Karim Qumosani - Academia.edu (original) (raw)
Papers by Karim Qumosani
JAMA Network Open
IMPORTANCE Trainees routinely participate in colonoscopy procedures, yet whether their involvemen... more IMPORTANCE Trainees routinely participate in colonoscopy procedures, yet whether their involvement is positively or negatively associated with procedural quality is unknown because prior studies involved small number of trainees and/or supervisors, lacked generalizability, and/or failed to adjust for potential confounders. OBJECTIVE To assess the association between trainee participation and colonoscopy quality metrics. DESIGN, SETTING, AND PARTICIPANTS This multicenter population-based cohort study was conducted at 21 academic and community hospitals between April 1, 2017, and October 31, 2018, among consecutive adult patients undergoing colonoscopy. Procedures performed by endoscopists who did not supervise trainees were excluded. Statistical analysis was performed from April 3, 2017, to October 31, 2018. EXPOSURE Participation by a trainee, defined as a resident or fellow enrolled in a gastroenterology or general surgery training program. MAIN OUTCOMES AND MEASURES The primary outcome was the adenoma detection rate (ADR), and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), cecal intubation rate (CIR), and perforation rate. RESULTS A total of 35 499 colonoscopies (18 989 women [53.5%]; mean [SD] patient age, 60.0 [14.1] years) were performed by 71 physicians (mean [SD] time in practice, 14.0 [9.3] years); 5941 colonoscopies (16.7%) involved trainees. There were no significant differences in the ADR (26.4% vs 27.3%; P = .19), CIR (96.7% vs 97.2%; P = .07), and perforation rate (0.05% vs 0.06%; P = .82) when trainees participated vs when they did not participate, whereas the the ssPDR (4.4% vs 5.2%;
Obstetric Medicine, 2020
Cirrhosis is a multisystemic condition in which pregnancy is uncommon; however, the combination m... more Cirrhosis is a multisystemic condition in which pregnancy is uncommon; however, the combination may lead to a higher incidence of spontaneous fetal loss and complications such as progressive jaundi...
Annals of Hepatology
Sirolimus is an approved anti-rejection agent following liver or kidney transplantation that work... more Sirolimus is an approved anti-rejection agent following liver or kidney transplantation that works through inhibition of the mammalian target of rapamycin (mTOR). As sirolimus functions through a pathway independent of calcineurin inhibition, it may have less potential for nephrotoxicity and carcinogenesis. That being said, there are a myriad of potential adverse effects reported with sirolimus, many of which are severe and unknown or poorly understood. Herein we present a case of sirolimus causing a serious but uncommon adverse event in an adult liver transplant recipient; the adverse event in this instance unfortunately resulted in significant medical testing and morbidity. The adverse event profile of sirolimus is summarized through review of available evidence.
BMC Gastroenterology
Background Transplantation offers the best survival for patients with end stage organ disease. Tr... more Background Transplantation offers the best survival for patients with end stage organ disease. Transplant of hepatitis C virus (HCV) nucleic acid test (NAT) positive organs into negative recipients is a novel strategy that can expand the donor pool. We aim to evaluate our centre’s experience. Methods We preformed a retrospective review of anti-HCV NAT positive and negative organs into negative recipients transplanted over 27 months. Primary outcome was the success rate of eradication of HCV post-transplant. Secondary outcomes were rate of transmission of HCV, treatment adverse events, and graft failure. Results 33 anti-HCV positive organs were transplanted into negative recipients. 22 (66.7%) were NAT positive. Median recipients age was 49 years (interquartile range [IQR] 44.5–62.0) with the majority being males (57.6%). NAT positive organ transplantations included 16 kidneys, 3 livers, 1 kidney-pancreas, 1 liver-kidney, and 1 heart. The most common HCV genotype was 1a (59.1%). The ...
Journal of the Canadian Association of Gastroenterology
Background: Inhibitors of tumor necrosis factor alpha (anti-TNF alpha) are an important component... more Background: Inhibitors of tumor necrosis factor alpha (anti-TNF alpha) are an important component of treatment of number of inflammatory conditions. However, multiple adverse effects have been identified with the growing use of these agents and the prolonged follow up. Autoimmunity has been linked to Infliximab. This includes Lupus, Vasculitis and interstitial lung disease. There are a few reports in the literature regarding infliximab induced autoimmune hepatitis. We report an interesting case of infliximab-induced autoimmune hepatitis that was successfully treated by discontinuation of infliximab. On the other hand, Infliximab induced autoimmune hepatitis can be quite dramatic. Withdrawal of infliximab and even steroid treatment might not be sufficient to reverse the process and patients might eventually need liver transplant. We are reporting a second unfortunate case where infliximab induced autoimmune hepatitis leads to fulminant liver failure requiring liver transplant. Aims: To increase the awareness a potential side effect and improve early identification and treatment. Methods: Case report and review of the literature. Results: A 57 years old lady with a 1-year history of Crohn's disease, maintained on Infliximab, started 4 months prior to her presentation. She was referred to our hepatology clinic because of elevated liver enzymes. The patient was a symptomatic. Her investigations showed elevated liver enzymes as well as positive autoimmune markers. A liver biopsy was done. The biopsy Excluded element of chronicity, and the acute insult was related to Infliximab. Inflixamab was stopped and the patient was started on Vidolizumab. Her liver enzymes came down to a normal level. The second case is a 69 years old lady with a 13 years history of fistulizing Crohn's disease with multiple small bowel resections and fistulectomy. The patient was started on Infliximab 3 months prior to her presentation and than she was noticed to be jaundiced. Subsequently, a blood work showed elevated liver enzymes with positive autoimmune markers. Imaging showed no intra or extra hepatic obstructions.During her hospitalization she showed further elevation of liver enzymes with deterioration of synthetic liver function. Additionally, The patient developed hepatorenal syndrome and encephalopathy. She was started on prednisone 20 mg daily without significant improvement. Liver biopsy was done and showed no evidence of chronicity with evidence of prominent plasma cells infiltrate suggestive of autoimmune hepatitis. Our transplant team evaluated the patient and a she underwent a liver transplant. Conclusions: Early recognition of this entity prevents further sequela and unnecessary investigations. The presentation of infliximab induced autoimmune hepatitis can range from mild elevation of liver enzyme that can respond to discontinuation of Infliximab to a fulminant liver failure.
Journal of the Canadian Association of Gastroenterology
Transplantation Proceedings
BMC Gastroenterology
Background IgG4-related disease involvement of the digestive tract is very rare. In few reported ... more Background IgG4-related disease involvement of the digestive tract is very rare. In few reported cases of isolated gastric/duodenal IgG4-related disease, none of which resulted in luminal obstruction. Case presentation A 59 years old female presented with longstanding gastrointestinal symptoms. CT showed mural thickening of the proximal duodenum. Gastroscopy showed antral ulcer extending into the duodenum with outlet obstruction and biopsy showed acute on chronic duodenitis. Whipple’s procedure was performed and IgG4-related disease was diagnosed on final pathology. Symptoms were revolved on mycophenolate mofetil and prednisone with no recurrence. Conclusions Our case is the only reported case with gastric outlet obstruction secondary to gastroduodenal IgG4-related disease. The diagnosis should be considered in the differential diagnosis of unexplained duodenal stricture, gastric outlet obstruction or gastrointestinal ulceration. IgG4-related disease usually responds to steroids but...
BMC Gastroenterology
Background Liver transplantation (LT) remains the curative treatment for symptomatic Polycystic L... more Background Liver transplantation (LT) remains the curative treatment for symptomatic Polycystic Liver Disease (PCLD) patients and is associated with excellent survival rates. The aim of the study is to review the Ontario experience in LT for PCLD. Methods A retrospective study was performed from pre-existing LT databases from the LT Units at Toronto General Hospital and London Health Sciences Center, which are the two LT programs in Ontario, Canada. This database contains demographic, clinical parameters and follow-up of all patients transplanted for PCLD. Data was extracted for patients who underwent LT between January 2000–April 2017 and included follow up until December 31st, 2018. Results A total of 3560 patients underwent LT, of whom 51 (1.4%) had PCLD and met inclusion criteria. 43 (84%) of these patients were female. The median physiologic Model for End Stage Liver Disease (MELD-Na) score at time of referral was 13 (IQR = 7–22), however all patients required MELD-Na exception...
American Journal of Gastroenterology
Transplantation Proceedings
Inflammatory Bowel Diseases
Background Patients with inflammatory bowel disease (IBD) post–liver transplant (LT) may have bow... more Background Patients with inflammatory bowel disease (IBD) post–liver transplant (LT) may have bowel inflammation requiring biologic therapy. We aimed to evaluate the safety of combination biologic and antirejection therapy in IBD patients after LT from a tertiary center case series and an updated literature review. Methods Inflammatory bowel disease patients undergoing LT between 1985 and 2018 and requiring combination biologic and antirejection therapy post-LT were identified from the London Health Sciences Transplant Registry (Ontario, Canada). Safety outcomes were extracted by medical chart review. For an updated literature review, EMBASE, Medline, and CENTRAL were searched to identify studies evaluating the safety of combination biologic and antirejection therapy in IBD patients. Results In the case series, 19 patients were identified. Most underwent LT for primary sclerosing cholangitis (PSC; 14/19, 74%) treated with anti-integrins (8/19, 42%) or tumor necrosis factor α (TNF) a...
Clinical Case Reports
This is an open access article under the terms of the Creative Commons Attribution License, which... more This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Canadian Journal of Nutrition, 2016
Background: Hepatic encephalopathy (HE) is common and is characterized by several neuropsychiatri... more Background: Hepatic encephalopathy (HE) is common and is characterized by several neuropsychiatric symptoms ranging from mild impairments in cognitive function to coma, experienced by cirrhotic patients. Advanced encephalopathy or overt hepatic encephalopathy is associated with poor outcomes including increased mortality, but consequences of reduced physical and mental function as well as reductions in quality of life can be just as devastating. The cost of hepatic encephalopathy for the healthcare system is exorbitant. While therapies exist for severe encephalopathy, increasingly researchers are aiming to prevent clinically overt hepatic encephalopathy. There is growing interest in the use of probiotic products, which have an excellent physiological basis to reduce the absorption of ammonia, a key neurotoxin in precipitating encephalopathy. The present review discusses hepatic encephalopathy, the various classifications, and reviews literature for probiotics studying the effects on preventing severe encephalopathy. We subsequently postulate on the potential studies and strategies for research studies moving forward.
Gastroenterology & hepatology, 2013
Immunosuppressive therapies are indicated following liver transplantation (LT) to prevent graft l... more Immunosuppressive therapies are indicated following liver transplantation (LT) to prevent graft loss through rejection, and these same agents also may have a role in the management of inflammatory bowel disease (IBD). The aims of this study were to examine the effects of immunosuppression following LT on IBD activity and to identify markers of IBD control post-LT in patients with IBD who underwent LT for primary sclerosing cholangitis (PSC). A retrospective analysis of all adult patients with a pre-LT diagnosis of IBD who underwent LT for PSC over a 15-year period was performed. The primary outcome was IBD activity based on symptomatology and endoscopic assessment. Secondary outcomes included recipient mortality and post-LT development of colorectal cancer or small bowel lymphoma. A total of 105 patients underwent LT for PSC, and IBD was diagnosed in 27 (26%) pre-LT. Patients were followed for a mean of 88.5 months. Fourteen (52%) patients had stable IBD, 6 (22%) had worsening disea...
Acta gastro-enterologica Belgica, 2013
JAMA Network Open
IMPORTANCE Trainees routinely participate in colonoscopy procedures, yet whether their involvemen... more IMPORTANCE Trainees routinely participate in colonoscopy procedures, yet whether their involvement is positively or negatively associated with procedural quality is unknown because prior studies involved small number of trainees and/or supervisors, lacked generalizability, and/or failed to adjust for potential confounders. OBJECTIVE To assess the association between trainee participation and colonoscopy quality metrics. DESIGN, SETTING, AND PARTICIPANTS This multicenter population-based cohort study was conducted at 21 academic and community hospitals between April 1, 2017, and October 31, 2018, among consecutive adult patients undergoing colonoscopy. Procedures performed by endoscopists who did not supervise trainees were excluded. Statistical analysis was performed from April 3, 2017, to October 31, 2018. EXPOSURE Participation by a trainee, defined as a resident or fellow enrolled in a gastroenterology or general surgery training program. MAIN OUTCOMES AND MEASURES The primary outcome was the adenoma detection rate (ADR), and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), cecal intubation rate (CIR), and perforation rate. RESULTS A total of 35 499 colonoscopies (18 989 women [53.5%]; mean [SD] patient age, 60.0 [14.1] years) were performed by 71 physicians (mean [SD] time in practice, 14.0 [9.3] years); 5941 colonoscopies (16.7%) involved trainees. There were no significant differences in the ADR (26.4% vs 27.3%; P = .19), CIR (96.7% vs 97.2%; P = .07), and perforation rate (0.05% vs 0.06%; P = .82) when trainees participated vs when they did not participate, whereas the the ssPDR (4.4% vs 5.2%;
Obstetric Medicine, 2020
Cirrhosis is a multisystemic condition in which pregnancy is uncommon; however, the combination m... more Cirrhosis is a multisystemic condition in which pregnancy is uncommon; however, the combination may lead to a higher incidence of spontaneous fetal loss and complications such as progressive jaundi...
Annals of Hepatology
Sirolimus is an approved anti-rejection agent following liver or kidney transplantation that work... more Sirolimus is an approved anti-rejection agent following liver or kidney transplantation that works through inhibition of the mammalian target of rapamycin (mTOR). As sirolimus functions through a pathway independent of calcineurin inhibition, it may have less potential for nephrotoxicity and carcinogenesis. That being said, there are a myriad of potential adverse effects reported with sirolimus, many of which are severe and unknown or poorly understood. Herein we present a case of sirolimus causing a serious but uncommon adverse event in an adult liver transplant recipient; the adverse event in this instance unfortunately resulted in significant medical testing and morbidity. The adverse event profile of sirolimus is summarized through review of available evidence.
BMC Gastroenterology
Background Transplantation offers the best survival for patients with end stage organ disease. Tr... more Background Transplantation offers the best survival for patients with end stage organ disease. Transplant of hepatitis C virus (HCV) nucleic acid test (NAT) positive organs into negative recipients is a novel strategy that can expand the donor pool. We aim to evaluate our centre’s experience. Methods We preformed a retrospective review of anti-HCV NAT positive and negative organs into negative recipients transplanted over 27 months. Primary outcome was the success rate of eradication of HCV post-transplant. Secondary outcomes were rate of transmission of HCV, treatment adverse events, and graft failure. Results 33 anti-HCV positive organs were transplanted into negative recipients. 22 (66.7%) were NAT positive. Median recipients age was 49 years (interquartile range [IQR] 44.5–62.0) with the majority being males (57.6%). NAT positive organ transplantations included 16 kidneys, 3 livers, 1 kidney-pancreas, 1 liver-kidney, and 1 heart. The most common HCV genotype was 1a (59.1%). The ...
Journal of the Canadian Association of Gastroenterology
Background: Inhibitors of tumor necrosis factor alpha (anti-TNF alpha) are an important component... more Background: Inhibitors of tumor necrosis factor alpha (anti-TNF alpha) are an important component of treatment of number of inflammatory conditions. However, multiple adverse effects have been identified with the growing use of these agents and the prolonged follow up. Autoimmunity has been linked to Infliximab. This includes Lupus, Vasculitis and interstitial lung disease. There are a few reports in the literature regarding infliximab induced autoimmune hepatitis. We report an interesting case of infliximab-induced autoimmune hepatitis that was successfully treated by discontinuation of infliximab. On the other hand, Infliximab induced autoimmune hepatitis can be quite dramatic. Withdrawal of infliximab and even steroid treatment might not be sufficient to reverse the process and patients might eventually need liver transplant. We are reporting a second unfortunate case where infliximab induced autoimmune hepatitis leads to fulminant liver failure requiring liver transplant. Aims: To increase the awareness a potential side effect and improve early identification and treatment. Methods: Case report and review of the literature. Results: A 57 years old lady with a 1-year history of Crohn's disease, maintained on Infliximab, started 4 months prior to her presentation. She was referred to our hepatology clinic because of elevated liver enzymes. The patient was a symptomatic. Her investigations showed elevated liver enzymes as well as positive autoimmune markers. A liver biopsy was done. The biopsy Excluded element of chronicity, and the acute insult was related to Infliximab. Inflixamab was stopped and the patient was started on Vidolizumab. Her liver enzymes came down to a normal level. The second case is a 69 years old lady with a 13 years history of fistulizing Crohn's disease with multiple small bowel resections and fistulectomy. The patient was started on Infliximab 3 months prior to her presentation and than she was noticed to be jaundiced. Subsequently, a blood work showed elevated liver enzymes with positive autoimmune markers. Imaging showed no intra or extra hepatic obstructions.During her hospitalization she showed further elevation of liver enzymes with deterioration of synthetic liver function. Additionally, The patient developed hepatorenal syndrome and encephalopathy. She was started on prednisone 20 mg daily without significant improvement. Liver biopsy was done and showed no evidence of chronicity with evidence of prominent plasma cells infiltrate suggestive of autoimmune hepatitis. Our transplant team evaluated the patient and a she underwent a liver transplant. Conclusions: Early recognition of this entity prevents further sequela and unnecessary investigations. The presentation of infliximab induced autoimmune hepatitis can range from mild elevation of liver enzyme that can respond to discontinuation of Infliximab to a fulminant liver failure.
Journal of the Canadian Association of Gastroenterology
Transplantation Proceedings
BMC Gastroenterology
Background IgG4-related disease involvement of the digestive tract is very rare. In few reported ... more Background IgG4-related disease involvement of the digestive tract is very rare. In few reported cases of isolated gastric/duodenal IgG4-related disease, none of which resulted in luminal obstruction. Case presentation A 59 years old female presented with longstanding gastrointestinal symptoms. CT showed mural thickening of the proximal duodenum. Gastroscopy showed antral ulcer extending into the duodenum with outlet obstruction and biopsy showed acute on chronic duodenitis. Whipple’s procedure was performed and IgG4-related disease was diagnosed on final pathology. Symptoms were revolved on mycophenolate mofetil and prednisone with no recurrence. Conclusions Our case is the only reported case with gastric outlet obstruction secondary to gastroduodenal IgG4-related disease. The diagnosis should be considered in the differential diagnosis of unexplained duodenal stricture, gastric outlet obstruction or gastrointestinal ulceration. IgG4-related disease usually responds to steroids but...
BMC Gastroenterology
Background Liver transplantation (LT) remains the curative treatment for symptomatic Polycystic L... more Background Liver transplantation (LT) remains the curative treatment for symptomatic Polycystic Liver Disease (PCLD) patients and is associated with excellent survival rates. The aim of the study is to review the Ontario experience in LT for PCLD. Methods A retrospective study was performed from pre-existing LT databases from the LT Units at Toronto General Hospital and London Health Sciences Center, which are the two LT programs in Ontario, Canada. This database contains demographic, clinical parameters and follow-up of all patients transplanted for PCLD. Data was extracted for patients who underwent LT between January 2000–April 2017 and included follow up until December 31st, 2018. Results A total of 3560 patients underwent LT, of whom 51 (1.4%) had PCLD and met inclusion criteria. 43 (84%) of these patients were female. The median physiologic Model for End Stage Liver Disease (MELD-Na) score at time of referral was 13 (IQR = 7–22), however all patients required MELD-Na exception...
American Journal of Gastroenterology
Transplantation Proceedings
Inflammatory Bowel Diseases
Background Patients with inflammatory bowel disease (IBD) post–liver transplant (LT) may have bow... more Background Patients with inflammatory bowel disease (IBD) post–liver transplant (LT) may have bowel inflammation requiring biologic therapy. We aimed to evaluate the safety of combination biologic and antirejection therapy in IBD patients after LT from a tertiary center case series and an updated literature review. Methods Inflammatory bowel disease patients undergoing LT between 1985 and 2018 and requiring combination biologic and antirejection therapy post-LT were identified from the London Health Sciences Transplant Registry (Ontario, Canada). Safety outcomes were extracted by medical chart review. For an updated literature review, EMBASE, Medline, and CENTRAL were searched to identify studies evaluating the safety of combination biologic and antirejection therapy in IBD patients. Results In the case series, 19 patients were identified. Most underwent LT for primary sclerosing cholangitis (PSC; 14/19, 74%) treated with anti-integrins (8/19, 42%) or tumor necrosis factor α (TNF) a...
Clinical Case Reports
This is an open access article under the terms of the Creative Commons Attribution License, which... more This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Canadian Journal of Nutrition, 2016
Background: Hepatic encephalopathy (HE) is common and is characterized by several neuropsychiatri... more Background: Hepatic encephalopathy (HE) is common and is characterized by several neuropsychiatric symptoms ranging from mild impairments in cognitive function to coma, experienced by cirrhotic patients. Advanced encephalopathy or overt hepatic encephalopathy is associated with poor outcomes including increased mortality, but consequences of reduced physical and mental function as well as reductions in quality of life can be just as devastating. The cost of hepatic encephalopathy for the healthcare system is exorbitant. While therapies exist for severe encephalopathy, increasingly researchers are aiming to prevent clinically overt hepatic encephalopathy. There is growing interest in the use of probiotic products, which have an excellent physiological basis to reduce the absorption of ammonia, a key neurotoxin in precipitating encephalopathy. The present review discusses hepatic encephalopathy, the various classifications, and reviews literature for probiotics studying the effects on preventing severe encephalopathy. We subsequently postulate on the potential studies and strategies for research studies moving forward.
Gastroenterology & hepatology, 2013
Immunosuppressive therapies are indicated following liver transplantation (LT) to prevent graft l... more Immunosuppressive therapies are indicated following liver transplantation (LT) to prevent graft loss through rejection, and these same agents also may have a role in the management of inflammatory bowel disease (IBD). The aims of this study were to examine the effects of immunosuppression following LT on IBD activity and to identify markers of IBD control post-LT in patients with IBD who underwent LT for primary sclerosing cholangitis (PSC). A retrospective analysis of all adult patients with a pre-LT diagnosis of IBD who underwent LT for PSC over a 15-year period was performed. The primary outcome was IBD activity based on symptomatology and endoscopic assessment. Secondary outcomes included recipient mortality and post-LT development of colorectal cancer or small bowel lymphoma. A total of 105 patients underwent LT for PSC, and IBD was diagnosed in 27 (26%) pre-LT. Patients were followed for a mean of 88.5 months. Fourteen (52%) patients had stable IBD, 6 (22%) had worsening disea...
Acta gastro-enterologica Belgica, 2013