Yatish Agarwal - Academia.edu (original) (raw)

Papers by Yatish Agarwal

Research paper thumbnail of Cytomorphological findings in drug defaulters of tuberculous lymphadenitis

Research paper thumbnail of Grading of Liver Fibrosis using Shear Wave Elastography and Aminotransferase Platelet Ratio Index in Chronic Viral Hepatitis: A Case-control Study

Journal of Clinical and Diagnostic Research, 2021

Introduction: Liver fibrosis is a progressive disorder that if diagnosed early and staged precise... more Introduction: Liver fibrosis is a progressive disorder that if diagnosed early and staged precisely, allows early clinical intervention that may hinder or slow down the progression to end stage decompensated cirrhosis. Grading of hepatic fibrosis is important not only for diagnosis but also for prognostic evaluation, planning appropriate therapy, and follow-up of patients with chronic viral hepatitis. Liver biopsy has been considered the reference standard for grading liver fibrosis. As liver biopsy is invasive and associated with complications, non invasive serological and imaging techniques like Shear Wave Elastography (SWE) and Aminotransferase Platelet Ratio Index (APRI) have come to the spotlight. Aim: To evaluate SWE alone and together with APRI as a reliable alternative to liver biopsy for diagnosing and grading hepatic fibrosis in chronic viral hepatitis. Materials and Methods: This case control study was conducted over a period of 18 months from October 2017 to March 2019, at a tertiary care hospital in New Delhi, India. Total 120 subjects (60 cases of chronic viral hepatitis and 60 case matched healthy volunteers as controls) were enrolled in the study. Biopsy could not be performed in 10 cases so these cases and their matched controls were excluded from the statistical analysis. SWE was performed using a 1-5 MHz curvilinear transducer (Philips iU22x MATRIX). The APRI and the mean of six SWE measurements (in kilopascals) were calculated for all subjects. The analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: Among all 50 cases of chronic hepatitis who have underwent biopsy, the mean SWE values corresponding to the histopathological grade of fibrosis i.e., F0, F1, F2, F3 and F4 was found to be 4.48±1.05 kPa, 7.16±0.75 kPa, 8.08±1.05 kPa, 8.44±0.47 kPa and 16.01±3.78 kPa, respectively. The mean APRI values of the cases in F1, F2 and F3 grades showed significant overlap (cut off value between 0.5-1.5). Also, when APRI was used along with SWE, does not have a statistically significant contribution to improve its diagnostic accuracy in liver fibrosis grading. Conclusion: Shear wave elastography has high accuracy in detecting and grading of fibrosis. APRI does not appear to have a significant role in the grading of liver fibrosis however it can be combined with SWE for post-treatment follow-up of chronic viral hepatitis patients thus avoiding the need for repeated biopsy.

Research paper thumbnail of MRI of perianal fistulae: a pictorial kaleidoscope

Clinical Radiology, Dec 1, 2015

Perianal fistulae are an abnormal communication between the anorectum and the perianal skin. A se... more Perianal fistulae are an abnormal communication between the anorectum and the perianal skin. A seemingly benign condition, it can be a cause of considerable distress to the patient if it is not mapped out adequately before embarking upon surgical correction. The persistence of residual disease complicates and up-stages the grade of the remnant fistula with increased risk of anal incontinence following surgery secondary to damage to the anal sphincter complex. Magnetic resonance imaging (MRI) can play a critical role in mapping the fistulae tract in relation to the anal sphincter complex and hence, act as a reliable guide for the surgeon to chart the optimised management of perianal fistulae. This review illustrates the role of MRI in the imaging evaluation of perianal fistulae, to facilitate a well-planned surgical course.

Research paper thumbnail of Comparative analysis of airway invasive aspergillosis and endobronchial spread of tuberculosis on high resolution computed tomography

Monaldi archives for chest disease, Oct 25, 2022

https://www.monaldi-archives.org/ Publisher's Disclaimer. E-publishing ahead of print is increasi... more https://www.monaldi-archives.org/ Publisher's Disclaimer. E-publishing ahead of print is increasingly important for the rapid dissemination of science. The Early Access service lets users access peer-reviewed articles well before print / regular issue publication, significantly reducing the time it takes for critical findings to reach the research community. These articles are searchable and citable by their DOI (Digital Object Identifier). The Monaldi Archives for Chest Disease is, therefore, e-publishing PDF files of an early version of manuscripts that undergone a regular peer review and have been accepted for publication, but have not been through the typesetting, pagination and proofreading processes, which may lead to differences between this version and the final one. The final version of the manuscript will then appear on a regular issue of the journal. E-publishing of this PDF file has been approved by the authors.

Research paper thumbnail of Endovascular management and outcomes of aortoiliac occlusive disease

Indian journal of vascular and endovascular surgery, 2021

Introduction: Aorto-iliac Occlusive Disease (AIOD) involves the infra-renal aorta and the iliac a... more Introduction: Aorto-iliac Occlusive Disease (AIOD) involves the infra-renal aorta and the iliac arteries. Recent studies advocate endovascular management in TASC C and D lesions also. It involves balloon angioplasty with or without stent deployment.5 The aim of this retrospective study is to evaluate the results of endovascular balloon angioplasty and primary stenting in patients of AIOD. Methods: Twenty-five patients with Aorto-iliac occlusion disease who met the inclusion criteria during 1-year study period were included. Patients with acute thrombosis, abdominal aorta or iliac artery aneurysm and additional common femoral artery occlusion were excluded. The TASC II classification was used to define the characteristics of the lesions. The baseline data, procedural details and follow-up results were analysed. Results: Amongst 25 patients studied, age ranged from 40-75 years. Self-expanding metallic stent was employed in all patients. Technical success following primary stenting was achieved in all patients. Procedural times for TASC-II A, B, C and D lesions were 90+ 30, 110+ 40, 135+35 and 155+ 45 minutes, respectively. During follow-up, the cumulative primary patency rates at 1 month and 6 months were 100%. Cumulative primary patency rates at 1 year were 91.67%. Conclusion: Short- term outcomes of balloon angioplasty and stenting for Aorto-iliac artery occlusions in terms of primary patency rates were excellent.

Research paper thumbnail of Of divinity, retro dynamics and basic edicts in physician-patient relationship

Astrocyte, 2014

T practice of medicine is probably almost as old as the human race. Just as the first human being... more T practice of medicine is probably almost as old as the human race. Just as the first human beings built homes, created communes, a few men devoted themselves to the job of diagnosing and treating the physical and mental symptoms afflicting sick members of the tribe. The first healers — call them shamans, vaids, hakims, or more generically, physicians — were held in high social esteem, despite the fact that few of their remedies actually worked! The clinical practice in those early days was bereft of any scientific basis, yet, the faith the patient harbored in the powers of his physician helped. The recipes gave relief perhaps due to a placebo effect, while the healer offered hope, encouragement, and time and space for natural healing.

Research paper thumbnail of Renal vasculature: Spectrum of anatomical variations and the significance from a surgeon's standpoint

Astrocyte, 2018

Background: Renal vasculature is known for having a broad spectrum of variants, and some of them ... more Background: Renal vasculature is known for having a broad spectrum of variants, and some of them hold important implications at the time of renal surgeries, particularly for the renal transplant. Materials and Methods: This observational study was performed using multidetector computed tomography (MDCT) angiography in patients with various renal and other abdominal disorders and advised for pathologies in which MDCT angiography was indicated. A total of 760 patients were evaluated. Various parameters that have surgical importance were studied. Results: This study includes 123 (16%) patients that had accessory renal artery on right side and 152 (20%) patients that had on the left side. Among the right-side renal artery patients, 72 (58.5%) were hilar and 51 (41.5%) were polar arteries, and of left-side patients, 94 (61.8%) were hilar and 58 (38.2%) were polar arteries. The average diameter of the right and left renal artery was 5.1 and 5.07 mm, respectively. The average diameter of the right and left accessory renal artery was 2.4 and 2.6 mm, respectively. Early segmentary bifurcation of the right renal artery was seen in 651 patients (85.6%) with 319 (42%) being retro-caval, and early segmentary bifurcation of the left renal artery was seen in 94 patients (12.3%). Double right and left renal veins were seen in 96 (12.6%) and 37 (4.8%) patients, respectively. Late right renal vein confluence was seen in 50.6% of patients (340/671). Late left renal vein confluence was seen in 181 out of 700 patients (25.85%); 60 (7.9%) patients had circum-/retro-aortic renal vein. Conclusion: CT angiography is highly accurate modality for evaluation of renal vasculature. Although the increasing number of laparoscopic nephrectomies being performed as part of renal transplant procedure, it is becoming important for the radiologists to better understand the anatomy, its variations, its implications, and to accurately demonstrate vascular anatomy on imaging to the surgical team.

Research paper thumbnail of Systemic to pulmonary venous collaterals in lung malignancy: Rare acquired right-to-left shunt

Apollo Medicine, Mar 1, 2017

Please cite this article in press as: Rastogi G, et al. Systemic to pulmonary venous collaterals ... more Please cite this article in press as: Rastogi G, et al. Systemic to pulmonary venous collaterals in lung malignancy: Rare acquired right-to-left shunt, Apollo Med.

Research paper thumbnail of The Journey Within

Astrocyte, 2016

f these long years in medicine have taught us anything it is this: The science and practice of cl... more f these long years in medicine have taught us anything it is this: The science and practice of clinical medicine requires a systematic critical analysis of one’s doing at each step. Not just in the present, but equally the recent past! A kind of continuous self-audit. Of the diagnostic and treatment processes employed by the practitioners of medicine, and the resulting outcome and quality of life that the patients end up with.

Research paper thumbnail of Birth of a star

Astrocyte, 2014

ABSTRACT The term Astrocyte is derived from ancient Greek: astron, which means a star, or a flame... more ABSTRACT The term Astrocyte is derived from ancient Greek: astron, which means a star, or a flame; and kutos, hollow vessel, or cell. The present journal will try and live up to this mission. The natural synergy between the house of mind and house of knowledge will allow astrocyte to take on a new connotation. Being an open access journal, it stands tall as a living tribute to the ways of Lao-tzu, the legendary 6th century BC Chinese philosopher, who wrote: If you have knowledge, let others light their candles at it.

Research paper thumbnail of Of medical literature, heartstrings, and a physician′s prayer

Astrocyte, 2014

The amount of writings of a profession is a measure of its vitality and activity, whilst their qu... more The amount of writings of a profession is a measure of its vitality and activity, whilst their quality is a rough indication of its intellectual state. Medical literature . . . is the currency or medium of exchange by which a man contributes to or borrows from the common stock of knowledge and experience, and the volume of this currency and the character of its metal are of the greatest importance to us all.[1]

Research paper thumbnail of Multihued complications in acute pancreatitis: A kaleidoscopic retrospective

Astrocyte, 2014

Acute pancreatitis is a diffuse inflammatory process in and around the pancreas triggered by the ... more Acute pancreatitis is a diffuse inflammatory process in and around the pancreas triggered by the leakage of activated pancreatic secretions. It may remain localized within the pancreatic glandular tissue or spread to involve the adjacent or remote tissue planes and organs. Since the morbidity and mortality of acute pancreatitis is closely related to the extent of intra- and extra-pancreatic complications, cross-sectional contrast-enhanced computed tomography (CECT) imaging plays a major role in assessing the complications, stratifying the severity, and thus, prognosticating the outcome. Early diagnosis of complications allows for timely institution of specific measures that can help decrease the morbidity and mortality. This kaleidoscopic retrospective presents the complications of acute pancreatitis on CECT. The essay may benefit family physicians, surgeons, gastro-intestinal (GI) surgeons and GI physicians who manage such patients in their clinical practice, besides drawing the attention of residents and fellows practicing GI radiology.

Research paper thumbnail of Comparative study of Balthazar Computed Tomography Severity Index and Modified Computed Tomography Severity Index in predicting the outcome of acute pancreatitis

Apollo Medicine, Jun 1, 2014

Objective: To compare the Balthazar CT Severity Index and Modified CT Severity Index in predictin... more Objective: To compare the Balthazar CT Severity Index and Modified CT Severity Index in predicting the outcome of acute pancreatitis. Materials and methods: 150 cases of acute pancreatitis, underwent CECT. The scans were reviewed and scored using both CT indices. Severity parameters included length of hospital stay, need for intervention, occurrence of organ failure, evidence of infection, and mortality. Descriptive statistics were used for baseline characteristics. Chi-square or Fisher's exact tests were used to compare the two indices. Results: Using Balthazar CTSI with the patient outcome, statistically significant correlation was found between the grades and the length of hospital stay (p ¼ 0.011), development of infection (p ¼ 0.018), occurrence of organ failure (p ¼ 0.027), and mortality (p ¼ 0.019). No correlation, however, was obtained between the score and the need for an interventional procedure (p ¼ 0.126). In contrast, the correlation between the grades under the Modified CT Severity Index and outcome was much stronger (p ¼ 0.000 for length of hospital stay, p ¼ 0.004 for development of infection, p ¼ 0.024 for occurrence of organ failure and p ¼ 0.013 for mortality). It could also accurately predict the need for interventions (p ¼ 0.030). Conclusion: The modified CTSI correlates more closely with patient outcome than the CTSI.

Research paper thumbnail of Evaluation of MR Spectroscopy and Diffusion-Weighted MRI in Postmenopausal Bone Strength

Cureus, Sep 21, 2015

Aim: To prospectively investigate the role of MR spectroscopy (MRS) and diffusion-weighted magnet... more Aim: To prospectively investigate the role of MR spectroscopy (MRS) and diffusion-weighted magnetic resonance imaging (DWI) in assessing vertebral marrow changes in postmenopausal women. Materials and Methods: Fifty postmenopausal women, who underwent dual-energy x-ray absorptiometry of the spine, were divided into three bone density groups (normal, osteopenia, and osteoporosis) based on T-score. Both MRS and DWI of the L3 vertebral body were performed to calculate the marrow fat content and apparent diffusion coefficient (ADC). The results were compared between three groups and correlated with BMD. Results: Vertebral marrow fat content was significantly increased in the osteoporotic group when compared with that of the osteopenic group and the normal bone density group. ADC values in the osteoporotic, osteopenic, and normal bone density groups were 338, 408 and 464, respectively, with statistically significant differences (P < 0.001). A statistically significant positive correlation between T-scores and ADC existed (r=0.694, p value <0.001). The vertebral marrow fat content was negatively correlated to the bone density (r=-0.455, p< 0.001) and to marrow ADC (r=-0.302, p < 0.05). Conclusion: The postmenopausal women with osteoporosis exhibited a corresponding increase in vertebral marrow fat content as the bone density decreased. Marrow fat content and ADC were related to the bone density. MRS and DWI are helpful in evaluating the bone marrow changes in postmenopausal women.

Research paper thumbnail of Association of serum calcium levels with clinical severity of ischemic stroke at the time of admission as defined by NIHSS score: A cross-sectional, observational study

Journal of family medicine and primary care, 2022

Research paper thumbnail of Whence clinical guidelines must govern medical practice

Research paper thumbnail of The “reverse breast–oesophagus syndrome”: metastatic carcinosis of breast in oesophageal cancer

BJR|case reports, Nov 1, 2016

A "breast-oesophagus syndrome" has been described previously, wherein breast carcinoma metastasiz... more A "breast-oesophagus syndrome" has been described previously, wherein breast carcinoma metastasizes to the inner layers of the oesophagus. The entity is extremely rare, but rarer still is metastatic breast carcinosis from oesophageal cancer (EC), a clinical event that might be termed as "reverse breast-oesophagus syndrome". Considered as the sixth most lethal malignancy, 50% EC patients present with metastatic disease. However, they rarely ever metastasize to the breast. For that reason, a malignant breast mass, which develops following EC, is often thought of as a second malignancy. We report a 62-year-old female who had EC, who was treated with oesophagectomy 2 years ago, and represented with a painful left breast mass. Radiological evaluation revealed suspicious findings (breast imaging-reporting and data system score of 4C), while cytology demonstrated squamous pearls, consistent with metastatic squamous cell EC, which probably disseminated to the breast at the time of surgery. She was treated with local excision of the breast mass, which is the treatment of choice in isolated metastasis to the breast. Such an unusual presentation reminds us that, in any "radiologically suspicious" breast lesion in patients with a history of carcinoma of the oesophagus, the possibility of breast metastasis must not be negated.

Research paper thumbnail of Tissue and organ transplantation: Myths, miracles, and triumphs

Astrocyte, 2014

Notwithstanding the unfulfilled quest for immortality, man′s endeavor to outdo organ failure and ... more Notwithstanding the unfulfilled quest for immortality, man′s endeavor to outdo organ failure and prolong life has been a journey bejeweled with hues of ingenuity. This exciting odyssey has been marked with chimerical events and miracles in the olden times, and, in the more recent, by triumphs of technical and cognitive advances in organ preservation, surgical skill, immunology, management of infectious diseases, and multidisciplinary innovative approaches, which have collated to fructify the realm of tissue and organ transplantation. The remarkable evolution-colored with serendipitous discoveries, tragic accidents, abandoned paths, and incidents that have produced ethical and legal predicaments-stems from a confluence of cultural, legal, and political acceptance of the need to facilitate organ donation, procurement, and allocation. This serial narrative, punctuated with historic pictures, captures some of the major milestones in the saga of transplant medicine.

Research paper thumbnail of Giant epithelioid hemangioma of the external auditory canal: Role of imaging in clinical management

Apollo Medicine, Mar 1, 2017

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign, locally proliferating tumor with ... more Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign, locally proliferating tumor with a predilection for the periauricular area and scalp. The nodules are usually 2-3 cm in diameter, though rarely, larger and deeper neoplasms may occur. These tumors can cause significant morbidity because of recurrent bleeding, pain, and disfigurement. 1-3 We report a case of epithelioid hemangioma, which occurred in a 23-year-old male, in whom it was thought to be malignant because of its overwhelming gross appearance (Fig. 1), and yet, when evaluated on computed tomography (CT) and magnetic resonance imaging (MRI), the benign highly a p o l l o m e d i c i n e x x x (2 0 1 6) x x x-x x x a r t i c l e i n f o Article history:

Research paper thumbnail of Perfusion CT imaging as a diagnostic and prognostic tool for dementia: prospective case-control study

PubMed, Jan 19, 2022

Background: As functional changes precede structural changes in dementia, we aimed to elucidate c... more Background: As functional changes precede structural changes in dementia, we aimed to elucidate changes on cerebral perfusion CT (PCT) for early diagnosis of dementia; and to differentiate Alzheimer's disease (AD) from vascular dementia (VaD). We also aimed to study correlation between Montreal Cognitive Assessment (MOCA) score and PCT parameters. Methods: We conducted a prospective case-control study enrolling 25 dementia patients (15 cases of VaD, 10 cases of AD) and 25 age-matched controls. PCT was performed on a 256-slice CT scanner. Using perfusion software, colour maps were generated for cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time and time-to-peak. These colour maps were first visually inspected for any abnormalities. Subsequently, quantitative assessment of perfusion parameters was done using symmetrical freehand region of interests drawn in bilateral frontal, temporal, parietal regions, basal ganglia and hippocampi. Results: Strategic infarcts were present in 93.3% cases and white matter ischaemic changes in 100% cases of VaD. A global reduction in CBF and CBV was also observed in cases of VaD; whereas these parameters were significantly lower mainly in temporoparietal regions and hippocampi of patients with AD. There was significant positive correlation between MOCA score and various perfusion parameters in both forms of dementia. Conclusion: PCT is a reliable imaging modality for early diagnosis of dementia and in differentiating VaD from AD. As perfusion parameters show positive correlation with MOCA score, they could be used as a surrogate marker of cognitive status in the follow-up of patients with dementia.

Research paper thumbnail of Cytomorphological findings in drug defaulters of tuberculous lymphadenitis

Research paper thumbnail of Grading of Liver Fibrosis using Shear Wave Elastography and Aminotransferase Platelet Ratio Index in Chronic Viral Hepatitis: A Case-control Study

Journal of Clinical and Diagnostic Research, 2021

Introduction: Liver fibrosis is a progressive disorder that if diagnosed early and staged precise... more Introduction: Liver fibrosis is a progressive disorder that if diagnosed early and staged precisely, allows early clinical intervention that may hinder or slow down the progression to end stage decompensated cirrhosis. Grading of hepatic fibrosis is important not only for diagnosis but also for prognostic evaluation, planning appropriate therapy, and follow-up of patients with chronic viral hepatitis. Liver biopsy has been considered the reference standard for grading liver fibrosis. As liver biopsy is invasive and associated with complications, non invasive serological and imaging techniques like Shear Wave Elastography (SWE) and Aminotransferase Platelet Ratio Index (APRI) have come to the spotlight. Aim: To evaluate SWE alone and together with APRI as a reliable alternative to liver biopsy for diagnosing and grading hepatic fibrosis in chronic viral hepatitis. Materials and Methods: This case control study was conducted over a period of 18 months from October 2017 to March 2019, at a tertiary care hospital in New Delhi, India. Total 120 subjects (60 cases of chronic viral hepatitis and 60 case matched healthy volunteers as controls) were enrolled in the study. Biopsy could not be performed in 10 cases so these cases and their matched controls were excluded from the statistical analysis. SWE was performed using a 1-5 MHz curvilinear transducer (Philips iU22x MATRIX). The APRI and the mean of six SWE measurements (in kilopascals) were calculated for all subjects. The analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: Among all 50 cases of chronic hepatitis who have underwent biopsy, the mean SWE values corresponding to the histopathological grade of fibrosis i.e., F0, F1, F2, F3 and F4 was found to be 4.48±1.05 kPa, 7.16±0.75 kPa, 8.08±1.05 kPa, 8.44±0.47 kPa and 16.01±3.78 kPa, respectively. The mean APRI values of the cases in F1, F2 and F3 grades showed significant overlap (cut off value between 0.5-1.5). Also, when APRI was used along with SWE, does not have a statistically significant contribution to improve its diagnostic accuracy in liver fibrosis grading. Conclusion: Shear wave elastography has high accuracy in detecting and grading of fibrosis. APRI does not appear to have a significant role in the grading of liver fibrosis however it can be combined with SWE for post-treatment follow-up of chronic viral hepatitis patients thus avoiding the need for repeated biopsy.

Research paper thumbnail of MRI of perianal fistulae: a pictorial kaleidoscope

Clinical Radiology, Dec 1, 2015

Perianal fistulae are an abnormal communication between the anorectum and the perianal skin. A se... more Perianal fistulae are an abnormal communication between the anorectum and the perianal skin. A seemingly benign condition, it can be a cause of considerable distress to the patient if it is not mapped out adequately before embarking upon surgical correction. The persistence of residual disease complicates and up-stages the grade of the remnant fistula with increased risk of anal incontinence following surgery secondary to damage to the anal sphincter complex. Magnetic resonance imaging (MRI) can play a critical role in mapping the fistulae tract in relation to the anal sphincter complex and hence, act as a reliable guide for the surgeon to chart the optimised management of perianal fistulae. This review illustrates the role of MRI in the imaging evaluation of perianal fistulae, to facilitate a well-planned surgical course.

Research paper thumbnail of Comparative analysis of airway invasive aspergillosis and endobronchial spread of tuberculosis on high resolution computed tomography

Monaldi archives for chest disease, Oct 25, 2022

https://www.monaldi-archives.org/ Publisher's Disclaimer. E-publishing ahead of print is increasi... more https://www.monaldi-archives.org/ Publisher's Disclaimer. E-publishing ahead of print is increasingly important for the rapid dissemination of science. The Early Access service lets users access peer-reviewed articles well before print / regular issue publication, significantly reducing the time it takes for critical findings to reach the research community. These articles are searchable and citable by their DOI (Digital Object Identifier). The Monaldi Archives for Chest Disease is, therefore, e-publishing PDF files of an early version of manuscripts that undergone a regular peer review and have been accepted for publication, but have not been through the typesetting, pagination and proofreading processes, which may lead to differences between this version and the final one. The final version of the manuscript will then appear on a regular issue of the journal. E-publishing of this PDF file has been approved by the authors.

Research paper thumbnail of Endovascular management and outcomes of aortoiliac occlusive disease

Indian journal of vascular and endovascular surgery, 2021

Introduction: Aorto-iliac Occlusive Disease (AIOD) involves the infra-renal aorta and the iliac a... more Introduction: Aorto-iliac Occlusive Disease (AIOD) involves the infra-renal aorta and the iliac arteries. Recent studies advocate endovascular management in TASC C and D lesions also. It involves balloon angioplasty with or without stent deployment.5 The aim of this retrospective study is to evaluate the results of endovascular balloon angioplasty and primary stenting in patients of AIOD. Methods: Twenty-five patients with Aorto-iliac occlusion disease who met the inclusion criteria during 1-year study period were included. Patients with acute thrombosis, abdominal aorta or iliac artery aneurysm and additional common femoral artery occlusion were excluded. The TASC II classification was used to define the characteristics of the lesions. The baseline data, procedural details and follow-up results were analysed. Results: Amongst 25 patients studied, age ranged from 40-75 years. Self-expanding metallic stent was employed in all patients. Technical success following primary stenting was achieved in all patients. Procedural times for TASC-II A, B, C and D lesions were 90+ 30, 110+ 40, 135+35 and 155+ 45 minutes, respectively. During follow-up, the cumulative primary patency rates at 1 month and 6 months were 100%. Cumulative primary patency rates at 1 year were 91.67%. Conclusion: Short- term outcomes of balloon angioplasty and stenting for Aorto-iliac artery occlusions in terms of primary patency rates were excellent.

Research paper thumbnail of Of divinity, retro dynamics and basic edicts in physician-patient relationship

Astrocyte, 2014

T practice of medicine is probably almost as old as the human race. Just as the first human being... more T practice of medicine is probably almost as old as the human race. Just as the first human beings built homes, created communes, a few men devoted themselves to the job of diagnosing and treating the physical and mental symptoms afflicting sick members of the tribe. The first healers — call them shamans, vaids, hakims, or more generically, physicians — were held in high social esteem, despite the fact that few of their remedies actually worked! The clinical practice in those early days was bereft of any scientific basis, yet, the faith the patient harbored in the powers of his physician helped. The recipes gave relief perhaps due to a placebo effect, while the healer offered hope, encouragement, and time and space for natural healing.

Research paper thumbnail of Renal vasculature: Spectrum of anatomical variations and the significance from a surgeon's standpoint

Astrocyte, 2018

Background: Renal vasculature is known for having a broad spectrum of variants, and some of them ... more Background: Renal vasculature is known for having a broad spectrum of variants, and some of them hold important implications at the time of renal surgeries, particularly for the renal transplant. Materials and Methods: This observational study was performed using multidetector computed tomography (MDCT) angiography in patients with various renal and other abdominal disorders and advised for pathologies in which MDCT angiography was indicated. A total of 760 patients were evaluated. Various parameters that have surgical importance were studied. Results: This study includes 123 (16%) patients that had accessory renal artery on right side and 152 (20%) patients that had on the left side. Among the right-side renal artery patients, 72 (58.5%) were hilar and 51 (41.5%) were polar arteries, and of left-side patients, 94 (61.8%) were hilar and 58 (38.2%) were polar arteries. The average diameter of the right and left renal artery was 5.1 and 5.07 mm, respectively. The average diameter of the right and left accessory renal artery was 2.4 and 2.6 mm, respectively. Early segmentary bifurcation of the right renal artery was seen in 651 patients (85.6%) with 319 (42%) being retro-caval, and early segmentary bifurcation of the left renal artery was seen in 94 patients (12.3%). Double right and left renal veins were seen in 96 (12.6%) and 37 (4.8%) patients, respectively. Late right renal vein confluence was seen in 50.6% of patients (340/671). Late left renal vein confluence was seen in 181 out of 700 patients (25.85%); 60 (7.9%) patients had circum-/retro-aortic renal vein. Conclusion: CT angiography is highly accurate modality for evaluation of renal vasculature. Although the increasing number of laparoscopic nephrectomies being performed as part of renal transplant procedure, it is becoming important for the radiologists to better understand the anatomy, its variations, its implications, and to accurately demonstrate vascular anatomy on imaging to the surgical team.

Research paper thumbnail of Systemic to pulmonary venous collaterals in lung malignancy: Rare acquired right-to-left shunt

Apollo Medicine, Mar 1, 2017

Please cite this article in press as: Rastogi G, et al. Systemic to pulmonary venous collaterals ... more Please cite this article in press as: Rastogi G, et al. Systemic to pulmonary venous collaterals in lung malignancy: Rare acquired right-to-left shunt, Apollo Med.

Research paper thumbnail of The Journey Within

Astrocyte, 2016

f these long years in medicine have taught us anything it is this: The science and practice of cl... more f these long years in medicine have taught us anything it is this: The science and practice of clinical medicine requires a systematic critical analysis of one’s doing at each step. Not just in the present, but equally the recent past! A kind of continuous self-audit. Of the diagnostic and treatment processes employed by the practitioners of medicine, and the resulting outcome and quality of life that the patients end up with.

Research paper thumbnail of Birth of a star

Astrocyte, 2014

ABSTRACT The term Astrocyte is derived from ancient Greek: astron, which means a star, or a flame... more ABSTRACT The term Astrocyte is derived from ancient Greek: astron, which means a star, or a flame; and kutos, hollow vessel, or cell. The present journal will try and live up to this mission. The natural synergy between the house of mind and house of knowledge will allow astrocyte to take on a new connotation. Being an open access journal, it stands tall as a living tribute to the ways of Lao-tzu, the legendary 6th century BC Chinese philosopher, who wrote: If you have knowledge, let others light their candles at it.

Research paper thumbnail of Of medical literature, heartstrings, and a physician′s prayer

Astrocyte, 2014

The amount of writings of a profession is a measure of its vitality and activity, whilst their qu... more The amount of writings of a profession is a measure of its vitality and activity, whilst their quality is a rough indication of its intellectual state. Medical literature . . . is the currency or medium of exchange by which a man contributes to or borrows from the common stock of knowledge and experience, and the volume of this currency and the character of its metal are of the greatest importance to us all.[1]

Research paper thumbnail of Multihued complications in acute pancreatitis: A kaleidoscopic retrospective

Astrocyte, 2014

Acute pancreatitis is a diffuse inflammatory process in and around the pancreas triggered by the ... more Acute pancreatitis is a diffuse inflammatory process in and around the pancreas triggered by the leakage of activated pancreatic secretions. It may remain localized within the pancreatic glandular tissue or spread to involve the adjacent or remote tissue planes and organs. Since the morbidity and mortality of acute pancreatitis is closely related to the extent of intra- and extra-pancreatic complications, cross-sectional contrast-enhanced computed tomography (CECT) imaging plays a major role in assessing the complications, stratifying the severity, and thus, prognosticating the outcome. Early diagnosis of complications allows for timely institution of specific measures that can help decrease the morbidity and mortality. This kaleidoscopic retrospective presents the complications of acute pancreatitis on CECT. The essay may benefit family physicians, surgeons, gastro-intestinal (GI) surgeons and GI physicians who manage such patients in their clinical practice, besides drawing the attention of residents and fellows practicing GI radiology.

Research paper thumbnail of Comparative study of Balthazar Computed Tomography Severity Index and Modified Computed Tomography Severity Index in predicting the outcome of acute pancreatitis

Apollo Medicine, Jun 1, 2014

Objective: To compare the Balthazar CT Severity Index and Modified CT Severity Index in predictin... more Objective: To compare the Balthazar CT Severity Index and Modified CT Severity Index in predicting the outcome of acute pancreatitis. Materials and methods: 150 cases of acute pancreatitis, underwent CECT. The scans were reviewed and scored using both CT indices. Severity parameters included length of hospital stay, need for intervention, occurrence of organ failure, evidence of infection, and mortality. Descriptive statistics were used for baseline characteristics. Chi-square or Fisher's exact tests were used to compare the two indices. Results: Using Balthazar CTSI with the patient outcome, statistically significant correlation was found between the grades and the length of hospital stay (p ¼ 0.011), development of infection (p ¼ 0.018), occurrence of organ failure (p ¼ 0.027), and mortality (p ¼ 0.019). No correlation, however, was obtained between the score and the need for an interventional procedure (p ¼ 0.126). In contrast, the correlation between the grades under the Modified CT Severity Index and outcome was much stronger (p ¼ 0.000 for length of hospital stay, p ¼ 0.004 for development of infection, p ¼ 0.024 for occurrence of organ failure and p ¼ 0.013 for mortality). It could also accurately predict the need for interventions (p ¼ 0.030). Conclusion: The modified CTSI correlates more closely with patient outcome than the CTSI.

Research paper thumbnail of Evaluation of MR Spectroscopy and Diffusion-Weighted MRI in Postmenopausal Bone Strength

Cureus, Sep 21, 2015

Aim: To prospectively investigate the role of MR spectroscopy (MRS) and diffusion-weighted magnet... more Aim: To prospectively investigate the role of MR spectroscopy (MRS) and diffusion-weighted magnetic resonance imaging (DWI) in assessing vertebral marrow changes in postmenopausal women. Materials and Methods: Fifty postmenopausal women, who underwent dual-energy x-ray absorptiometry of the spine, were divided into three bone density groups (normal, osteopenia, and osteoporosis) based on T-score. Both MRS and DWI of the L3 vertebral body were performed to calculate the marrow fat content and apparent diffusion coefficient (ADC). The results were compared between three groups and correlated with BMD. Results: Vertebral marrow fat content was significantly increased in the osteoporotic group when compared with that of the osteopenic group and the normal bone density group. ADC values in the osteoporotic, osteopenic, and normal bone density groups were 338, 408 and 464, respectively, with statistically significant differences (P < 0.001). A statistically significant positive correlation between T-scores and ADC existed (r=0.694, p value <0.001). The vertebral marrow fat content was negatively correlated to the bone density (r=-0.455, p< 0.001) and to marrow ADC (r=-0.302, p < 0.05). Conclusion: The postmenopausal women with osteoporosis exhibited a corresponding increase in vertebral marrow fat content as the bone density decreased. Marrow fat content and ADC were related to the bone density. MRS and DWI are helpful in evaluating the bone marrow changes in postmenopausal women.

Research paper thumbnail of Association of serum calcium levels with clinical severity of ischemic stroke at the time of admission as defined by NIHSS score: A cross-sectional, observational study

Journal of family medicine and primary care, 2022

Research paper thumbnail of Whence clinical guidelines must govern medical practice

Research paper thumbnail of The “reverse breast–oesophagus syndrome”: metastatic carcinosis of breast in oesophageal cancer

BJR|case reports, Nov 1, 2016

A "breast-oesophagus syndrome" has been described previously, wherein breast carcinoma metastasiz... more A "breast-oesophagus syndrome" has been described previously, wherein breast carcinoma metastasizes to the inner layers of the oesophagus. The entity is extremely rare, but rarer still is metastatic breast carcinosis from oesophageal cancer (EC), a clinical event that might be termed as "reverse breast-oesophagus syndrome". Considered as the sixth most lethal malignancy, 50% EC patients present with metastatic disease. However, they rarely ever metastasize to the breast. For that reason, a malignant breast mass, which develops following EC, is often thought of as a second malignancy. We report a 62-year-old female who had EC, who was treated with oesophagectomy 2 years ago, and represented with a painful left breast mass. Radiological evaluation revealed suspicious findings (breast imaging-reporting and data system score of 4C), while cytology demonstrated squamous pearls, consistent with metastatic squamous cell EC, which probably disseminated to the breast at the time of surgery. She was treated with local excision of the breast mass, which is the treatment of choice in isolated metastasis to the breast. Such an unusual presentation reminds us that, in any "radiologically suspicious" breast lesion in patients with a history of carcinoma of the oesophagus, the possibility of breast metastasis must not be negated.

Research paper thumbnail of Tissue and organ transplantation: Myths, miracles, and triumphs

Astrocyte, 2014

Notwithstanding the unfulfilled quest for immortality, man′s endeavor to outdo organ failure and ... more Notwithstanding the unfulfilled quest for immortality, man′s endeavor to outdo organ failure and prolong life has been a journey bejeweled with hues of ingenuity. This exciting odyssey has been marked with chimerical events and miracles in the olden times, and, in the more recent, by triumphs of technical and cognitive advances in organ preservation, surgical skill, immunology, management of infectious diseases, and multidisciplinary innovative approaches, which have collated to fructify the realm of tissue and organ transplantation. The remarkable evolution-colored with serendipitous discoveries, tragic accidents, abandoned paths, and incidents that have produced ethical and legal predicaments-stems from a confluence of cultural, legal, and political acceptance of the need to facilitate organ donation, procurement, and allocation. This serial narrative, punctuated with historic pictures, captures some of the major milestones in the saga of transplant medicine.

Research paper thumbnail of Giant epithelioid hemangioma of the external auditory canal: Role of imaging in clinical management

Apollo Medicine, Mar 1, 2017

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign, locally proliferating tumor with ... more Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign, locally proliferating tumor with a predilection for the periauricular area and scalp. The nodules are usually 2-3 cm in diameter, though rarely, larger and deeper neoplasms may occur. These tumors can cause significant morbidity because of recurrent bleeding, pain, and disfigurement. 1-3 We report a case of epithelioid hemangioma, which occurred in a 23-year-old male, in whom it was thought to be malignant because of its overwhelming gross appearance (Fig. 1), and yet, when evaluated on computed tomography (CT) and magnetic resonance imaging (MRI), the benign highly a p o l l o m e d i c i n e x x x (2 0 1 6) x x x-x x x a r t i c l e i n f o Article history:

Research paper thumbnail of Perfusion CT imaging as a diagnostic and prognostic tool for dementia: prospective case-control study

PubMed, Jan 19, 2022

Background: As functional changes precede structural changes in dementia, we aimed to elucidate c... more Background: As functional changes precede structural changes in dementia, we aimed to elucidate changes on cerebral perfusion CT (PCT) for early diagnosis of dementia; and to differentiate Alzheimer's disease (AD) from vascular dementia (VaD). We also aimed to study correlation between Montreal Cognitive Assessment (MOCA) score and PCT parameters. Methods: We conducted a prospective case-control study enrolling 25 dementia patients (15 cases of VaD, 10 cases of AD) and 25 age-matched controls. PCT was performed on a 256-slice CT scanner. Using perfusion software, colour maps were generated for cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time and time-to-peak. These colour maps were first visually inspected for any abnormalities. Subsequently, quantitative assessment of perfusion parameters was done using symmetrical freehand region of interests drawn in bilateral frontal, temporal, parietal regions, basal ganglia and hippocampi. Results: Strategic infarcts were present in 93.3% cases and white matter ischaemic changes in 100% cases of VaD. A global reduction in CBF and CBV was also observed in cases of VaD; whereas these parameters were significantly lower mainly in temporoparietal regions and hippocampi of patients with AD. There was significant positive correlation between MOCA score and various perfusion parameters in both forms of dementia. Conclusion: PCT is a reliable imaging modality for early diagnosis of dementia and in differentiating VaD from AD. As perfusion parameters show positive correlation with MOCA score, they could be used as a surrogate marker of cognitive status in the follow-up of patients with dementia.