Browsing by Author "Fayad, Nabil"

Now showing 1 - 7 of 7
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    An Unusual Cause of Obstructive Jaundice and Acute Pancreatitis: Visceral Artery Pseudoaneurysm
    (Springer Nature, 2021-04-05) Saito, Akira; Fayad, Nabil; Medicine, School of Medicine
    Visceral artery pseudoaneurysm (VAPA) is an uncommon vascular disorder with a tendency to present with nonspecific signs and abdominal symptoms. This case describes a patient with severe atherosclerosis who developed multiple VAPAs including a hepatic artery pseudoaneurysm bleeding into a large hematoma, which resulted in obstructive jaundice and acute pancreatitis. Prompt diagnosis of VAPA is important due to the high risk of vessel wall perforation with associated increased mortality rate. Biliary obstruction with acute pancreatitis is not a well-described presentation for VAPAs.
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    Colonic Myeloid Sarcoma as a Rare Presentation of Relapsed Acute Myeloid Leukemia
    (Wolters Kluwer, 2020-06-15) Phatharacharukul, Parkpoom; Fayad, Nabil; Siwiec, Robert; Medicine, School of Medicine
    Myeloid sarcoma (MS), an extramedullary tumor of immature granulocytic cells, affects the gastrointestinal tract in approximately 10% of cases. MS involvement of the colon and rectum is considered to be extremely rare. We present a 36-year-old woman with acute myeloid leukemia and allogenic hematopoietic stem cell transplant 2 years before who was admitted with abdominal pain and nonmucous, nonbloody diarrhea. Colonoscopy revealed an ulcerated mass in the proximal colon, and biopsies showed MS compatible with acute myeloid leukemia relapse.
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    Long-Term Follow-Up of Colonoscopy Quality Monitoring
    (Wolters Kluwer, 2023-09-01) Patel, Feenalie; Dilly, Christen; Fayad, Nabil; Marri, Smitha; Eckert, George J.; Kahi, Charles; Medicine, School of Medicine
    Introduction: High-quality colonoscopy is paramount for colorectal cancer prevention. Since 2009, endoscopists at our institution have received quarterly report cards summarizing individual colonoscopy quality indicators. We have previously shown that implementing this intervention was associated with short-term improvement in adenoma detection rate (ADR). However, the long-term effect of continued monitoring on colonoscopy quality is unclear. Methods: We conducted a retrospective study of prospectively administered quarterly colonoscopy quality report cards at the Roudebush Veteran's Affairs Medical Center between April 1, 2012, and August 31, 2019. The anonymized reports included individual endoscopists' ADRs, cecal intubation rates, and withdrawal times. Analyses were performed to determine slopes over time for each quality metric by physician and assess for differences based on whether ADRs were calculated quarterly or yearly. Results: Data from the report cards of 17 endoscopists who had performed 24,361 colonoscopies were included. The mean quarterly ADR (±SD) was 51.7% (±11.7%) and mean yearly ADR was 47.2% (±13.8%). There was a small increase in overall ADR based on quarterly and yearly measurements (slope + 0.6%, P = 0.02; and slope +2.7%, P < 0.001, respectively), but no significant change in individual ADRs, cecal intubation rates, or withdrawal times. Analysis of SD of ADRs showed no significant difference between yearly and quarterly measurements ( P = 0.064). Individual endoscopists' ADR SD differences between yearly and quarterly measurements ranged from -4.7% to +6.8%. Discussion: Long-term colonoscopy quality monitoring paralleled stable improvements in overall ADR. For endoscopists with baseline high ADR, frequent monitoring and reporting of colonoscopy quality metrics may not be necessary.
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    Not FIT for Use: Fecal Immunochemical Testing in the Inpatient and Emergency Settings
    (Elsevier, 2022-01) Bhatti, Umer; Jansson-Knodell, Claire; Saito, Akira; Han, Andrew; Krajicek, Edward; Han, Yan; Imperiale, Thomas F.; Fayad, Nabil; Medicine, School of Medicine
    Background Fecal immunochemical testing (FIT) is widely used for colorectal cancer screening, its only indication. Its effect on clinical decision-making beyond screening is unknown. We studied the use of FIT in emergency and inpatient settings and its impact on patient care. Methods Using electronic medical records, we reviewed all non-ambulatory FITs performed from November 2017 to October 2019 at a tertiary care community hospital. We collected data on demographics, indications, gastroenterology consultations, and endoscopic procedures. Multivariate logistic regression was performed to determine the effect of FIT on gastroenterology consultation and endoscopy. Results We identified 550 patients with at least 1 FIT test. Only 3 FITs (0.5%) were performed for colorectal cancer screening. FITs were primarily ordered from the emergency department (45.3%) or inpatient hospital floor (42.2%). Anemia (44.0%), followed by gastrointestinal bleeding (40.9%), were the most common indications. FIT was positive in 253 patients (46.0%), and gastroenterology consultation was obtained for 47.4% (n = 120), compared with 14.5% (n = 43) of the 297 FIT-negative patients (odds ratio 3.28; 95% confidence interval, 2.23-4.82, P < .0001). A potential bleeding source was identified in 80% of patients with reported or witnessed overt gastrointestinal bleeding, a similar proportion (80.7%; P = .92) to patients who were FIT positive with overt gastrointestinal bleeding. Multivariate analysis showed that melena, hematemesis, and a positive FIT were associated with gastroenterology consultation (all P < .05), while only melena (odds ratio 3.34; 95% confidence interval, 1.48-7.54) was associated with endoscopy. Conclusions Nearly all emergency department and inpatient FIT use was inappropriate. FIT resulted in more gastroenterology consultation but was not independently associated with inpatient endoscopy.
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    Practical Teaching Case – A Small Complaint
    (Elsevier, 2020) Obaitan, Itegbemie; Jansson-Knodell, Claire; Fayad, Nabil; Medicine, School of Medicine
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    Unrelenting Abdominal Pain after recent initiation of a Direct Oral Anticoagulant: A Cause for Concern
    (Elsevier, 2019) Crews, Nicholas R.; Fayad, Nabil; Medicine, School of Medicine
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    Virtual Gastroenterology Fellowship Recruitment During COVID-19 and Its Implications for the Future
    (Springer, 2021) Hamade, Nour; Bhavsar-Burke, Indira; Jansson-Knodell, Claire; Wani, Sachin; Patel, Swati G.; Ehrlich, Adam C.; Paine, Elizabeth; Hosseini‑Carroll, Pegah; Menard-Katcher, Paul; Fayad, Nabil; Medicine, School of Medicine
    Background and Aims Amid the COVID-19 pandemic, medical education organizations endorsed a virtual recruitment format, representing a stark change from traditional in-person interviews. We aimed to identify the attitudes and perceptions of Gastroenterology Fellowship Program Directors (PDs) and applicants regarding the virtual interview experience and the role of virtual interviews (VI) in the future. Methods We designed separate surveys targeting PDs and applicants using the Qualtrics software. At the end of the interview season, we e-mailed both survey links to all PDs and requested that they forward the applicant survey to their interviewed candidates. Surveys were voluntary and anonymous. Descriptive statistics were used to analyze the data with results presented as percentages. Results A total of 29.7% of PDs completed the survey. Compared to traditional interviews, VI were viewed by 46.5% of PDs to be very suboptimal or suboptimal. Yet, 69.1% envisioned a role for VI in the future. A total of 14.2% of applicants completed the survey. Compared to traditional interviews, VI were viewed by 42.3% of applicants to be very suboptimal or suboptimal. However, 61.8% saw a future role for VI. While both applicants and PDs reported that establishing an interpersonal connection was a disadvantage with VI, applicants placed more emphasis on this need for connection (p = 0.001). Conclusion Overall, PDs and applicants report mixed views with regard to VI but anticipate that it may continue to have a future role. VI may augment future recruitment cycles with care taken to not disadvantage applicants, who rely heavily on the interview process to create personal connections with programs.