Browsing by Author "Sarkis, Yara"

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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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    Endoscopic Ultrasound Guided Treatment of Peristomal Varices
    (Elsevier, 2023) Sarkis, Yara; Masuoka, Howard; Ghabril, Marwan; Gutta, Aditya; Al-Haddad, Mohammad A.; DeWitt, John M.; Medicine, School of Medicine
    Background and aims The use of endoscopic ultrasound (EUS) for peristomal varices (PV) is limited to case reports. Methods Patients who underwent EUS-guided treatment of PV with cyanoacrylate (CYA) and/or coils between 04/2013 and 12/2019 were identified. All had failed previous therapies or had comorbidities precluding other options. Endoscopic technique, adverse events (AEs), rebleeding and repeat interventions were assessed. Results 20 patients (12 male, median: 62 years (IQR, 54.8-69.5) underwent initial EUS PV injection of CYA for secondary (n=19) or primary prophylaxis (n=1). Within 30 days, AEs occurred in 11 (55%) and 8 were mild. During a median 2.5 months (IQR, 2-8.5) follow-up, confirmed (n=6) or suspected (n=2) PV bleeding recurred; five of 8 recurrences were retreated with CYA and/or coils without AEs. After retreatment, PV bleeding recurred in two a median 6 months (IQR, 6-30) later. Conclusion EUS appears to be a safe and promising technique for treatment of PV.
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    High index of suspicion: diagnosing a carotid-cavernous fistula
    (BMJ, 2023-03-02) Sarkis, Yara; Worden, Astin; Schreiber, Torsten; Lapitz, Alvaro; Medicine, School of Medicine
    A woman in her 70s presented with acute bilateral retro-orbital headache, diplopia, chemosis and eye swelling. Ophthalmology and neurology were consulted after detailed physical examination and diagnostic workup including laboratory analysis, imaging and lumbar puncture. The patient was diagnosed with non-specific orbital inflammation and was started on methylprednisolone and dorzolamide-timolol for intraocular hypertension. The patient's condition improved slightly, but a week later, she developed subconjunctival haemorrhage in the right eye, which prompted investigation for a low-flow carotid-cavernous fistula. Digital subtraction angiography showed bilateral indirect carotid-cavernous fistula (Barrow type D). The patient underwent bilateral carotid-cavernous fistula embolisation. Her swelling improved considerably on day 1 after the procedure and her diplopia improved over the following weeks.