Publications by authors named "Omar Abughanimeh"

31 Publications

Surgical management of patients with von Willebrand Disease: summary of 2 systematic reviews of the literature.

Blood Adv 2021 Oct 15. Epub 2021 Oct 15.

Department of Health Research Methods, Evidence and Impact, McMaster University, Canada.

Von Willebrand disease (VWD) is the most common inherited bleeding disorder. The management of patients with VWD undergoing surgeries is crucial to prevent bleeding complications. To systematically summarize the evidence on the management of patients with VWD undergoing major and minor surgeries to support the development of practice guidelines. We searched Medline and EMBASE through October 2019 for randomized clinical trials (RCTs), comparative observational studies and case series comparing maintaining factor VIII levels or VWF levels >0.50 IU/mL for at least 3 days in patients undergoing major surgery, and options for perioperative management of patients undergoing minor surgery. Two authors screened, abstracted data, and assessed the risk of bias. We conducted meta-analysis when possible. We evaluated the certainty of the evidence using the GRADE approach. We included 7 case series for major surgeries and 2 RCTs and 12 case series for minor surgeries. Very low certainty evidence showed that maintaining factor VIII levels, or VWF levels > 0.50 IU/mL for at least 3 consecutive days showed excellent hemostatic efficacy (as labeled by the researchers) after 74-100% of major surgeries. Low to very low certainty evidence showed that prescribing tranexamic acid and increasing VWF levels to 0.50 IU/mL resulted in less bleeding complications after minor procedures compared to increasing VWF levels to 0.50 IU/mL alone. Given the low-quality evidence to guide management decisions, a shared-decision model leading to individualized therapy plans will be important in patients with VWD undergoing surgical and invasive procedures.
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http://dx.doi.org/10.1182/bloodadvances.2021005666DOI Listing
October 2021

Von Willebrand Factor Levels in The Diagnosis of Von Willebrand Disease: A Systematic Review and Meta-Analysis.

Blood Adv 2021 Oct 5. Epub 2021 Oct 5.

University of Kansas Medical Center, Kansas City, Kansas, United States.

Von Willebrand Disease (VWD) is associated with significant morbidity as a result of excessive mucocutaneous bleeding symptoms. Patients with VWD can experience easy bruising, epistaxis, gastrointestinal and oral cavity bleeding, as well as heavy menstrual bleeding and bleeding after dental work, surgical procedures, and childbirth. Early diagnosis and treatment is important to prevent and treat these symptoms. We systematically reviewed the accuracy of diagnostic tests using different cut-off values of VWF:Ag and platelet-dependent VWF activity assays in the diagnosis of VWD. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies. Two investigators screened and abstracted data. Risk of bias was assessed using QUADAS-2 and certainty of evidence using the GRADE framework. We pooled estimates of sensitivity and specificity and reported patient important outcomes when relevant. This review included 21 studies that evaluated VWD diagnosis, including the approach to patients with VWF levels that have normalized with age (6 studies), VWF cut-off levels for the diagnosis of Type 1 VWD (9 studies), and platelet-dependent VWF activity/VWF:Ag ratio cut-off levels for the diagnosis of Type 2 VWD (6 studies). The results showed low certainty in the evidence for a net health benefit from reconsidering the diagnosis of VWD versus simply removing the disease in patients with VWF levels that have normalized with age. For the diagnosis of Type 1 VWD, in patients with VWF:Ag <0.30 IU/mL, VWF sequence variants were detected in 75-82% of patients in 2 studies, and for VWF:Ag between 0.30-0.50 IU/mL, VWF sequence variants were detected in 44-60% of patients in 3 studies. A sensitivity of 0.90 (95% CI: 0.83 to 0.94), and a specificity of 0.91 (95% CI: 0.76 to 0.97) were observed for a platelet-dependent VWF activity /VWF:Ag ratio of <0.7 in detecting type 2 VWD (moderate certainty in the test accuracy results). VWF antigen and platelet-dependent activity are continuous variables with an increase in bleeding risk with decreasing levels. This systematic review shows that using a VWF activity/VWF:Ag ratio of <0.7 versus lower cutoff levels in patients with an abnormal initial VWD screen is more accurate for the diagnosis of type 2 VWD.
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http://dx.doi.org/10.1182/bloodadvances.2021005430DOI Listing
October 2021

Bleeding assessment tools in the diagnosis of VWD in adults and children: a systematic review and meta-analysis of test accuracy.

Blood Adv 2021 Dec;5(23):5023-5031

Department of Internal Medicine.

Von Willebrand disease (VWD) can be associated with significant morbidity. Patients with VWD can experience bruising, mucocutaneous bleeding, and bleeding after dental and surgical procedures. Early diagnosis and treatment are important to minimize the risk of these complications. Several bleeding assessment tools (BATs) have been used to quantify bleeding symptoms as a screening tool for VWD. We systematically reviewed diagnostic test accuracy results of BATs to screen patients for VWD. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Risk of bias was assessed using the revised tool for the quality assessment of diagnostic accuracy studies and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 7 cohort studies that evaluated the use of BATs to screen adult and pediatric patients for VWD. The pooled estimates for sensitivity and specificity were 75% (95% confidence interval, 66-83) and 54% (29-77), respectively. Certainty of evidence varied from moderate to high. This systematic review provides accuracy estimates for validated BATs as a screening modality for VWD. A BAT is a useful initial screening test to determine who needs specific blood testing. The pretest probability of VWD (often determined by the clinical setting/patient population), along with sensitivity and specificity estimates, will influence patient management.
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http://dx.doi.org/10.1182/bloodadvances.2021004368DOI Listing
December 2021

Current Management of Refractory Germ Cell Tumors.

Curr Oncol Rep 2021 07 16;23(9):101. Epub 2021 Jul 16.

Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, 68198-6840, USA.

Purpose Of Review: Germ cell tumors (GCTs) are the most common solid tumors affecting men between ages of 20 and 34 years. Most of the cases, even in advanced disease, will have good prognosis. However, around 20-30% of advanced disease will be refractory or develop relapse after treatment. Herein, we review the current management of refractory/relapsed GCTs.

Recent Findings: Salvage treatment of GCTs has been a controversial topic for the last few decades. Conventional dose chemotherapy (CDCT), high-dose chemotherapy (HDCT) with stem cell infusion, and surgical salvage were proven to be effective and curative options in some cases. The international randomized trial (TIGER) will ultimately answer which chemotherapy approach may be optimal. Furthermore, the usage of immunotherapy is still under investigation with limited data so far in the setting of relapsed/refractory GCTs. Curative paradigms including with CDCT and HDCT are possible, although novel approaches beyond HDCT are still needed to eliminate mortality from this disease.
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http://dx.doi.org/10.1007/s11912-021-01093-zDOI Listing
July 2021

Venous thromboembolism prophylaxis in inflammatory bowel disease flare-ups.

Ann Gastroenterol 2019 Nov-Dec;32(6):578-583. Epub 2019 Aug 31.

Department of Gastroenterology (Osama Kaddourah, Khalil Abuamr).

Background: Inflammatory bowel disease (IBD) is a set of chronic inflammatory diseases associated with significant morbidity. Generally, IBD patients have twice the risk of venous thromboembolism (VTE) compared to healthy controls. VTE in IBD is associated with greater morbidity and mortality. This is compounded by the underutilization of pharmacological anticoagulation in hospitalized patients with IBD. One study showed that half the IBD patients who developed VTE were not receiving any thrombotic prophylaxis.

Method: We carried out a retrospective chart review of VTE prophylaxis use and safety in patients admitted with IBD flare-up between 2014 and 2017.

Results: We evaluated 233 patients (mean age 36.7 years; 53.6% male). Of these patients, 55.2% were Caucasian and 40.5% were African American; 72.5% had Crohn's disease and 21% ulcerative colitis. About one-third of our patients were on chronic steroids. Pharmacological prophylaxis was used in 39.7% of the patients. This significantly correlated with male sex, recent surgery, history of VTE, smoking, and chronic steroid use. Meanwhile, hematochezia, aspirin use, and a history of gastrointestinal bleeding were correlated with less use of pharmacological prophylaxis. Patients receiving pharmacological prophylaxis showed no difference in the incidence of bleeding events.

Conclusions: Multiple factors were associated with the use of pharmacological prophylaxis in hospitalized patients, including sex, steroid use, history of VTE events or gastrointestinal bleeding, and hematochezia. The incidence of major bleeding was not significantly greater in IBD patients receiving pharmacological prophylaxis.
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http://dx.doi.org/10.20524/aog.2019.0412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826077PMC
August 2019

Maxillary Osteomyelitis with an Incidental Diagnosis of Maxillary Diffuse Large B-Cell Lymphoma: A Case Report.

Cureus 2019 Jul 25;11(7):e5238. Epub 2019 Jul 25.

Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA.

Raoultella planticola osteomyelitis is rarely reported in the literature. The most likely source in our case is the oral microbiome secondary to the tooth extraction. Herein we present a case of Raoultella planticola osteomyelitis of the jaw that leads to the diagnosis of diffuse large B-cell lymphoma (DLBCL) of the jaw. A 75-year-old male with no significant medical history, presented to the emergency department with right upper jaw pain after he had a tooth extraction a week before his presentation. Computed tomography (CT) scan of the face showed concerns of right maxillary osteomyelitis with soft tissue swelling and prominent cervical lymph nodes. He underwent a bone biopsy of the maxilla and was started on intravenous ampicillin-sulbactam. His bone culture grew pan-sensitive Raoultella planticola. in addition to that, his bone biopsy revealed diffuse large B-cell lymphoma of the jaw. The patient underwent staging imaging, and he was found to have metastasis to the liver. He was started on chemotherapy and had a good response. In conclusion, Raoultella planticola osteomyelitis is extremely rare. The diagnosis of maxillary DLBCL can be a challenge. Fortunately, our patient had an infection at the same site that led to the diagnosis of DLBCL.
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http://dx.doi.org/10.7759/cureus.5238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6758960PMC
July 2019

An Unusual Case of Diffuse Alveolar Hemorrhage as a Clinical Manifestation of Atypical Hemolytic Uremic Syndrome: A Case Report.

Cureus 2019 Jul 1;11(7):e5059. Epub 2019 Jul 1.

Critical Care, University of Missouri-Kansas City l Saint Luke's Health System, Kansas City, USA.

Hemolytic uremic syndrome (HUS) is a constellation of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury. HUS is subcategorized into primary or secondary HUS. Primary HUS is synonymous with atypical HUS (aHUS) and is attributed to genetic complement deficiency. Diffuse alveolar hemorrhage (DAH) is a serious condition complicating multiple systemic conditions. aHUS presenting as DAH is exceedingly rare. In this case, we present a 75-year-old male patient who presented with generalized weakness, malaise, and hemoptysis. He was found to have hemolytic anemia and thrombocytopenia, with elevated creatinine. Bronchoscopy confirmed DAH. He was started on plasmapheresis with a suboptimal response. aHUS was suspected and the patient was started on eculizumab with subsequent laboratory and clinical improvement. HUS and aHUS can present as DAH. It is very important to recognize both conditions as both are life threatening with high morbidity and mortality.
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http://dx.doi.org/10.7759/cureus.5059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721894PMC
July 2019

Isolated Renal Metastasis from Primary Lung Squamous Cell Carcinoma with Synchronous Small Cell Lung Cancer.

Cureus 2019 Jun 12;11(6):e4891. Epub 2019 Jun 12.

Hematology/Oncology, University of Nebraska Medical Center, Omaha, USA.

Synchronous multiple primary lung cancer is a unique type of lung carcinomas that are diagnosed with more than two different pathological types in the same or different lung lobes. Isolated metastasis to the kidney is considered rare. Herein, we present a case of a 58-year-old male with a history of chronic obstructive pulmonary disease (COPD) and 40 pack-year of cigarette smoking, who was diagnosed with synchronous small cell lung cancer (SCLC) and squamous cell carcinoma (SCC) with isolated metastasis to the kidney. Isolated kidney metastasis from lung cancer is an infrequent finding; it should be considered when the patient is diagnosed with lung cancer. In the absence of disseminated disease and contraindications, nephrectomy is an option for treatment with chemotherapy or as a palliative measure if the patient is symptomatic.
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http://dx.doi.org/10.7759/cureus.4891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689493PMC
June 2019

A Case of Prostate Cancer Presenting with Rash.

Cureus 2019 May 23;11(5):e4734. Epub 2019 May 23.

Hematology / Oncology, University of Missouri-Kansas City School of Medicine, Kansas City, USA.

Mixed cryoglobulinemia (MC) is well known for its association with chronic hepatitis C virus (HCV) infection. However, it has also been linked to autoimmune disorders and hematological malignancies, particularly of B-cell lymphoid origin. Association with solid malignancies is poorly described in the literature. Non-HCV-related MC, in the setting of prostate cancer, has been reported only twice. Here, we describe a case of MC in a prostate cancer patient complicated by membranoproliferative glomerulonephritis (MPGN) that responded well to plasma exchange therapy and treatment with both corticosteroids and rituximab.
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http://dx.doi.org/10.7759/cureus.4734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649886PMC
May 2019

Acute Appendicitis and Small Bowel Obstruction Secondary to Metastatic Breast Cancer.

Cureus 2019 May 21;11(5):e4706. Epub 2019 May 21.

Hematology/Oncology, University of Nebraska Medical Center, Omaha, USA.

Breast cancer is the most common cancer in women; it is well-known to metastasize to lymph nodes, lungs, liver, brain, and bones. However, luminal gastrointestinal metastasis is rare, especially to the appendix. Herein, we report a case where cancer metastasized to the ileum and appendix, causing acute appendicitis and small bowel obstruction. This is a 44-year-old female with a history of stage IV metastatic breast cancer to bones, lungs, and ovaries, presented with acute abdominal pain for one day. Her abdomen was soft, distended with generalized tenderness. Computed tomography (CT) of the abdomen and pelvis showed a partial small bowel obstruction and swollen appendix. After her symptoms worsened on conservative treatment, she was taken to the operating room where she was found to have a markedly dilated ileum with signs of acute appendicitis, so she underwent ileocecectomy, appendectomy, and lysis of adhesions. Pathology showed metastatic breast cancer in the appendix with findings consistent with acute appendicitis. She tolerated surgery well without complications. In conclusion, small intestinal and appendiceal metastases of breast cancer are very rare though they should be considered in the differential diagnosis in cancer patients presenting with acute abdominal pain.
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http://dx.doi.org/10.7759/cureus.4706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649874PMC
May 2019

Hepatocellular Carcinoma with Tumor Thrombus Extending from the Portal Vein to the Right Atrium.

Cureus 2019 May 17;11(5):e4689. Epub 2019 May 17.

Hematology/Oncology, University of Nebraska Medical Center, Omaha, USA.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Tumor thrombus formation in advanced HCC stages is common and usually involves the hepatic or portal veins. The formation of tumor thrombus is considered a poor prognostic factor. Herein, we report a rare case wherein the thrombus extended to the inferior vena cava (IVC) reaching the right atrium without affecting the hemodynamic status. This is a 59-year-old male who presented with melena. He was found to have grade 3 esophageal varices with findings suggestive of recent bleeding associated with a large amount of blood in the gastric body that required banding. Computed tomography (CT) of the abdomen and pelvis showed multiple liver masses with an intraluminal IVC mass extending from the hepatic vein into the right atrium. A CT scan of the chest confirmed the presence of a tumor thrombus in the IVC extending to the right atrium. The patient declines surgical intervention and he was discharged. Unfortunately, he passed after a short period of time. In conclusion, tumor thrombus formation is common in HCC. However, expansion of the thrombus to IVC and right atrium is rare and indicates poor prognosis.
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http://dx.doi.org/10.7759/cureus.4689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639066PMC
May 2019

Zieve's Syndrome: An Under-reported Cause of Anemia in Alcoholics.

Cureus 2019 Feb 22;11(2):e4121. Epub 2019 Feb 22.

Hematology and Oncology, University of Missouri-Kansas City School of Medicine, Kansas City, USA.

Anemia is a common finding in alcoholics. It is often multifactorial and caused by a combination of liver dysfunction, ineffective erythropoiesis, and poor nutrition. Zieve's syndrome (ZS) is a clinical syndrome that presents with a triad of jaundice, hemolytic anemia, and hyperlipidemia secondary to alcohol use. Herein, we present a case of a 58-year-old male with a history of liver cirrhosis who presented after a fall due to binge drinking and was found to have severe anemia. Workup was consistent with hemolytic anemia with no source of active bleeding. The patient was managed with supportive treatment and blood transfusions which improved his anemia. However, given his advanced liver disease, he developed encephalopathy and subsequently severe aspiration pneumonia. He died 18 days after admission.
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http://dx.doi.org/10.7759/cureus.4121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478496PMC
February 2019

Diffuse Large B-cell Lymphoma Presenting as Bilateral Renal Masses: Successful Treatment with Dose-adjusted REPOCH (Rituximab, Etoposide, Prednisone, Vincristine, Cyclophosphamide, Doxorubicin) Chemotherapy Regimen.

Cureus 2019 Jan 2;11(1):e3814. Epub 2019 Jan 2.

Hematology and Oncology, Saint Luke's Hospital, Kansas City, USA.

Diffuse large B-cell lymphoma (DLBL) is an aggressive type of non-Hodgkin lymphoma (NHL). Renal involvement in NHL is not uncommon in advanced stages; however, it is rare to have kidneys affected early in the course of the disease. Usual chemotherapy regimen for DLBL is rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone (R-CHOP). This is a case of a 50-year-old female diagnosed with DLBL who presented with bilateral renal involvement at disease onset and also underwent complete remission after six cycles of dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (DA-REPOCH). Limited data exist on outcomes of patients with DLBL and renal disease who are treated with high-intensity regimes such as DA-REPOCH. It would be worth looking further into outcomes of DLBL patients especially with renal involvement on DA-REPOCH. Multicenter trials are required to demonstrate which of the two chemotherapy regimens (R-CHOP vs. DA-REPOCH) have better progression-free survival in this particular subset of patients.
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http://dx.doi.org/10.7759/cureus.3814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402740PMC
January 2019

Cladribine in the remission induction of adult acute myeloid leukemia: where do we stand?

Ann Hematol 2019 Mar 23;98(3):561-579. Epub 2018 Nov 23.

NCI Community Oncology Research Program - Kansas City (NCORP-KC), 4121 W 83rd St #259, Prairie Village, Kansas, USA.

The combination of cytarabine and an anthracycline has been the standard of care for the induction of remission in acute myeloid leukemia (AML). The response to treatment and survival of adult patients with AML are still variable and depend on multiple factors. Therefore, there have been many efforts to improve the response to treatment and survival rates by either increasing the cytarabine dose or adding a third agent to the standard induction chemotherapy regimen. Unfortunately, attempts to improve response and survival have been mostly unsuccessful. Recent clinical trials and retrospective studies explored the addition of cladribine to standard induction chemotherapy for AML. Some of these studies showed higher rates of complete remission, and one showed improved survival. In this review, we will discuss the antileukemic properties of cladribine and summarize the recent clinical data regarding its incorporation into the induction therapy for adult AML.
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http://dx.doi.org/10.1007/s00277-018-3562-8DOI Listing
March 2019

Posterior reversible encephalopathy syndrome while receiving irinotecan with fluorouracil and folinic acid for metastatic gastric cancer.

BJR Case Rep 2018 17;4(1):20170033. Epub 2017 Nov 17.

Department of Internal medicine-Division of gastroenterology, Henry Ford Health System, Gastroenterology, Detroit, MI, USA.

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiographic syndrome with seizures, headache, altered mental status and visual disturbances. It is typically associated with posterior cerebral white matter oedema on neuroimaging. There is an increasing number of cases of PRES reported with different chemotherapeutic protocols. However, PRES is rarely reported in association with irinotecan, fluorouracil and folinic acid (FOLFIRI). We report a 28-year-old female patient with a history of Stage IV gastric cancer who presented with abdominal pain and recurrent vomiting that was thought to be related to a partial intestinal obstruction secondary to peritoneal metastasis. Eventually, she was treated with FOLFIRI. A few hours after initiation of the fluorouracil infusion in the second cycle, she developed a tonic-clonic seizure. MRI of the brain showed multiple bilateral and flair hyperintense cortical and subcortical lesions suggestive of PRES. Other causes of PRES were excluded, as well as brain metastasis. Unfortunately, the patient developed septic shock and died a few days after her presentation.
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http://dx.doi.org/10.1259/bjrcr.20170033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159153PMC
November 2017

infection in oncology patients: epidemiology, pathophysiology, risk factors, diagnosis, and treatment.

Hosp Pract (1995) 2018 Dec 15;46(5):266-277. Epub 2018 Oct 15.

c Henry Ford Health System - Internal Medicine-Gastroenterology , USA.

infection (CDI) is one of the most common healthcare-associated infections in the United States. Its incidence has been increasing in the recent years despite preventative measures. CDI increases annual expenses by 1.5 billion dollars. Cancer patients are at higher risk to acquire CDI, as explained by their frequent exposure to risk factors. CDI in cancer patients is associated with higher mortality rates and prolonged hospitalization. Furthermore, CDI affects the course of the disease by delaying treatments such as chemotherapy. Chemotherapeutics drugs are considered independent risk factors for CDI. This review discusses infection in cancer patients, including those who are receiving chemotherapy. Herein, we summarize recent data regarding the epidemiology, risk factors, including chemotherapy regimens, pathogenesis, diagnostic techniques and treatment options, including newer agents. : A literature search was performed using the PubMed and Google Scholar databases. The MeSH terms utilized in different combinations were '', 'neoplasia/cancer/oncology', 'chemotherapy', 'diagnosis', and 'treatment', in addition to looking up each treatment option individually to generate a comprehensive search. The articles were initially screened by title alone, followed by screening through abstracts. Full texts of pertinent articles (including letters to editors, case reports, case series, cohort studies, and clinical trials) were included in this review.
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http://dx.doi.org/10.1080/21548331.2018.1533673DOI Listing
December 2018

Pylephlebitis Caused by Actinomyces Bacteremia.

Cureus 2018 Jun 26;10(6):e2887. Epub 2018 Jun 26.

Internal Medicine/Gastroenterology, Henry Ford Health System, Detroit, USA.

Pylephlebitis is a thrombophlebitis of the portal vein or its branches, which usually occurs as a complication of intra-abdominal infections that are drained by the portal vein, most commonly as a result of diverticulitis or appendicitis. Diagnosis of pylephlebitis is achieved by visualizing a portal vein thrombosis in a patient with bacteremia or a recent intra-abdominal infection. Many microorganisms have been reported to cause this infection. However, Actinomyces has never been reported before as a cause of pylephlebitis. Here, we describe a case of a 56-year-old female who had pylephlebitis that was caused by Actinomyces bacteremia and was treated with intravenous antibiotics.
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http://dx.doi.org/10.7759/cureus.2887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110410PMC
June 2018

Metastatic Lung Adenocarcinoma Presenting with Hypereosinophilia.

Cureus 2018 Jun 22;10(6):e2866. Epub 2018 Jun 22.

Internal Medicine/Gastroenterology, Henry Ford Health System, Detroit, USA.

Lung cancer is one of the most common malignancies in both male and female patients. It is classified into small cell lung cancers and non-small cell lung cancers. Lung adenocarcinoma is a subtype of non-small cell lung cancer and accounts for the highest prevalence of lung cancer. Eosinophils are white blood cells (WBCs) that originate from the granulocytic lineage. Hypereosinophilia is a rare condition characterized by an absolute eosinophil count (AEC) of more than 1500 cells/µL. This is different from eosinophilia, which is defined as an absolute eosinophil count of more than 500 cells/µL. Hypereosinophilia is associated with several conditions, including allergic disorders, helminth infections, rheumatologic disorders, and hematologic malignancies. Paraneoplastic eosinophilia is a rare finding in solid malignancies. Herein, we report the case of a 55-year-old male who presented with shortness of breath and chest pain and whose workup showed metastatic lung adenocarcinoma associated with hypereosinophilia in the absence of a primary bone marrow disorder.
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http://dx.doi.org/10.7759/cureus.2866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107036PMC
June 2018

Recurrent Gastric Gastrointestinal Stromal Tumor in a Patient with Neurofibromatosis.

Cureus 2018 Jun 21;10(6):e2854. Epub 2018 Jun 21.

Department of Gastroenterology, East Tennessee State University, Johnson City, USA.

Neurofibromatosis type 1 is an autosomal dominant neurocutaneous disorder characterized by a mutation of the neurofibromin 1 (NF1) gene, resulting in increased susceptibility for multiple tumors, namely, gastrointestinal stromal tumors (GISTs)-the most common types of mesenchymal neoplasms in the gastrointestinal tract. Despite these tumors' predilection for the stomach, it seems to be the least likely part of the gastrointestinal (GI) tract to be affected in cases of neurofibromatosis. Herein, we report a case of a 61-year-old male patient with known neurofibromatosis, who presented with acute blood loss anemia due to a recurrent gastric GIST, requiring partial gastrectomy due to its size and multiple recurrences.
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http://dx.doi.org/10.7759/cureus.2854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104896PMC
June 2018

Hemophagocytic Lymphohistiocytosis Complicating Systemic Sarcoidosis.

Cureus 2018 Jun 19;10(6):e2838. Epub 2018 Jun 19.

Department of Internal Medicine/Gastroenterology, Henry Ford Health System, Detroit, USA.

Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome characterized by histiocyte proliferation and hemophagocytosis. Primary HLH is caused by genetic defects, whereas secondary HLH occurs in the setting of underlying diseases, such as infections, malignancies, or rheumatic diseases. Rheumatic diseases, such as systemic juvenile arthritis or systemic lupus erythematosus, have been associated with HLH. However, the association between sarcoidosis and HLH has been rarely reported in the literature. Herein, we report a case of a 36-year-old female who was recently diagnosed with sarcoidosis, and she developed fatal HLH that was not responsive to high-dose steroids.
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http://dx.doi.org/10.7759/cureus.2838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101461PMC
June 2018

Fidaxomicin vs Vancomycin for the Treatment of a First Episode of Clostridium Difficile Infection: A Meta-analysis and Systematic Review.

Cureus 2018 Jun 11;10(6):e2778. Epub 2018 Jun 11.

Department of Gastroenterology, East Tennessee State University, Johnson City, USA.

Clostridium difficile infection (CDI) continues to possess a significant disease burden in the United States (US) as well as all over the world. Given the increase in severity and recurrence rate, the decrease in cure rate, and the fact that the virulent ribotype 027 strain remains one of the most commonly identified strains in the US, the Infectious Diseases Society of America (IDSA) published a clinical practice guideline in February 2018 moving away from metronidazole as the first-line treatment for initial CDI and recommending either oral vancomycin or fidaxomicin. The aim of this study is to evaluate the clinical data available comparing the efficacy of primary treatment of CDI between those two antibiotics. We performed a PubMed, PubMed Central, and ScienceDirect database search without restriction to regions, publication types, or languages. A comprehensive literature search was performed from January 1, 1980 up to March 20, 2018. We used the following keywords in different combinations: Clostridium difficile, Clostridium difficile infection, CDI, C. diff, C. difficile, fidaxomicin, vancomycin, pseudomembranous colitis, and antibiotic-associated colitis. The search was limited to human studies. Data were independently extracted by two reviewers with disagreements resolved by a third author. We pooled an odds ratio (OR) on two primary outcomes: Clinical cure rate and rate of recurrence during the follow-up period. The computer search was also supplemented with manual searches by the authors of the retrieved review articles and primary studies. The search phrase "((Clostridium difficile) AND vancomycin) AND fidaxomicin" had the highest yield results. We identified four observational studies with a total of 2,303 patients with CDI that met our inclusion criteria. Compared with vancomycin, fidaxomicin use was associated with a significantly lower recurrence of CDI with a pooled OR of 0.47 (95% confidence interval (CI), 0.37 - 0.60, I2 = 0). On the other hand, there was no significant association of fidaxomicin use with CDI cure rate compared to vancomycin with a pooled OR of 1.22 (95% CI, 0.93 - 1.60, I2 = 0). In light of the recently updated clinical practice guidelines by the IDSA, our review suggests that fidaxomicin has a more sustained clinical response with a statistically significant lower recurrence rate. Although fidaxomicin appears to be the better drug with statistical significance, its cost-effectiveness continues to be an ongoing controversy. More randomized clinical trials are needed to shed light on this matter to assess if there is any clinical significance in fidaxomicin superiority.
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http://dx.doi.org/10.7759/cureus.2778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089486PMC
June 2018

A Case of Multiple Myeloma Associated with Extramedullary Plasmacytoma of the Gallbladder Manifesting as Acute Cholecystitis.

Cureus 2018 May 25;10(5):e2688. Epub 2018 May 25.

Department of Internal Medicine-Gastroenterology, Henry Ford Health System, DETROIT, USA.

Multiple myeloma (MM) is a common hematological malignancy that represents 1% of all cancers. MM is distinguished from other plasma cell disorders by prominent bone marrow involvement and systemic organ damage. Extramedullary plasmacytomas of the gall bladder (GB) or biliary ducts, whether solitary or in association with MM, are very rare. We report a case of a 66-year-old female with a history of refractory MM who presented with right upper quadrant abdominal pain. Her laboratory evaluation revealed an abnormal liver panel and lactic acidosis. Abdominal ultrasonography was consistent with acute cholecystitis with no evidence of biliary obstruction or abnormal liver parenchyma. An open cholecystectomy with liver biopsy was performed. The histological evaluation revealed involvement of the GB submucosa and serosa, as well as the liver parenchyma by abnormal plasma cells with lambda light chain restriction. Congo red stain for the GB sample was positive. The patient declined further treatment for MM and was discharged home with comfort measures.
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http://dx.doi.org/10.7759/cureus.2688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059516PMC
May 2018

Trastuzumab-associated Posterior Reversible Encephalopathy Syndrome.

Cureus 2018 May 24;10(5):e2686. Epub 2018 May 24.

Hematology and Oncology, University of Missouri Kansas City School of Medicine, Kansas City, USA.

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiographic syndrome that presents with neurological manifestations, including seizures, headache, or confusion, and is associated with posterior cerebral white matter edema on imaging. PRES is typically a benign and reversible condition. However, PRES can be fatal or associated with permanent deficits. Numerous conditions are associated with PRES, including hypertensive encephalopathy, renal diseases, and cytotoxic or immunosuppressant drugs. Recently, many case reports described the association between PRES and chemotherapeutic agents. However, trastuzumab-associated PRES is rarely reported. Herein, we report a case of a 51-year-old female with a history of metastatic gastric cancer who developed seizures while being treated with trastuzumab, and neuroimaging confirmed the diagnosis of PRES.
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http://dx.doi.org/10.7759/cureus.2686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059531PMC
May 2018

Dental Impaction in the Cecum: Case Report and Review of Gastrointestinal Foreign Body Impactions.

Case Rep Gastrointest Med 2018 10;2018:2154879. Epub 2018 Jun 10.

University of Missouri of Kansas City/School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA.

Approximately 20% of the adult population in the United States wears dentures. Foreign body ingestions, including dentures, are not uncommon. Although the majority of all ingested foreign bodies pass spontaneously through the gastrointestinal tract, impaction may occur, especially with physiologic constrictions, angulations, or stenosis. The esophagus is the most common site of impaction, whereas colonic impaction is extremely uncommon. We present a case of an 84-year-old male who was referred to the gastroenterology clinic for denture impaction, which lasted for two weeks. The patient had already failed to pass the denture following conservative treatment with laxatives, and repeated abdominal imaging showed the dental plate in the cecum. Colonoscopy was performed three weeks after the ingestion of his dentures, and tripod forceps were used to dislodge the end of the dental plate and ultimately remove it. The patient was asymptomatic for the entire period.
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http://dx.doi.org/10.1155/2018/2154879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015707PMC
June 2018

Current updates in management of Clostridium difficile infection in cancer patients.

Curr Med Res Opin 2019 03 5;35(3):473-478. Epub 2018 Jul 5.

e Department of Hematology & Oncology , St. Luke's Hospital of Kansas City/University of Missouri , Kansas City , MO , USA.

Background: Clostridium difficile infection (CDI) is a significant health burden, now recognized as the leading cause of acquired diarrhea in patients receiving antibiotic therapy. Complications of infection with this pathogen include severe diarrhea, causing electrolyte imbalances, dehydration, hemodynamic instability, toxic megacolon, shock, and death. Hence it is extremely paramount to stay updated on management options for this infection, especially in cancer patients.

Review: This article presents an in-depth review of literature on the treatment modalities available for CDI in cancer patients. Relevant articles highlighting therapeutic and symptomatic management of CDI patients with underlying malignancy have been summarized.

Conclusions: Despite the current options available, more studies are needed to assess the newer therapeutic options that are being employed for populations other than cancer patients.
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http://dx.doi.org/10.1080/03007995.2018.1487389DOI Listing
March 2019

Colopancreatic Fistula: An Uncommon Complication of Recurrent Acute Pancreatitis.

Case Rep Gastrointest Med 2018 27;2018:4521632. Epub 2018 Mar 27.

Gastroenterology, School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA.

Colonic complications, including colopancreatic fistulas (CPFs), are uncommon after acute and chronic pancreatitis. However, they have been reported and are serious. CPFs are less likely to close spontaneously and are associated with a higher risk of complications. Therefore, more definitive treatment is required that includes surgical and endoscopic options. We present a case of a 62-year-old male patient with a history of heavy alcohol intake and recurrent acute pancreatitis who presented with a 6-month history of watery diarrhea and abdominal pain. His abdominal imaging showed a possible connection between the colon and the pancreas. A further multidisciplinary workup by the gastroenterology and surgery teams, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and colonoscopy, resulted in a diagnosis of CPF. A distal pancreatectomy and left hemicolectomy were performed, and the diagnosis of CPF was confirmed intraoperatively. The patient showed improvement afterward.
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http://dx.doi.org/10.1155/2018/4521632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892304PMC
March 2018

Intrahepatic Cholangiocarcinoma Masquerading as Acute Fatty Liver of Pregnancy: A Case Report and Review of the Literature.

Case Reports Hepatol 2018 26;2018:6939747. Epub 2018 Feb 26.

Division of Gastroenterology, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.

Cholangiocarcinoma (CCA) is an uncommon cancer and accounts only for 3% of all gastrointestinal malignancies. In this report, we present a case of an intrahepatic cholangiocarcinoma masquerading as acute fatty liver of pregnancy (AFLP). A 38-year-old female who is 36-week pregnant presented with a 1-week history of headache, nausea, vomiting, and right upper abdominal pain, along with hepatomegaly. Laboratory investigations were remarkable for mild leukocytosis, hyperbilirubinemia, proteinuria, and elevated transaminases and prothrombin time. Ultrasound of the liver revealed hepatomegaly, fatty infiltration, and a right hepatic lobe mass. Based on the overall picture, AFLP was suspected, and the patient underwent delivery by Cesarean section. However, bilirubin and liver enzyme levels gradually increased after delivery. MRI revealed a large dominant hepatic mass along with multiple satellite lesions in both lobes. Biopsy revealed the presence of intrahepatic CCA. CCA presenting during pregnancy is extremely rare with only 9 other cases reported in the literature. Therefore, the signs and symptoms can be easily confused with other more common disorders that occur during pregnancy.
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http://dx.doi.org/10.1155/2018/6939747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846373PMC
February 2018

Achalasia after bariatric Roux-en-Y gastric bypass surgery reversal.

World J Gastroenterol 2017 Oct;23(37):6902-6906

Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, United States.

Achalasia is a rare esophageal motility disorder that is characterized by a loss of peristalsis in the distal esophagus and failure of lower esophageal sphincter relaxation. The risk of developing esophageal motility disorders, including achalasia, following bariatric surgery is controversial and differs based on the type of surgery. Most of the reported cases occurred with laparoscopic adjustable gastric banding. To our knowledge, there are only three reported cases of achalasia after Roux-en-Y gastric bypass and no reported cases after revision of the surgery. We present a case of a 70-year-old female who had a previous history of Roux-en-Y gastric bypass with revision. She presented with persistent nausea and regurgitation for one month. Esophagogastroduodenoscopy showed a dilated esophagus without strictures or stenosis. A barium study was performed after the endoscopy and was suggestive of achalasia. Those findings were confirmed by a manometry. The patient was referred for laparoscopic Heller's myotomy.
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http://dx.doi.org/10.3748/wjg.v23.i37.6902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645623PMC
October 2017

Gastric Metastasis from Renal Cell Carcinoma, Clear Cell Type, Presenting with Gastrointestinal Bleeding.

Case Rep Gastrointest Med 2017 29;2017:5879374. Epub 2017 Aug 29.

Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.

Renal cell carcinoma (RCC) accounts for 80-85% of all primary renal neoplasms. Although RCC can metastasize to any organ, gastric metastases from RCC are exceedingly rare. A 67-year-old male presented with melena and acute blood loss anemia. The patient had a history of RCC that had been treated with a radical nephrectomy. He had a recent myocardial infarction and was receiving double antiplatelet therapy. After hemodynamic stabilization, esophagogastroduodenoscopy showed a polypoid mass in the gastric fundus. The mass was excised. Histological and immunohistochemical evaluation were consistent with clear cell RCC. The polypoid lesion is consistent with a late solitary metastasis.
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http://dx.doi.org/10.1155/2017/5879374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603082PMC
August 2017

V600Q-mutated lung adenocarcinoma with duodenal metastasis and extreme leukocytosis.

World J Clin Oncol 2017 Aug;8(4):360-365

Ayman Qasrawi, Mouhanna Abu Ghanimeh, Omar Abughanimeh, Department of Internal Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64108, United States.

Driver mutations in patients with non-small cell lung cancer (NSCLC) can lead to distinct behaviors and patterns of metastasis. Mutations in the proto-oncogene B-raf () occur in approximately 3% of NSCLC cases. In the literature, reports of patients with lung adenocarcinomas metastasizing to the duodenum are rare, and most of the only 21 cases reported were from before the advent of next-generation sequencing. We present here a case involving a 57-year-old female who had a lytic lesion in her lesser trochanter. Biopsy showed metastatic adenocarcinoma of lung origin. Chest X-ray showed a large left upper lobe mass. Next-generation sequencing analysis confirmed the presence of V600Q mutation. The patient presented with persistent anemia and melena. Esophagogastroduodenoscopy confirmed the presence of duodenal metastasis. She also had suspected paraneoplastic leukemoid reaction. To our knowledge, this is only the second well-documented case of gastrointestinal metastasis from -mutated lung cancer.
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http://dx.doi.org/10.5306/wjco.v8.i4.360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554880PMC
August 2017
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