Chinmay Bera - Academia.edu (original) (raw)

Papers by Chinmay Bera

Research paper thumbnail of Predictors of Respiratory Failure Development in A Multi-Center Cohort of Inpatients with Cirrhosis

American Journal of Gastroenterology

Objectives: Hospitalized patients with cirrhosis can develop respiratory failure (RF), which is a... more Objectives: Hospitalized patients with cirrhosis can develop respiratory failure (RF), which is associated with a poor prognosis but predisposing factors are unclear. Methods: We prospectively enrolled a multi-center North American cirrhosis inpatient cohort and collected admission and in-hospital data [grading per EASL-CLIF scoring system, acute kidney injury (AKI), infections (admission/nosocomial) and albumin use] in an era when terlipressin was not available in North America. Multi-variable regression to predict RF was performed using only admission day, and in-hospital events occurring prior to RF. Results: 511 patients from 14 sites (median 57 years, admission MELD-Na 23) were enrolled: RF developed in 15%; AKI occurred in 24%; and 11% developed nosocomial infections (NI). At admission, patients who developed RF had higher MELD-Na, GI bleeding/AKI-related admission, and prior infections/ascites. During hospitalization, RF developers had higher NI (especially respiratory), albu...

Research paper thumbnail of 652 Albumin Use and Aki Are Independently Associated with Respiratory Distress Development in a Multi-Center Cohort of Inpatients with Cirrhosis

Research paper thumbnail of Sa1602 THE UTILITY OF AMAP SCORE IN PREDICTING HEPATOCELLULAR CARCINOMA RISK IN PATIENTS WITH ADVANCED NON-ALCOHOLIC FATTY LIVER DISEASE

Research paper thumbnail of Global disparities in mortality and liver transplantation in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium

The Lancet Gastroenterology & Hepatology

Research paper thumbnail of Hydrogen sulfide plays a role in the development of hepatopulmonary syndrome

BACKGROUND & AIM OF THE STUDY: Hepatopulmonary syndrome (HPS) is an important pulmonary complicat... more BACKGROUND & AIM OF THE STUDY: Hepatopulmonary syndrome (HPS) is an important pulmonary complication of cirrhosis and portal hypertension, characterized by intrapulmonary vasodilatation (IPVD) leading to impaired oxygenation. Prevalence of this syndrome varied from 5 to 30% in different studies. Hydrogen sulfide (H2S), which is generated by vascular smooth muscle cells and liver by enzyme cystathione γ-lyase, has vasodilatory effect. Current study aimed at determining the prevalence of clinical and subclinical HPS in cryptogenic cirrhosis and establishing the role of H2S in pathogenesis of HPS. METHODS: During the period of January 2012 to November 2013, consecutive patients with cryptogenic cirrhosis were enrolled after a written informed consent. Diagnosis of cirrhosis was made by history, liver function abnormalities, endoscopy and abdominal ultrasonography. Chest x-ray, arterial blood gas analysis (ABG) and contrast echocardiography (CE) was done in all patients. HPS was diagnos...

Research paper thumbnail of Availability and affordability of services affects outcome in hospitalized patients with cirrhosis-results from CLEARED consortium

Research paper thumbnail of Machine learning using simple non-invasive tests of fibrosis and B-mode ultrasound for the prediction of adverse liver-related outcomes in NAFLD

Research paper thumbnail of Management of hepatorenal syndrome in liver cirrhosis: a recent update

Therapeutic Advances in Gastroenterology

Hepatorenal syndrome (HRS) is a serious form of renal dysfunction in patients with cirrhosis and ... more Hepatorenal syndrome (HRS) is a serious form of renal dysfunction in patients with cirrhosis and ascites. It is an important component of the acute-on-chronic liver failure (ACLF) syndrome. Significant recent changes in the understanding of the pathophysiology of renal dysfunction in cirrhosis include the role of inflammation in addition to hemodynamic changes. The term acute kidney injury (AKI) is now adopted to include all functional and structural forms of acute renal dysfunction in cirrhosis, with various stages describing the severity of the condition. Type 1 hepatorenal syndrome (HRS1) is renamed HRS-AKI, which is stage 2 AKI [doubling of baseline serum creatinine (sCr)] while fulfilling all other criteria of HRS1. Albumin is used for its volume expanding and anti-inflammatory properties to confirm the diagnosis of HRS-AKI. Vasoconstrictors are added to albumin as pharmacotherapy to improve the hemodynamics. Terlipressin, although not yet available in North America, is the mos...

Research paper thumbnail of Primary Pancreatic Lymphoma Presenting as Gastric Fistula: A Case Report

Journal of the Pancreas, 2017

Non Hodgkin lymphoma primarily originating from the pancreas is a rare condition. Usual presentat... more Non Hodgkin lymphoma primarily originating from the pancreas is a rare condition. Usual presentations include abdominal pain, anorexia and weight loss. Rarely, it may present as acute pancreatitis. Differentiating from the adenocarcinoma is difficult due to similar presentation and imaging features. Histopathological diagnosis is essential considering the impact on the management and prognostication. Presentation as fistulous communication with stomach or colon has not been reported in the literature. Here, we report a 73-year-male with primary pancreatic lymphoma presenting with gastric fistula.

Research paper thumbnail of {"__content__"=>"Raised plasma levels of HS and nitrate predict intrapulmonary vascular dilations: A preliminary report in patients with cryptogenic cirrhosis.", "sub"=>{"__content__"=>"2"}}

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, May 1, 2018

The role of vasoactive chemicals in the pathogenesis of hepatopulmonary syndrome (HPS), a disorde... more The role of vasoactive chemicals in the pathogenesis of hepatopulmonary syndrome (HPS), a disorder characterized by intrapulmonary vascular dilation (IPVD), is only vaguely elucidated. We aimed to study the association between plasma HS, nitrate levels, and presence and severity of IPVD and HPS. Consecutive adult patients with cryptogenic cirrhosis were evaluated for IPVD (by contrast echocardiography) and for hypoxemia (by arterial blood gas analysis). Plasma HS and nitrate levels were measured in these patients. Fifty-eight patients with cryptogenic cirrhosis (male, 45; median age, range, 45, 16-74 years; Child's class; A, 30; B, 18; C, 10) were enrolled in this study. Thirty-four of the 58 (59%) patients had IPVD and 13 (22%) had HPS (mild, 4; moderate, 5; severe, 2; very severe, 2). Plasma HS levels were significantly higher in patients with IPVD (19.6, 5.7-83 μmol/L) as compared to patients who had no IPVD (12.3, 0-47 μmol/L; p-value 0.03) with an area under receiver operat...

Research paper thumbnail of Safety and Efficacy of Sofosbuvir Based Regimen on Patients With End Stage Renal Disease—A Single Centre Experience

Journal of Clinical and Experimental Hepatology, 2017

Research paper thumbnail of Mo1067 The Use of Self-Expanding Metal Stent for Refractory Variceal Haemorrhage

Gastrointestinal Endoscopy, 2017

Along with errors in meiosis, mitotic errors during post-zygotic cell division contribute to perv... more Along with errors in meiosis, mitotic errors during post-zygotic cell division contribute to pervasive aneuploidy in human embryos. Relatively little is known, however, about the genesis of these errors or their fitness consequences. Rapid technological advances are helping close this gap, revealing diverse molecular mechanisms contributing to mitotic error. These include altered cell cycle checkpoints, aberrations of the centrosome, and failed chromatid cohesion, mirroring findings from cancer biology. Recent studies are challenging the idea that mitotic error is abnormal, emphasizing that the fitness impacts of mosaicism depend on its scope and severity. In light of these findings, technical and philosophical limitations of various screening approaches are discussed, along with avenues for future research.

Research paper thumbnail of Acoustic Radiation Force Imaging Elastography Correlation with Liver Biopsy in the Evaluation of Staging of Liver Fibrosis

Journal of Clinical and Experimental Hepatology, 2016

Resumo: Este artigo trata das crônicas literárias publicadas no jornal Gazeta de Noticias, do Rio... more Resumo: Este artigo trata das crônicas literárias publicadas no jornal Gazeta de Noticias, do Rio de Janeiro, no período de transição para o século vinte. A partir do estudo das crônicas de Machado de Assis, Olavo Bilac e João do Rio procura-se examinar a relação entre os textos e a atividade profissional dos escritores do pré-modernismo brasileiro.

Research paper thumbnail of ARFI Elastography of Liver Can Predict the Presence of Clinically Significant Esophageal Varices

Journal of Clinical and Experimental Hepatology, 2016

platelet count between patients with cirrhosis and NCPF, but total leucocyte count was significan... more platelet count between patients with cirrhosis and NCPF, but total leucocyte count was significantly lower in patients with NCPF compared to patients with cirrhosis (4.1 AE 2.3 vs 6.7 AE 4.3 Â 103/cumm, P = 0.01). TE was high in patients with NCPF compared to healthy controls (6.6 AE 2.7 vs 4.7 AE 0.5 kPa, P = 0.001) but it was significantly low compared to cirrhotic patients (6.6 AE 2.7 vs 48.7 AE 17.8 kPa, P = 0.001). HVPG was significantly low in patients with NCPF compared to patients with cirrhosis (5.6 AE 3.0 vs 16.6 AE 2.8 mmHg, P = 0.001). Conclusion: Transient elastography (Fibroscan) is significantly low in patients with NCPF compared to patients with cirrhosis. It is a useful technique to assess whether variceal bleed is due to Child's A cirrhosis or non-cirrhotic portal fibrosis.

Research paper thumbnail of Tissue Xpert™ MTB/Rif assay is of limited use in diagnosing peritoneal tuberculosis in patients with exudative ascites

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, Jan 4, 2015

Xpert™ MTB/Rif is a multiplex hemi-nested real-time PCR-based assay to detect presence of M. tube... more Xpert™ MTB/Rif is a multiplex hemi-nested real-time PCR-based assay to detect presence of M. tuberculosis within 2 hours of sample collection. The present study aimed at assessing efficacy of Xpert™ MTB/Rif assay for diagnosing peritoneal tuberculosis. Patients with exudative ascites, fluid negative for acid-fast bacilli on auramine O fluorescence staining and unyielding fluid cytology for malignant cells, were included. Ultrasound-guided omental biopsy samples were obtained in all. Xpert™ MTB/Rif assay on tissue samples was assessed against a composite "reference" standard for diagnosis of peritoneal tuberculosis, defined as presence of any of the three-culture showing M tuberculosis, granulomatous inflammation on histology or resolution of ascites with 2 months of antitubercular therapy. During January 2012-July 2013, 28 patients (age:43 ± 15 years; mean ± SD; male:20) were recruited. Serum ascitic albumin gradient was <1.1 in all except in four patients with underlyi...

Research paper thumbnail of To Study the Prevalence of Hepatopulmonary Syndrome (HPS) and Role of Hydrogen Sulfide (H2S) in Its Pathogenesis

Journal of Clinical and Experimental Hepatology, 2014

Research paper thumbnail of Tenofovir Inchronic Hepatitis B – CMC Experience Over 3 Years

Journal of Clinical and Experimental Hepatology, 2013

Research paper thumbnail of Salvage TIPS for refractory variceal bleeding after failed port-systemic shunt surgery in a patient with non cirrhotic portal hypertension

University Journal of Medicine and Medical Specialities, 2016

In patients with refractory variceal bleed and well preserved liver function (Childs class A and ... more In patients with refractory variceal bleed and well preserved liver function (Childs class A and B) surgical shunt and transjugular intrahepatic portosystemic shunt (TIPS) are the only few options available. The long-term survival depends on the severity of underlying liver disease, rather than on the variceal bleeding per se(1). Efficacy of TIPS in preventing variceal bleed is almost similar in comparison to splenorenal shunt (SRS) which may be a more cost effective option(2). Both have been used as salvage therapy for refractory variceal bleeding. We herein report a case of refractory variceal bleed after failed distal spleno-renal shunt managed with emergency TIPS in a patient with non cirrhotic portal hypertension.

Research paper thumbnail of EP1225: Machine Learning Algorithms for Prediction of Nash and Advanced Fibrosis in Nafld Patients

Research paper thumbnail of Predictors of Respiratory Failure Development in A Multi-Center Cohort of Inpatients with Cirrhosis

American Journal of Gastroenterology

Objectives: Hospitalized patients with cirrhosis can develop respiratory failure (RF), which is a... more Objectives: Hospitalized patients with cirrhosis can develop respiratory failure (RF), which is associated with a poor prognosis but predisposing factors are unclear. Methods: We prospectively enrolled a multi-center North American cirrhosis inpatient cohort and collected admission and in-hospital data [grading per EASL-CLIF scoring system, acute kidney injury (AKI), infections (admission/nosocomial) and albumin use] in an era when terlipressin was not available in North America. Multi-variable regression to predict RF was performed using only admission day, and in-hospital events occurring prior to RF. Results: 511 patients from 14 sites (median 57 years, admission MELD-Na 23) were enrolled: RF developed in 15%; AKI occurred in 24%; and 11% developed nosocomial infections (NI). At admission, patients who developed RF had higher MELD-Na, GI bleeding/AKI-related admission, and prior infections/ascites. During hospitalization, RF developers had higher NI (especially respiratory), albu...

Research paper thumbnail of 652 Albumin Use and Aki Are Independently Associated with Respiratory Distress Development in a Multi-Center Cohort of Inpatients with Cirrhosis

Research paper thumbnail of Sa1602 THE UTILITY OF AMAP SCORE IN PREDICTING HEPATOCELLULAR CARCINOMA RISK IN PATIENTS WITH ADVANCED NON-ALCOHOLIC FATTY LIVER DISEASE

Research paper thumbnail of Global disparities in mortality and liver transplantation in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium

The Lancet Gastroenterology & Hepatology

Research paper thumbnail of Hydrogen sulfide plays a role in the development of hepatopulmonary syndrome

BACKGROUND & AIM OF THE STUDY: Hepatopulmonary syndrome (HPS) is an important pulmonary complicat... more BACKGROUND & AIM OF THE STUDY: Hepatopulmonary syndrome (HPS) is an important pulmonary complication of cirrhosis and portal hypertension, characterized by intrapulmonary vasodilatation (IPVD) leading to impaired oxygenation. Prevalence of this syndrome varied from 5 to 30% in different studies. Hydrogen sulfide (H2S), which is generated by vascular smooth muscle cells and liver by enzyme cystathione γ-lyase, has vasodilatory effect. Current study aimed at determining the prevalence of clinical and subclinical HPS in cryptogenic cirrhosis and establishing the role of H2S in pathogenesis of HPS. METHODS: During the period of January 2012 to November 2013, consecutive patients with cryptogenic cirrhosis were enrolled after a written informed consent. Diagnosis of cirrhosis was made by history, liver function abnormalities, endoscopy and abdominal ultrasonography. Chest x-ray, arterial blood gas analysis (ABG) and contrast echocardiography (CE) was done in all patients. HPS was diagnos...

Research paper thumbnail of Availability and affordability of services affects outcome in hospitalized patients with cirrhosis-results from CLEARED consortium

Research paper thumbnail of Machine learning using simple non-invasive tests of fibrosis and B-mode ultrasound for the prediction of adverse liver-related outcomes in NAFLD

Research paper thumbnail of Management of hepatorenal syndrome in liver cirrhosis: a recent update

Therapeutic Advances in Gastroenterology

Hepatorenal syndrome (HRS) is a serious form of renal dysfunction in patients with cirrhosis and ... more Hepatorenal syndrome (HRS) is a serious form of renal dysfunction in patients with cirrhosis and ascites. It is an important component of the acute-on-chronic liver failure (ACLF) syndrome. Significant recent changes in the understanding of the pathophysiology of renal dysfunction in cirrhosis include the role of inflammation in addition to hemodynamic changes. The term acute kidney injury (AKI) is now adopted to include all functional and structural forms of acute renal dysfunction in cirrhosis, with various stages describing the severity of the condition. Type 1 hepatorenal syndrome (HRS1) is renamed HRS-AKI, which is stage 2 AKI [doubling of baseline serum creatinine (sCr)] while fulfilling all other criteria of HRS1. Albumin is used for its volume expanding and anti-inflammatory properties to confirm the diagnosis of HRS-AKI. Vasoconstrictors are added to albumin as pharmacotherapy to improve the hemodynamics. Terlipressin, although not yet available in North America, is the mos...

Research paper thumbnail of Primary Pancreatic Lymphoma Presenting as Gastric Fistula: A Case Report

Journal of the Pancreas, 2017

Non Hodgkin lymphoma primarily originating from the pancreas is a rare condition. Usual presentat... more Non Hodgkin lymphoma primarily originating from the pancreas is a rare condition. Usual presentations include abdominal pain, anorexia and weight loss. Rarely, it may present as acute pancreatitis. Differentiating from the adenocarcinoma is difficult due to similar presentation and imaging features. Histopathological diagnosis is essential considering the impact on the management and prognostication. Presentation as fistulous communication with stomach or colon has not been reported in the literature. Here, we report a 73-year-male with primary pancreatic lymphoma presenting with gastric fistula.

Research paper thumbnail of {"__content__"=>"Raised plasma levels of HS and nitrate predict intrapulmonary vascular dilations: A preliminary report in patients with cryptogenic cirrhosis.", "sub"=>{"__content__"=>"2"}}

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, May 1, 2018

The role of vasoactive chemicals in the pathogenesis of hepatopulmonary syndrome (HPS), a disorde... more The role of vasoactive chemicals in the pathogenesis of hepatopulmonary syndrome (HPS), a disorder characterized by intrapulmonary vascular dilation (IPVD), is only vaguely elucidated. We aimed to study the association between plasma HS, nitrate levels, and presence and severity of IPVD and HPS. Consecutive adult patients with cryptogenic cirrhosis were evaluated for IPVD (by contrast echocardiography) and for hypoxemia (by arterial blood gas analysis). Plasma HS and nitrate levels were measured in these patients. Fifty-eight patients with cryptogenic cirrhosis (male, 45; median age, range, 45, 16-74 years; Child's class; A, 30; B, 18; C, 10) were enrolled in this study. Thirty-four of the 58 (59%) patients had IPVD and 13 (22%) had HPS (mild, 4; moderate, 5; severe, 2; very severe, 2). Plasma HS levels were significantly higher in patients with IPVD (19.6, 5.7-83 μmol/L) as compared to patients who had no IPVD (12.3, 0-47 μmol/L; p-value 0.03) with an area under receiver operat...

Research paper thumbnail of Safety and Efficacy of Sofosbuvir Based Regimen on Patients With End Stage Renal Disease—A Single Centre Experience

Journal of Clinical and Experimental Hepatology, 2017

Research paper thumbnail of Mo1067 The Use of Self-Expanding Metal Stent for Refractory Variceal Haemorrhage

Gastrointestinal Endoscopy, 2017

Along with errors in meiosis, mitotic errors during post-zygotic cell division contribute to perv... more Along with errors in meiosis, mitotic errors during post-zygotic cell division contribute to pervasive aneuploidy in human embryos. Relatively little is known, however, about the genesis of these errors or their fitness consequences. Rapid technological advances are helping close this gap, revealing diverse molecular mechanisms contributing to mitotic error. These include altered cell cycle checkpoints, aberrations of the centrosome, and failed chromatid cohesion, mirroring findings from cancer biology. Recent studies are challenging the idea that mitotic error is abnormal, emphasizing that the fitness impacts of mosaicism depend on its scope and severity. In light of these findings, technical and philosophical limitations of various screening approaches are discussed, along with avenues for future research.

Research paper thumbnail of Acoustic Radiation Force Imaging Elastography Correlation with Liver Biopsy in the Evaluation of Staging of Liver Fibrosis

Journal of Clinical and Experimental Hepatology, 2016

Resumo: Este artigo trata das crônicas literárias publicadas no jornal Gazeta de Noticias, do Rio... more Resumo: Este artigo trata das crônicas literárias publicadas no jornal Gazeta de Noticias, do Rio de Janeiro, no período de transição para o século vinte. A partir do estudo das crônicas de Machado de Assis, Olavo Bilac e João do Rio procura-se examinar a relação entre os textos e a atividade profissional dos escritores do pré-modernismo brasileiro.

Research paper thumbnail of ARFI Elastography of Liver Can Predict the Presence of Clinically Significant Esophageal Varices

Journal of Clinical and Experimental Hepatology, 2016

platelet count between patients with cirrhosis and NCPF, but total leucocyte count was significan... more platelet count between patients with cirrhosis and NCPF, but total leucocyte count was significantly lower in patients with NCPF compared to patients with cirrhosis (4.1 AE 2.3 vs 6.7 AE 4.3 Â 103/cumm, P = 0.01). TE was high in patients with NCPF compared to healthy controls (6.6 AE 2.7 vs 4.7 AE 0.5 kPa, P = 0.001) but it was significantly low compared to cirrhotic patients (6.6 AE 2.7 vs 48.7 AE 17.8 kPa, P = 0.001). HVPG was significantly low in patients with NCPF compared to patients with cirrhosis (5.6 AE 3.0 vs 16.6 AE 2.8 mmHg, P = 0.001). Conclusion: Transient elastography (Fibroscan) is significantly low in patients with NCPF compared to patients with cirrhosis. It is a useful technique to assess whether variceal bleed is due to Child's A cirrhosis or non-cirrhotic portal fibrosis.

Research paper thumbnail of Tissue Xpert™ MTB/Rif assay is of limited use in diagnosing peritoneal tuberculosis in patients with exudative ascites

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, Jan 4, 2015

Xpert™ MTB/Rif is a multiplex hemi-nested real-time PCR-based assay to detect presence of M. tube... more Xpert™ MTB/Rif is a multiplex hemi-nested real-time PCR-based assay to detect presence of M. tuberculosis within 2 hours of sample collection. The present study aimed at assessing efficacy of Xpert™ MTB/Rif assay for diagnosing peritoneal tuberculosis. Patients with exudative ascites, fluid negative for acid-fast bacilli on auramine O fluorescence staining and unyielding fluid cytology for malignant cells, were included. Ultrasound-guided omental biopsy samples were obtained in all. Xpert™ MTB/Rif assay on tissue samples was assessed against a composite "reference" standard for diagnosis of peritoneal tuberculosis, defined as presence of any of the three-culture showing M tuberculosis, granulomatous inflammation on histology or resolution of ascites with 2 months of antitubercular therapy. During January 2012-July 2013, 28 patients (age:43 ± 15 years; mean ± SD; male:20) were recruited. Serum ascitic albumin gradient was <1.1 in all except in four patients with underlyi...

Research paper thumbnail of To Study the Prevalence of Hepatopulmonary Syndrome (HPS) and Role of Hydrogen Sulfide (H2S) in Its Pathogenesis

Journal of Clinical and Experimental Hepatology, 2014

Research paper thumbnail of Tenofovir Inchronic Hepatitis B – CMC Experience Over 3 Years

Journal of Clinical and Experimental Hepatology, 2013

Research paper thumbnail of Salvage TIPS for refractory variceal bleeding after failed port-systemic shunt surgery in a patient with non cirrhotic portal hypertension

University Journal of Medicine and Medical Specialities, 2016

In patients with refractory variceal bleed and well preserved liver function (Childs class A and ... more In patients with refractory variceal bleed and well preserved liver function (Childs class A and B) surgical shunt and transjugular intrahepatic portosystemic shunt (TIPS) are the only few options available. The long-term survival depends on the severity of underlying liver disease, rather than on the variceal bleeding per se(1). Efficacy of TIPS in preventing variceal bleed is almost similar in comparison to splenorenal shunt (SRS) which may be a more cost effective option(2). Both have been used as salvage therapy for refractory variceal bleeding. We herein report a case of refractory variceal bleed after failed distal spleno-renal shunt managed with emergency TIPS in a patient with non cirrhotic portal hypertension.

Research paper thumbnail of EP1225: Machine Learning Algorithms for Prediction of Nash and Advanced Fibrosis in Nafld Patients