Browsing by Author "Saleem, Nasir"

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    COVID-Associated Cast-Forming Cholangiopathy: A Commentary on Disease Mechanism, Treatment, and Prognosis
    (Dove Press, 2023-03-28) Sarkis, Yara; Saleem, Nasir; Vuppalanchi, Raj; Gromski, Mark; Medicine, School of Medicine
    The complete impact of COVID-19 infection continues to develop since the onset of the COVID-19 pandemic. COVID-19 cholangiopathy has been recently described in a subset of patients who recovered from severe COVID-19 infection. The most common phenotype of patients suffering from COVID-19 cholangiopathy had severe infection requiring a stay in the intensive care unit, mechanical ventilation and vasopressor medications. Patients with COVID-cholangiopathy present with severe and prolonged cholestatic liver injury. In cases where biliary cast formation is identified, we defined the entity as “COVID-19 cast-forming cholangiopathy”. This subset of COVID-19 cholangiopathy is not well understood and there are no standardized diagnosis or management to this date. The reported clinical outcomes are variable, from resolution of symptoms and liver test abnormalities to liver transplant and death. In this commentary, we discuss the proposed pathophysiology, diagnosis, management, and prognosis of this disease.
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    Critical Illness Cholangiopathy in COVID-19 Long-haulers
    (Elsevier, 2022) Saleem, Nasir; Li, Betty H.; Vuppalanchi, Raj; Gawrieh, Samer; Gromski, Mark A.; Medicine, School of Medicine
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    Predictors of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Comprehensive Systematic Review and Meta-analysis
    (Elsevier, 2024) Beran, Azizullah; Aboursheid, Tarek; Ali, Adel Hajj; Nayfeh, Tarek; Albunni, Hashem; Vargas, Alejandra; Mohamed, Mouhand F.; Elfert, Khaled; Shaear, Mohammad; Obaitan, Ite; Saleem, Nasir; Ahmed, Awais; Gromski, Mark A.; DeWitt, John M.; Al-Haddad, Mohammad; Watkins, James L.; Fogel, Evan; Easler, Jeffrey J.; Medicine, School of Medicine
    Background & Aims Pancreatitis is the most common serious adverse event associated with endoscopic retrograde cholangiopancreatography (ERCP). This meta-analysis aimed to precisely assess the risk factors for post-ERCP pancreatitis (PEP). Methods We searched electronic databases for studies that assessed risk factors for PEP after adjusting for ≥3 risk factors, including at least one pre-specified patient-related and one procedure-related risk factor, and reported the data as adjusted odds ratios (ORs) with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted ORs for risk factors reported in ≥3 studies were constructed. Results A total of 159 studies with 315,580 ERCPs were included, assessing 31 unique risk factors (20 patient-related and 11 procedure-related). Key patient-related predictors of PEP were age ≤60 years (OR, 1.81; high credibility), prior acute pancreatitis (OR, 2.59; moderate), age ≤40 years (OR, 2.33; moderate), asymptomatic choledocholithiasis (OR, 4.76; low), prior PEP (OR, 4.40; low), sphincter of Oddi dysfunction (OR, 3.11; low), and female gender (OR, 1.70; low). Key procedure-related predictors of PEP were any guidewire passage into the pancreatic duct (PD) (OR, 2.18; high), first ERCP with a native papilla (OR, 1.91; high), endoscopic papillary balloon dilation of an intact papilla (OR, 2.91; moderate), pancreatic acinarization (OR, 4.23; low), any PD cannulation (OR, 2.73; low), pancreatic sphincterotomy (OR, 2.64; low), difficult cannulation (OR, 2.60; low), any pancreatogram (OR, 2.40; low), and precut sphincterotomy (OR, 1.98; low). Conclusions Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for PEP. Incorporating our results into a prediction model may reliably help identify high-risk patients, optimize informed consent, and guide prevention and management strategies for PEP.