologic Laparoscopists, 2001

An alternative to hysterectomy for abnormal uterine bleeding is endometrial ablation by hysterosc... more An alternative to hysterectomy for abnormal uterine bleeding is endometrial ablation by hysteroscopic and nonhysteroscopic techniques. A nonhysteroscopic technique is endometrial ablation with microwave energy (MEA). 1-3 Energy is delivered into the endometrium by an applicator and is transmitted to the tip, where it is radiated in a hemispheric pattern. The system was designed to enable the surgeon to spread this heating pattern throughout the uterine cavity. Although more than 1000 women worldwide have been treated with MEA, no systematic evaluation of the uterine cavity after the procedure has been done. To our knowledge, our evaluation of the appearance of the uterine cavity before and immediately after MEA is the first such series in North America.

The Journal of the American Association of Gynecologic Laparoscopists, 2000

Mesenteric cysts are usually managed by general surgeons, as gynecologists rarely encounter the l... more Mesenteric cysts are usually managed by general surgeons, as gynecologists rarely encounter the lesions. 1-9 These benign cysts are intraabdominal and treatment is surgical excision. In the past several years, excision has been done by laparoscopy. 1-9 In our patient, a mesenteric cyst was diagnosed preoperatively as an ovarian cyst and was removed by laparoscopy. Case Report A 20-year-old nulligravida woman was referred to us after ultrasound diagnosis of a right ovarian cyst. Her main symptoms were backache and vague abdominal pain. Ultrasound examination revealed a wellcircumscribed, fluid-filled mass measuring 5.3 × 7.6 × 7.0 cm 3. After providing informed consent, the patient underwent laparoscopy.

The incidence of venous thromboembolism and practice of deep venous thrombosis prophylaxis in hos... more The incidence of venous thromboembolism and practice of deep venous thrombosis prophylaxis in hospitalized cirrhotic patients

Advances in Reproductive Sciences, 2018

Uterine septum is a common congenital anomaly of the female reproductive tract [1]. The reported ... more Uterine septum is a common congenital anomaly of the female reproductive tract [1]. The reported population prevalence ranges from 0.4 to 5% in general for uterine abnormalities, and rates in women with recurrent miscarriage are significantly higher [2]. In a review of 22 studies with more than 573,000 women screened for these malformations, Nahum et al. reported the distribution of uterine anomalies as follows: bicornuate 3%, septate 34%, didelphic 11% arcuate 7%, unicornuate 5% and hypo/ aplastic, 4%. These anomalies may be discovered during routine pelvic examinations, cesarean deliveries, laparoscopies for tubal sterilization, or infertility evaluations [2]. In general, congenital uterine anomalies have commonly affected women with recurrent miscarriage. Septate uterus is caused when a resorption defect leads to a persistent complete or partial longitudinal uterine cavity septum. This might result in multiple complications, such as diminished fertility as well as increased risks...

Cureus, 2021

Introduction One of the major hardships faced by married couples is the inability to conceive a c... more Introduction One of the major hardships faced by married couples is the inability to conceive a child. This issue is becoming more prevalent given the increasing rate of infertility worldwide. Assisted reproductive technology (ART) has brought hope to infertile couples. We aim to estimate the live birth rate (LBR) and pregnancy rate in women with one ovary compared with those with two ovaries. Methods A retrospective cohort study of women who underwent ART at King Abdulaziz Medical City (Jan 2000 - Dec 2018) was conducted. Five cycles of patient data were collected. The LBR (both conditional and cumulative) was compared between women with one and two ovaries. Results The final analysis included 403 women. Of these, 9% (n = 37) had one ovary. The majority (59%, n = 233) had primary infertility. A male-associated factor accounted for 52% (n = 208) of the infertility cases. The total number of live births was 164; and the overall LBR from five cycles was estimated as 9%, 16%, 18%, 18%,...

Journal of Clinical Research and Reports, 2020

Unilateral ectopic twin is a rare condition with only a few cases of viable ectopic twins reporte... more Unilateral ectopic twin is a rare condition with only a few cases of viable ectopic twins reported. We report a 41 year- old, Gravida 6 Para 5 at 6 weeks gestation, presented to the Emergency Department with complaint of lower abdominal pain and vaginal spotting. Pelvic ultrasound showed twins with positive fetal heart beats in the right tube. Laparoscopic salpingectomy was performed to remove to fetus. Conclusion: viable ectopic pregnancy is a life threatening condition and can be diagnosed with ultrasound. Surgical removal is the standard treatment option.

Thrombosis Journal, 2011

Background: Cirrhotic patients are characterized by a decreased synthesis of coagulation and anti... more Background: Cirrhotic patients are characterized by a decreased synthesis of coagulation and anticoagulation factors. The coagulopathy of cirrhotic patients is considered to be auto-anticoagulation. Our aim was to determine the incidence and predictors of venous thromboembolism (VTE) and examine the practice of deep venous thrombosis (DVT) prophylaxis among hospitalized cirrhotic patients. Methods: A retrospective cohort study was performed in a tertiary teaching hospital. We included all adult patients admitted to the hospital with a diagnosis of liver cirrhosis from January 1, 2009 to December 31, 2009. We grouped our cohort patients in two groups, cirrhotic patients without VTE and cirrhotic with VTE. Results: Over one year, we included 226 cirrhotic patients, and the characteristics of both groups were similar regarding their clinical and laboratory parameters and their outcomes. Six patients (2.7%) developed VTE, and all of the VTEs were DVT. Hepatitis C was the most common (51%) underlying cause of liver cirrhosis, followed by hepatitis B (22%); 76% of the cirrhotic patients received neither pharmacological nor mechanical DVT prophylaxis. Conclusion: Cirrhotic patients are at risk for developing VTE. The utilization of DVT prophylaxis was suboptimal.

The Journal of the American Association of Gynecologic Laparoscopists, 2001

Fertility and Sterility, 2001

Fertility and Sterility, 2000

Journal of Gynecology Research Reviews & Reports, 2020

Objective: Conventional laparoscopic myomectomy (LM) has inherent limitations due to its rigid st... more Objective: Conventional laparoscopic myomectomy (LM) has inherent limitations due to its rigid structure. The robotic system is a newly developed technology equipped with a flexible EndoWrist that offers good performance in delicate motions. Our objective was to share our clinical experience in the management robotic myomectomy. Materials and Methods: From 2009 to 2018, 42 patients with symptomatic uterine myomas were evaluated who underwent robotic myomectomy. We recorded and analyzed the preoperative characteristics of the patients and the fibroids, the detailed surgical time, and several postoperative outcomes to evaluate the feasibility and efficacy of robotic-assisted LM (RALM) myomectomy. Results: A total of 42 patients were enrolled in this study. The median age of the patients was 37 years and the mean size of the largest fibroid was 20 *17 cm. RALM achieved satisfactory results, including a short postoperative hospital stay 3 days), no cases required laparotomy, and a low c...

Obstetrics and Gynecology Research

Objective: To compare the results of treating male immunological infertility using two different ... more Objective: To compare the results of treating male immunological infertility using two different treatment options. Intrauterine Insemination (IUI) versus In-virto Fertilisation (IVF).

Middle East Fertility Society Journal

Middle East Fertility Society Journal, 2015

Saudi medical journal, 2003

Isolated unilateral pleural effusion is uncommon presentation of ovarian hyper stimulation syndro... more Isolated unilateral pleural effusion is uncommon presentation of ovarian hyper stimulation syndrome. The pathogenesis of this syndrome involved an increased permeability of the ovarian capillaries and of the mesothelial vessels triggered by the release of vasoactive substances by the ovaries under human chorionic gonadotropin stimulation. Early recognition of this unusual presentation of ovarian hyperstimulation syndrome should allow for physicians to ensure a better and minimally invasive management of these potentially pregnant patients.

The Journal of the American Association of Gynecologic Laparoscopists, 2001

One of the newest treatments of uterine myoma is uterine artery embolization (UAE). 1,2 Its main ... more One of the newest treatments of uterine myoma is uterine artery embolization (UAE). 1,2 Its main purposes are to reduce myoma size and to treat excessive uterine bleeding. In a review of 119 cases, about 70% of women reported immediate cessation of menorrhagia and improvement of pain and pressure symptoms after the procedure. 1 At 6-month follow-up, total uterine volume decreased by 56% and the average diameter of the largest myoma decreased by 36%. After UAE, light spotting and passage of small amounts of necrotic myomatous tissue may occur. Case Report A 43-year-old gravida zero woman was referred to us with menorrhagia of 1 year's duration and uterine myoma. Pelvic examination revealed a 16-week uterus. Transvaginal ultrasound examination confirmed the presence of myomatous uterus containing five hypoechoic lesions of 3 to 4 cm. All myomas were reported to be intramural. The patient's hemoglobin was 76 g/dl. Transfemoral selective bilateral uterine artery catheterization was performed. The main arteries supplying the myomas were embolized with 350-to 500-µ polyvinyl alcohol particles until they were completely devascularized. The procedure was uneventful.

The Journal of the American Association of Gynecologic Laparoscopists, 2001

The association between endometriosis and pelvic pain is unclear. Endometriosis is often associat... more The association between endometriosis and pelvic pain is unclear. Endometriosis is often associated with pain, but it is also present in up to 15% of asymptomatic women. 1 In those with pelvic pain, it is thought that the disease can stimulate nerve endings, resulting in tender lesions on pelvic examination or on probing during laparoscopy under conscious sedation. 2,3 To identify nerve fibers, we reported immunocytochemistry staining with a monoclonal antibody to neurofilament. 4 We found no difference in the proportion and mean nerve score in adhesions due to previous intraabdominal infection, endometriosis, and previous intraabdominal surgery. In the present study we evaluated the histopathology and presence of nerve fibers in peritoneum of women with and without endometriosis. Materials and Methods The study population consisted of 40 women (age range 26-39 yrs) found to have stage 2 (mild) endometriosis during laparoscopic surgery between April 1998 and June 1999. These were women with classic appearance of endometriosis (powder burn spots). Indications for operation were infertility or pelvic pain. Endometriosis lesions were treated by excision.

The Journal of the American Association of Gynecologic Laparoscopists, 2001

An alternative to hysterectomy for abnormal uterine bleeding is endometrial ablation by hysterosc... more An alternative to hysterectomy for abnormal uterine bleeding is endometrial ablation by hysteroscopic and nonhysteroscopic techniques. A nonhysteroscopic technique is endometrial ablation with microwave energy (MEA). 1-3 Energy is delivered into the endometrium by an applicator and is transmitted to the tip, where it is radiated in a hemispheric pattern. The system was designed to enable the surgeon to spread this heating pattern throughout the uterine cavity. Although more than 1000 women worldwide have been treated with MEA, no systematic evaluation of the uterine cavity after the procedure has been done. To our knowledge, our evaluation of the appearance of the uterine cavity before and immediately after MEA is the first such series in North America.

The Journal of the American Association of Gynecologic Laparoscopists, 2000

Mesenteric cysts are usually managed by general surgeons, as gynecologists rarely encounter the l... more Mesenteric cysts are usually managed by general surgeons, as gynecologists rarely encounter the lesions. 1-9 These benign cysts are intraabdominal and treatment is surgical excision. In the past several years, excision has been done by laparoscopy. 1-9 In our patient, a mesenteric cyst was diagnosed preoperatively as an ovarian cyst and was removed by laparoscopy. Case Report A 20-year-old nulligravida woman was referred to us after ultrasound diagnosis of a right ovarian cyst. Her main symptoms were backache and vague abdominal pain. Ultrasound examination revealed a wellcircumscribed, fluid-filled mass measuring 5.3 × 7.6 × 7.0 cm 3. After providing informed consent, the patient underwent laparoscopy.