Yogesh Acharya - Academia.edu (original) (raw)

Papers by Yogesh Acharya

Research paper thumbnail of Management of complicated aortic dissection: natural history, translational research, simulation, bioconvergence, clinical evidence and literature review

Italian Journal of Vascular and Endovascular Surgery

Research paper thumbnail of The 4-D in management of complex aortic pathology

Italian Journal of Vascular and Endovascular Surgery

Research paper thumbnail of Discovering symptom patterns of COVID-19 patients using association rule mining

Computers in Biology and Medicine

Research paper thumbnail of Refractory neck pain due to Eagle syndrome

Journal of Vascular Surgery Cases, Innovations and Techniques

Research paper thumbnail of Staged hybrid single lumen reconstruction (TIGER) with bilateral subclavian transposition coupled with thoracic endovascular aneurysm repair in the management of acute symptomatic complex type B aortic dissection in a patient with arteria lusoria

BMJ Case Reports

We present a 54-year-old Caucasian woman, who presented with acute symptomatic type B aortic diss... more We present a 54-year-old Caucasian woman, who presented with acute symptomatic type B aortic dissection with deteriorating renal function. She was a known smoker with a 2-year history of dysphagia. CT angiography documented the artery of lusoria arising from the mid-thoracic aorta, aneurysmal dilation of her descending aorta, and kinetic and static flaps around her visceral ostia. The patient was managed by staged hybrid single lumen reconstruction and bilateral subclavian to carotid transpositions. During follow-up, there was no aortic rupture or retrograde type A dissection. There were no renal, visceral, cardiac, pulmonary or spinal complications. The patient went off her antihypertensive medication with a normal estimated glomerular filtration rate and accelerated aortic modulation.

Research paper thumbnail of Modern techniques of teaching and learning in medical education: a descriptive literature review

Research paper thumbnail of New-Onset Seizure as the Only Presentation in a Child With COVID-19

Research paper thumbnail of Management of Concealed Type IV Endoleak and Aortic Sac Hygroma by Prone ContrASt EnHancement Computed Tomography Angiography

Annals of Vascular Surgery

Research paper thumbnail of Internal iliac artery sacrifice during endovascular abdominal aortic aneurysm repair

Research paper thumbnail of Challenges of New Healthcare Reform Act 2017 and Possible Rise of Defensive Medicine in Nepal

Journal of Nepal Health Research Council

Hippocratic oath, written 4th or 5th century BC, is still the binding mantra for physicians, whic... more Hippocratic oath, written 4th or 5th century BC, is still the binding mantra for physicians, which swears to fulfill to the best of one’s ability and judgement, and treat sick human beings not just illness. But with changing health trends in southeast Asia region, there is a dramatic shift in patients and patients’ party expectations regarding treatment, recovery, complications, and death. Such expectations havelead to violence against physicians and shift towards alternative medical practice. This article explores the possible rise of defensive medicine and its broader implications in health care system in Nepal with regard to the new ‘Muluki Aparadh Samhita Ain 2074/Criminal (Code) Act 2017’. Keywords: Changing health; criminal act; defensive medicine; muluki ain, Nepal.

Research paper thumbnail of A pilot protocol and review of triple neuroprotection with targeted hypothermia, controlled induced hypertension, and barbiturate infusion during emergency carotid endarterectomy for acute stroke after failed tPA or beyond 24-hour window of opportunity

Annals of Translational Medicine

An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in isc... more An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in ischemic stroke management. As tPA is time-dependent, delays can occur in definitive treatment while passively waiting to observe a clinical response to intravenous thrombolysis. Until today, uncertainty exists in the management strategy of wake-up stroke patients or those presenting beyond the therapeutic tPA window. Clinical dilemmas in these situations can prolong the transitional period of inertia, resulting in an adverse neurological outcome. We propose and review an innovative approach called triple neuro-protection (TNP), which encompasses three technical domains-targeted hypothermia, systemic induced hypertension, and barbiturates infusion, to protect the brain during carotid endarterectomy after failed tPA and/or beyond the 24-hour therapeutic mechanical thrombectomy window. This proposal assimilates discussion on the clinical evidence of the individual domains of TNP with our own clinical experience with TNP. Our first TNP was successfully employed in a 55-year-old man in 2015 while performing emergency carotid endarterectomy after he was referred to us 72 hours post tPA failure. The patient had a successful clinical outcome despite being in therapeutic inertia with 90-99% ipsilateral carotid stenosis and contralateral occlusion on presentation. In the last five years, we have safely used TNP in 25 selected cases with favourable clinical outcomes.

Research paper thumbnail of When Promising Innovators Lack Strategic Vision: The Concept of Flow Modulation in Aortic Dissection

Journal of Endovascular Therapy

Research paper thumbnail of Chloroquine and hydroxychloroquine as a repurposed agent against COVID-19: a narrative review

Therapeutic Advances in Infectious Disease

The predicament arising from the coronavirus disease 2019 (COVID-19) pandemic has become one of t... more The predicament arising from the coronavirus disease 2019 (COVID-19) pandemic has become one of the most significant modern public health challenges. Despite uncertainties in the viral determinants and pathogenesis, it is crucial to accurately inspect all available evidence to construct accurate clinical guidelines for optimised patient care. This study aims to discuss the available evidence for the use of chloroquine (CQ) and hydroxychloroquine (HCQ) against COVID-19. Early in vitro studies of CQ/HCQ against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are convincing. But contradictory evidence exists on the clinical use of CQ/HCQ, either alone or in combination with azithromycin. As of now, there is no compelling clinical evidence on CQ, HCQ, and azithromycin in COVID-19 and the available evidence is limited to methodologically inferior non-randomised studies. Studies have also shown detrimental drug reactions to CQ and ‘HCQ plus azithromycin’, mainly cardiac side ...

Research paper thumbnail of Antimalarial and cytotoxic drugs on COVID-19 and the cardiovascular burden: Literature review and lessons to be learned

Vascular

Background The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-1... more Background The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-19). It is important to accurately analyze the available evidence to provide correct clinical guidance for optimal patient care. We aim to discuss current clinical evidence regarding chloroquine, hydroxychloroquine, azithromycin, remdesivir, and the cardiovascular burden of COVID-19. Methods A literature review was performed using PubMed and Google Scholar. Additional clinical trials were identified through the “TrialsTracker” project. Results We found conflicting evidence of chloroquine, hydroxychloroquine plus azithromycin, and remdesivir in COVID-19 despite promising early reports of in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2. Some of the current studies have demonstrated adverse drug reactions to chloroquine and hydroxychloroquine + azithromycin. Widespread systemic inflammation and procoagulant/hypercoagulable state, including thrombotic micro...

Research paper thumbnail of Challenges in Diagnosing Aortic Leiomyosarcoma Post Endovascular Repair of Abdominal Aortic Aneurysm

Journal of Vascular Surgery Cases and Innovative Techniques

Research paper thumbnail of Isolated Chromosome 6q27 Terminal Deletion Syndrome

Research paper thumbnail of Integrated curriculum and the change process in undergraduate medical education

Research paper thumbnail of Re: Letter to the Editor of Public Health in response to 'Nipah virus infection: gaps in evidence and its public health importance

Research paper thumbnail of Smartphones and medical apps in modern medicine: breaking the health norms (Preprint)

UNSTRUCTURED Smartphones technology (s-tech) has been applied effectively in health education, pe... more UNSTRUCTURED Smartphones technology (s-tech) has been applied effectively in health education, personal health monitoring, tele-medicine, drug compliance monitoring and data collection in modern times. With an approximately more than 40,000 available mobile health apps, s-tech has established itself as a strong predictor of modern health monitoring. It is necessary that s-tech should be evidence based, scientific, user friendly and crater the health needs of target user groups. Although smartphones open a wide opportunity for effective health system delivery, there are clear concerns regarding the validation and effectiveness of these available mobile apps.

Research paper thumbnail of Isolated Sacral Extradural Hydatid Cyst with Posterior Paravertebral Extension Presenting as a Cauda Equina Syndrome

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Research paper thumbnail of Management of complicated aortic dissection: natural history, translational research, simulation, bioconvergence, clinical evidence and literature review

Italian Journal of Vascular and Endovascular Surgery

Research paper thumbnail of The 4-D in management of complex aortic pathology

Italian Journal of Vascular and Endovascular Surgery

Research paper thumbnail of Discovering symptom patterns of COVID-19 patients using association rule mining

Computers in Biology and Medicine

Research paper thumbnail of Refractory neck pain due to Eagle syndrome

Journal of Vascular Surgery Cases, Innovations and Techniques

Research paper thumbnail of Staged hybrid single lumen reconstruction (TIGER) with bilateral subclavian transposition coupled with thoracic endovascular aneurysm repair in the management of acute symptomatic complex type B aortic dissection in a patient with arteria lusoria

BMJ Case Reports

We present a 54-year-old Caucasian woman, who presented with acute symptomatic type B aortic diss... more We present a 54-year-old Caucasian woman, who presented with acute symptomatic type B aortic dissection with deteriorating renal function. She was a known smoker with a 2-year history of dysphagia. CT angiography documented the artery of lusoria arising from the mid-thoracic aorta, aneurysmal dilation of her descending aorta, and kinetic and static flaps around her visceral ostia. The patient was managed by staged hybrid single lumen reconstruction and bilateral subclavian to carotid transpositions. During follow-up, there was no aortic rupture or retrograde type A dissection. There were no renal, visceral, cardiac, pulmonary or spinal complications. The patient went off her antihypertensive medication with a normal estimated glomerular filtration rate and accelerated aortic modulation.

Research paper thumbnail of Modern techniques of teaching and learning in medical education: a descriptive literature review

Research paper thumbnail of New-Onset Seizure as the Only Presentation in a Child With COVID-19

Research paper thumbnail of Management of Concealed Type IV Endoleak and Aortic Sac Hygroma by Prone ContrASt EnHancement Computed Tomography Angiography

Annals of Vascular Surgery

Research paper thumbnail of Internal iliac artery sacrifice during endovascular abdominal aortic aneurysm repair

Research paper thumbnail of Challenges of New Healthcare Reform Act 2017 and Possible Rise of Defensive Medicine in Nepal

Journal of Nepal Health Research Council

Hippocratic oath, written 4th or 5th century BC, is still the binding mantra for physicians, whic... more Hippocratic oath, written 4th or 5th century BC, is still the binding mantra for physicians, which swears to fulfill to the best of one’s ability and judgement, and treat sick human beings not just illness. But with changing health trends in southeast Asia region, there is a dramatic shift in patients and patients’ party expectations regarding treatment, recovery, complications, and death. Such expectations havelead to violence against physicians and shift towards alternative medical practice. This article explores the possible rise of defensive medicine and its broader implications in health care system in Nepal with regard to the new ‘Muluki Aparadh Samhita Ain 2074/Criminal (Code) Act 2017’. Keywords: Changing health; criminal act; defensive medicine; muluki ain, Nepal.

Research paper thumbnail of A pilot protocol and review of triple neuroprotection with targeted hypothermia, controlled induced hypertension, and barbiturate infusion during emergency carotid endarterectomy for acute stroke after failed tPA or beyond 24-hour window of opportunity

Annals of Translational Medicine

An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in isc... more An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in ischemic stroke management. As tPA is time-dependent, delays can occur in definitive treatment while passively waiting to observe a clinical response to intravenous thrombolysis. Until today, uncertainty exists in the management strategy of wake-up stroke patients or those presenting beyond the therapeutic tPA window. Clinical dilemmas in these situations can prolong the transitional period of inertia, resulting in an adverse neurological outcome. We propose and review an innovative approach called triple neuro-protection (TNP), which encompasses three technical domains-targeted hypothermia, systemic induced hypertension, and barbiturates infusion, to protect the brain during carotid endarterectomy after failed tPA and/or beyond the 24-hour therapeutic mechanical thrombectomy window. This proposal assimilates discussion on the clinical evidence of the individual domains of TNP with our own clinical experience with TNP. Our first TNP was successfully employed in a 55-year-old man in 2015 while performing emergency carotid endarterectomy after he was referred to us 72 hours post tPA failure. The patient had a successful clinical outcome despite being in therapeutic inertia with 90-99% ipsilateral carotid stenosis and contralateral occlusion on presentation. In the last five years, we have safely used TNP in 25 selected cases with favourable clinical outcomes.

Research paper thumbnail of When Promising Innovators Lack Strategic Vision: The Concept of Flow Modulation in Aortic Dissection

Journal of Endovascular Therapy

Research paper thumbnail of Chloroquine and hydroxychloroquine as a repurposed agent against COVID-19: a narrative review

Therapeutic Advances in Infectious Disease

The predicament arising from the coronavirus disease 2019 (COVID-19) pandemic has become one of t... more The predicament arising from the coronavirus disease 2019 (COVID-19) pandemic has become one of the most significant modern public health challenges. Despite uncertainties in the viral determinants and pathogenesis, it is crucial to accurately inspect all available evidence to construct accurate clinical guidelines for optimised patient care. This study aims to discuss the available evidence for the use of chloroquine (CQ) and hydroxychloroquine (HCQ) against COVID-19. Early in vitro studies of CQ/HCQ against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are convincing. But contradictory evidence exists on the clinical use of CQ/HCQ, either alone or in combination with azithromycin. As of now, there is no compelling clinical evidence on CQ, HCQ, and azithromycin in COVID-19 and the available evidence is limited to methodologically inferior non-randomised studies. Studies have also shown detrimental drug reactions to CQ and ‘HCQ plus azithromycin’, mainly cardiac side ...

Research paper thumbnail of Antimalarial and cytotoxic drugs on COVID-19 and the cardiovascular burden: Literature review and lessons to be learned

Vascular

Background The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-1... more Background The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-19). It is important to accurately analyze the available evidence to provide correct clinical guidance for optimal patient care. We aim to discuss current clinical evidence regarding chloroquine, hydroxychloroquine, azithromycin, remdesivir, and the cardiovascular burden of COVID-19. Methods A literature review was performed using PubMed and Google Scholar. Additional clinical trials were identified through the “TrialsTracker” project. Results We found conflicting evidence of chloroquine, hydroxychloroquine plus azithromycin, and remdesivir in COVID-19 despite promising early reports of in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2. Some of the current studies have demonstrated adverse drug reactions to chloroquine and hydroxychloroquine + azithromycin. Widespread systemic inflammation and procoagulant/hypercoagulable state, including thrombotic micro...

Research paper thumbnail of Challenges in Diagnosing Aortic Leiomyosarcoma Post Endovascular Repair of Abdominal Aortic Aneurysm

Journal of Vascular Surgery Cases and Innovative Techniques

Research paper thumbnail of Isolated Chromosome 6q27 Terminal Deletion Syndrome

Research paper thumbnail of Integrated curriculum and the change process in undergraduate medical education

Research paper thumbnail of Re: Letter to the Editor of Public Health in response to 'Nipah virus infection: gaps in evidence and its public health importance

Research paper thumbnail of Smartphones and medical apps in modern medicine: breaking the health norms (Preprint)

UNSTRUCTURED Smartphones technology (s-tech) has been applied effectively in health education, pe... more UNSTRUCTURED Smartphones technology (s-tech) has been applied effectively in health education, personal health monitoring, tele-medicine, drug compliance monitoring and data collection in modern times. With an approximately more than 40,000 available mobile health apps, s-tech has established itself as a strong predictor of modern health monitoring. It is necessary that s-tech should be evidence based, scientific, user friendly and crater the health needs of target user groups. Although smartphones open a wide opportunity for effective health system delivery, there are clear concerns regarding the validation and effectiveness of these available mobile apps.

Research paper thumbnail of Isolated Sacral Extradural Hydatid Cyst with Posterior Paravertebral Extension Presenting as a Cauda Equina Syndrome

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH