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Browsing by Author "Wehbeh, Antonios"
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Item Enterococcus faecalis Endocarditis After Endoscopic Mucosal Resection of a Large Sessile Colonic Polyp(Wolters Kluwer Health, 2019-03-28) Wehbeh, Antonios; Gerson, Myron C.; Rex, Douglas K.; Medicine, School of MedicineA 71-year-old man with mitral regurgitation and apical cardiomyopathy underwent endoscopic mucosal resection of a 22-mm transverse colon tubulovillous adenoma with high-grade dysplasia. Six weeks later, he presented with fever, valvular vegetations, and positive blood cultures for Enterococcus faecalis. To our knowledge, this is the first reported case of endocarditis involving native heart valves after endoscopic mucosal resection.Item Improvement of Osteoporosis Screening among Inflammatory Bowel Disease Patients at Gastroenterology Fellows’ Clinics(Hindawi, 2020-06-19) Wehbeh, Antonios; Phatharacharukul, Parkpoom; Fayad, Nabil F.; Medicine, School of MedicineIntroduction Individuals with inflammatory bowel disease (IBD) have an increased risk of osteoporosis compared to the general population. We aimed to improve the osteoporosis screening rate in the IBD patient population of the gastroenterology (GI) fellows' continuity clinics. Methods Baseline preintervention data were collected on patients seen from July through September of 2018. Four simplified criteria for osteoporosis screening were extrapolated from 3 national guidelines. Among patients who met any of these criteria, we determined the baseline screening rate. Fellows were then educated with a didactic session and handout material, and a standardized template was incorporated into clinic notes. Following this intervention, screening rates were reassessed from December 2018 through February 2019. Results During the preintervention phase, fellows saw 80 patients with IBD. Dual-energy X-ray absorptiometry (DEXA) scan was obtained in 44% of IBD patients who qualify for screening at the county hospital clinic compared to 21% of veterans' clinic IBD patients. In the postintervention period, screening rates remarkably improved to 100% in the county hospital clinic and to 75% in the veterans' clinic. Overall, the screening rate increased by 56% (P < 0.001). Conclusions A large percentage of IBD patients at risk for osteoporosis did not have appropriate bone mass density testing. Educating GI fellows and adding a template to clinic notes were effective in significantly improving the number of patients at risk of osteoporosis to receive appropriate screening test, a DEXA scan. Similar educational interventions should be considered for providers caring for IBD patients to prevent complications of osteoporosis in these patients.Item Metal Stent Insertion for Malignant Obstruction of a Colostomy(Cureus, 2020-08-29) Wehbeh, Antonios; Rahal, Mahmoud; Fatima, Hala; Medicine, School of MedicineA 47-year-old female with metastatic cervical cancer and diverting colostomy presented with abdominal distention and minimal stool output from her colostomy. A computed tomography (CT) scan revealed a metastatic mass causing partial obstruction at the colostomy level and significant proximal colonic dilation. Her obstruction was relieved by the endoscopic placement of a metal stent through the stoma, with the stent’s distal edge visible externally but not protruding beyond skin level. Two months later, the stent remained patent and did not migrate. This case highlights a viable palliative treatment option for patients who are not operative candidates.Item Sigmoid Colon Perforation Caused by an Unapparent Foreign Body(Wolters Kluwer, 2020-07-09) Wehbeh, Antonios; Dilly, Christen; Medicine, School of Medicine