Publications by authors named "Binit Sureka"

148 Publications

Inhibin B Secreting Ovarian Fibroma.

J Obstet Gynaecol India 2022 Aug 23;72(4):356-359. Epub 2022 Feb 23.

Department of Diagnostic and Interventional Radiology, AIIMS Jodhpur, Jodhpur, India.

Background: Nearly 90% of all the hormone-producing ovarian tumours are sex cord-stromal tumours (SCSTs). The Ovarian fibroma is a hormonally inactive variant of SCST. It is composed of spindle, oval, round cells producing collagen and accounts for approximately 4% of all ovarian neoplasms. Amongst the other SCSTs, Inhibin B is an important tumour marker. It is a heterodimeric glycoprotein hormone that is secreted primarily by the granulosa cells of the developing follicles. High levels of Inhibin-B can hamper follicular recruitment, leading to amenorrhea in a reproductive age woman.

Finding: In this case report, we describe a rare case of a reproductive age female presenting with secondary amenorrhea, having an Ovarian Fibroma, producing massive amounts of Inhibin B.

Significance: Although some pathological variants of ovarian fibromas like cyst-adeno-fibroma and ovarian fibro-thecoma are known to secrete inhibin B, benign /pure ovarian fibromas rarely do so.
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http://dx.doi.org/10.1007/s13224-021-01601-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9339437PMC
August 2022

Cutoff values of body fat composition to predict metabolic risk factors with normal waist circumference in Asian Indian population.

Eur Radiol 2022 Jul 19. Epub 2022 Jul 19.

Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India.

Objectives: The aim of the study is to see if visceral fat volume (VFV), subcutaneous fat volume (SFV), and visceral-subcutaneous fat ratio (VSR) can be used to detect metabolically obese normal weight individuals in Asian Indian population.

Methods: This is a single center prospective cross-sectional study and 80 cases having either hypertension, diabetes, or hyperlipidemia with normal waist circumference and 80 controls having normal metabolic parameters with normal waist circumference were evaluated. Visceral and subcutaneous fat volumes and visceral to subcutaneous fat ratios were determined by computed tomography (CT) at L4-L5 level with a slice thickness of 5 mm.

Results: Visceral fat volume, subcutaneous fat volume, and VSR are significantly higher in patients with metabolic risk factors as compared to those without risk factors. Volume of subcutaneous fat is significantly higher in females as compared to males. VSR is higher in males in our study. The cutoff values for VFV, SFV, and VSR to predict at least one metabolic syndrome are 8.5 cm, 15.7 cm, and 0.61 in males and 7.0 cm, 16.5 cm, and 0.44 in females.

Conclusions: For individuals with normal waist circumference, VFV, SFV, and VSR can effectively predict the presence of one metabolic risk factor.

Key Points: • Visceral fat volume, subcutaneous fat volume, and visceral-subcutaneous fat ratio can predict individuals at risk of metabolic syndrome having normal waist circumference. • Higher VSR in Indian population is due to low reservoir of primary adipose tissue fat compartment which leads to diversion of adipocytes into the secondary adipose tissue fat compartment. • This data can be used as a screening tool in preventive radiology for identifying individuals at risk of developing metabolic syndrome.
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http://dx.doi.org/10.1007/s00330-022-09009-6DOI Listing
July 2022

A lumpy bumpy stomach: The more the murkier.

SA J Radiol 2022 28;26(1):2437. Epub 2022 Jun 28.

Department of Medical Oncology, All India Institute of Medical Sciences Jodhpur, Jodhpur, India.

This report describes the radiological and endoscopic findings in a 54-year-old male who presented with epigastric pain. The patient underwent an upper gastrointestinal (GI) barium study followed by axial imaging, which demonstrated nodular gastric wall thickening. The classic findings of aggressive primary gastric diffuse large B-Cell lymphoma are presented with a brief review differentiating the pathological subtypes, important for patient prognostication and planning of therapy.
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http://dx.doi.org/10.4102/sajr.v26i1.2437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257741PMC
June 2022

Mirizzi Syndrome With Bouveret Syndrome: A Rare Amalgam.

Cureus 2022 Apr 16;14(4):e24187. Epub 2022 Apr 16.

Radiology and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, IND.

Mirizzi and Bouveret syndromes are uncommon but important complications of calculous cholecystitis. Mirizzi syndrome commonly presents with jaundice due to extrinsic compression on the common bile duct by an impacted stone at the gall bladder infundibulum, whereas Bouveret syndrome presents with gastric outlet obstruction due to a large stone in the duodenum. Our case is a 65-year-old lady who presented with pain in the right upper abdomen associated with nausea and vomiting. Contrast-enhanced computed tomography and MRI of the abdomen were suggestive of calculus in the infundibulum of the gall bladder with compression over the common bile duct and a large stone in the first part of the duodenum. Upper gastrointestinal endoscopy confirmed the findings but could not retrieve the stone. Cholecystectomy with the retrieval of calculus from the infundibulum and duodenum was performed with the closure of the fistulous opening. The patient did well in the post-operative period and is doing well after nine months of follow-up. Chronic calculus cholecystitis can present in varied forms, and one should be aware of such rare complications and their management.
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http://dx.doi.org/10.7759/cureus.24187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9110074PMC
April 2022

Emergency Uterine Bleeding: A Pictorial Essay of Imaging and Endovascular Management.

Curr Probl Diagn Radiol 2022 Apr 22. Epub 2022 Apr 22.

Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Abnormal uterine bleeding is a common presentation in the emergency department. A spectrum of uterine vascular abnormalities can lead to potentially fatal hemorrhage. Radiology plays a crucial role in the early diagnosis of the cause of bleeding with the role of an interventional radiologist being pivotal in the management of these cases. This article provides a pictorial review of angiographic appearance of various uterine vascular abnormality and their management by endovascular technique.
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http://dx.doi.org/10.1067/j.cpradiol.2022.04.011DOI Listing
April 2022

Wernicke's encephalopathy - An oddball complication of nephrotic syndrome.

Saudi J Kidney Dis Transpl 2021 Sep-Oct;32(5):1456-1460

Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Metabolic encephalopathies are a common cause of altered mental status in various states of malnutrition. However, a high index of suspicion is required to recognize them and differentiate Metabolic Disorders from other causes of altered mental status such as infections. A 6-year old with steroid-resistant nephrotic syndrome (NS), peritonitis, and prolonged diarrhea and vomiting, developed a brief episode of altered mental status six days after starting tacrolimus. On imaging, there were features suggestive of Wernicke's encephalopathy and it ruled out other causes of seizure in the given scenario. The child was treated with thiamine supplementation and the changes reversed four weeks after treatment. This is to emphasize that although an uncommonly reported complication of nephrotic state, one should have a high index of suspicion for these metabolic encephalopathies, especially in the setting of malnutrition, where these children are highly predisposed to multivitamin deficiency.
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http://dx.doi.org/10.4103/1319-2442.344767DOI Listing
May 2022

Computed tomography perfusion (CTP) in primary lung cancer: Results from a tertiary care centre.

Lung India 2022 May-Jun;39(3):220-229

Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Context: Lung cancer is the leading cause of cancer-related deaths in the world. Computed tomography perfusion (CTP) parameters can be used to evaluate the vascular flow dynamics of lung tumours. We set out to evaluate the CTP parameters in lung cancer and correlate them with histopathological subtype and other characteristics of patients with Lung Cancer.

Settings And Design: This prospective study was conducted at a tertiary care referral hospital in western India.

Methods: Between January 2019 and July 2020, CTP was performed in 46 patients of lung cancer with histopathological confirmation. The CTP parameters were evaluated in detail and correlated with histopathological subtypes, staging and immunohistochemistry (IHC) markers. Analysis of variance (ANOVA) test, receiver operator characteristic (ROC) curve, Box and whiskers plot graph and Pearson correlation tests were used for statistical analysis.

Results: The most common subtype was adenocarcinoma (AC) in 21 patients, followed by squamous cell carcinoma (SCC) in 15 patients and others in 10 patients. Statistically significant difference in blood flow (BF) (f = 5.563, P = 0.007), blood volume (BV) (f = 3.548, P = 0.038) and permeability/flow extraction (FE) (f = 3.617, P = 0.036) were seen in different histopathological subtypes of lung cancer. BF is the main perfusion parameter for differentiation of AC from SCC. P63 positive lesions showed statistically significant lower BF, BV and FE parameters compared to P63 negative lesions (P = 0.013, 0.016 and 0.014, respectively). Different T stages showed statistically significant differences in BF (f = 3.573, P = 0.037), BV (f = 5.145, P = 0.010) and in FE (f = 4.849, P = 0.013).

Conclusion: CTP is a non-invasive imaging method to assess the vascular flow dynamics of the tumours that may predict the histopathological subtypes in lung cancer. It can be used to target large-sized lesions during biopsy and to predict the chemotherapy response.
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http://dx.doi.org/10.4103/lungindia.lungindia_365_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9200194PMC
April 2022

Point-of-Care Thoracic Ultrasound in Children with Bronchiolitis.

Indian J Pediatr 2022 Apr 19. Epub 2022 Apr 19.

Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.

Objective: To characterize thoracic (lung and diaphragm) ultrasound findings in children < 2 y with bronchiolitis, evaluate correlation between lung ultrasound severity score (USS) and bronchiolitis severity score (BSS), and study the interobserver agreement of USS between study pediatrician and radiologist.

Methods: In this prospective observational study, thoracic ultrasound was performed on children with bronchiolitis by the study pediatrician and USS score was assigned. A radiologist blinded to all clinical information, performed an independent thoracic ultrasound. Demographics, clinical course, and other relevant details were recorded.

Results: Fifty-three children were enrolled; 29/53 patients (54.7%) were classified as mild bronchiolitis and 24/53 (45.2%) had moderate bronchiolitis as per clinical score; 13.2% (7/53) patients had both anterior and posterior subpleural consolidation and went on to require higher respiratory support either in the form of continuous positive airway pressure in 71.4% (5/7), oxygen for > 24 h in 14.2% (1/7), or heated humidified high-flow nasal cannula in 14.2% (1/7). These results were statistically significant (p < 0.001). A statistically significant correlation was found between the USS and type and duration of respiratory support (p value 0.002) and with the mean duration of hospital stay (p value < 0.001). There was significant correlation between the BSS and USS (p < 0.001). There was a very good agreement between the ultrasound findings of study pediatrician and radiologist (kappa 0.83).

Conclusion: The findings of lung ultrasound (LUS) are not specific for bronchiolitis. However, LUS can be used as a good prognostic tool in patients with bronchiolitis.
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http://dx.doi.org/10.1007/s12098-022-04117-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9017416PMC
April 2022

Diffusion-Weighted Magnetic Resonance Imaging Is an Ideal Imaging Method to Detect Infection in Pancreatic Collections: A Brief Primer for the Gastroenterologists.

Cureus 2022 Jan 23;14(1):e21530. Epub 2022 Jan 23.

Diagnostic & Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND.

Background: The development of infection in pancreatitis significantly increases the mortality rate up to 100% in the absence of any intervention. Therefore, it is extremely important to diagnose these cases at an early stage. The objectives of this study were to assess the diagnostic performance of computed tomography (CT) and diffusion-weighted MR imaging (DW-MRI) in the diagnosis of infection in pancreatic collections.

Materials And Methods: Prospective observational study of abdominal collections due to pancreatitis that underwent both CT and DW-MRI from August 2018 to July 2020 were enrolled in the study. The collections were analysed for infections - air foci in CT and diffusion restriction on DW-MRI.

Results: Of the 39 patients recruited in the study, infected collections were present in 17, and 22 cases had sterile collections. On CT, air foci within the collection were present only in seven of the cases in our study (sensitivity 35%, specificity 95.4%, PPV 85.7%, NPV 65.6%). DW-MRI detected infection in all 17 cases (sensitivity 100%, specificity 72.7%, PPV 74%, NPV 100%).

Discussion: Thirteen out of 17 collections suspicious for infection on DW-MR showed microbiological growth on culture examination. We believe that this is likely due to the patient's prior antibiotic use, which might have altered the micro-environment or inflammatory cell and bacterial content of the collection.

Conclusion: DW-MRI is complementary and superior to CT in detecting infection in pancreatic collections. CT may be used to detect disease burden, extent and vascular complication.
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http://dx.doi.org/10.7759/cureus.21530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8863503PMC
January 2022

Role of Pigtail Catheter Drainage Versus Percutaneous Needle Aspiration in the Management of Liver Abscess: A Retrospective Analysis.

Cureus 2021 Dec 20;13(12):e20528. Epub 2021 Dec 20.

General Medicine, All India Institute of Medical Sciences, Jodhpur, IND.

Introduction A liver abscess is an important health concern in tropical countries. Effective management of liver abscesses includes appropriate antibiotics and drainage of the abscess cavity. Percutaneous abscess drainage by pigtail catheterization is now gaining popularity. We analyzed the role of pigtail catheter drainage over percutaneous aspiration in the treatment of liver abscesses. Methods and material This was a retrospective analytical study conducted in a tertiary care center in western India. Patients of age ≥ 18 years admitted with the diagnosis of liver abscess were included in this study. To find the effectiveness of different treatment modalities, data were analyzed in three groups: Group A (Conservative treatment), Group B (Percutaneous needle aspiration), and Group C (Pigtail catheter drainage). Results A total of 64 patients with a liver abscess were analyzed. There was male predominance (93.75%). Mean abscess volume in Group C (307.9 ± 212.8 ml) was significantly higher when compared to Group A (130.8 ± 72.9 ml, p = 0.03) and Group B (177.2 ± 129.5; p = 0.024). The duration of hospital stay and residual abscess volume at the time of discharge did not show a statistically significant difference between treatment groups. Pigtail catheterization of abscesses with volume >150 ml shortened the hospital stay, whereas it prolonged the hospital stay in patients with abscess volume <150 ml. Conclusion Percutaneous pigtail catheterization would be an operative decision for the management of liver abscess. We concluded that the use of pigtail catheterization of patients with abscess volume > 150 ml improved the clinical outcome.
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http://dx.doi.org/10.7759/cureus.20528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767523PMC
December 2021

Magnetic Resonance Imaging in Coronavirus Disease - 2019 Associated Rhino-Orbital-Cerebral Mucormycosis (CA-ROCM) - Imaging Analysis of 50 Consecutive Patients.

Curr Probl Diagn Radiol 2022 Jan-Feb;51(1):112-120. Epub 2021 Nov 3.

Professor Department of Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Background And Purpose: Rhino-orbital-cerebral mucormycosis has emerged as a major opportunistic infection in patients with COVID-19. High clinical suspicion and prompt imaging are crucial for early diagnosis and management. Our study evaluates imaging characteristics of patients with COVID-19 associated Rhino-orbital-cerebral Mucormycosis (CA-ROCM) in a tertiary care hospital in India.

Materials And Methods: A retrospective analysis of clinical and imaging data of patients with CA-ROCM who presented between December 2020 to June 2021 was performed. All patients had microbiologically or histologically proven sino-nasal mucormycosis along with documented SARS-CoV-2 positive RT-PCR test and/or classical lung imaging features of COVID-19 infection. The extent of sinus involvement, bony erosions, extra-sinus soft tissue extension, orbital-intracranial invasion, perineural spread, and vascular complications were assessed.

Results: Fifty patients were included for the final analysis. Diabetes was the most common associated comorbidity. Seven patients presented with stage I disease, 18 patients with stage II, and 25 patients with stage III disease. The stage of disease showed a positive statistical correlation with HbA1c levels using Pearson's correlation. The common imaging features were "Black turbinate sign" and nonenhancing sino-nasal mucosa (82%), orbital involvement (76%), and diffusion restriction in the optic nerve (24%). Intracranial involvement was seen as perineural extension into the brain (42%), cerebritis (30%), and internal carotid artery involvement (16%).

Conclusions: CA-ROCM is an acute invasive fungal sinusitis with an aggressive clinical course. Black-turbinate sign and peri-antral soft tissue infiltration are early features, whereas extra-nasal tissue infarction, optic nerve diffusion restriction, and vascular invasion are seen with advanced disease.
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http://dx.doi.org/10.1067/j.cpradiol.2021.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8564981PMC
December 2021

Eosinophilic Solid and Cystic Renal Cell Carcinoma: From Unclassified to Classified, A Case Report.

Turk Patoloji Derg 2022 ;38(1):60-65

Departments of Pathology and Lab Medicine, All India Institute of Medical Sciences, RAJASTHAN, INDIA.

Eosinophilic solid and cystic renal cell carcinoma (ESC RCC) is a novel tumour with unique morphological and immunohistochemical features. It is a recently described entity after the 2016 World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs and is characterised by a solid cystic tumour composed of polygonal cells with voluminous eosinophilic cytoplasm and CK20 positivity. This tumour has uncertain malignant potential and also has an association with tuberous sclerosis complex (TSC). Sarcomatoid differentiation has not been reported in ESC RCC till now. ESC RCC poses a diagnostic challenge as many eosinophilic/oncocytic renal tumours are included in the differentials. We present a case of ESC RCC with sarcomatoid differentiation in an elderly female without any clinical features of TSC and discuss the differential diagnosis of oncocytic renal tumours.
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http://dx.doi.org/10.5146/tjpath.2021.01531DOI Listing
March 2022

Neuroendocrine tumors of the urinary bladder - Report of two cases.

Autops Case Rep 2021 20;11:e2021305. Epub 2021 Aug 20.

All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Jodhpur, Rajasthan, India.

Primary paraganglioma and small cell neuroendocrine carcinoma of the urinary bladder are rare tumors, comprising 0.05% of all bladder tumors and <1% of all malignant bladder tumors, respectively. These tumors can be the cause of a diagnostic dilemma or misdiagnosis on morphology. Paraganglioma is often mistaken for urothelial carcinoma and small cell carcinoma for poorly differentiated carcinoma or lymphoma. Herein, we report a case of primary paraganglioma and another of a small cell carcinoma of the urinary bladder and discuss their closest differential diagnoses. The diagnostic pitfalls should be kept in mind so that correct, timely diagnosis of these entities can be made due to implications in the management and prognosis.
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http://dx.doi.org/10.4322/acr.2021.305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8387077PMC
August 2021

Abbreviated MRI in patients with suspected acute appendicitis in emergency: a prospective study.

Abdom Radiol (NY) 2021 11 11;46(11):5114-5124. Epub 2021 Aug 11.

Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India.

Purpose: To determine the diagnostic performance of an abbreviated non-contrast MRI protocol in diagnosing acute appendicitis.

Methods: Prospectively, a total of 67 consenting consecutive patients with clinical suspicion of acute appendicitis (Alvarado score ≥ 5) were evaluated with an abbreviated three-sequence non-contrast MRI protocol (axial T2WI, coronal T2WI, axial DWI) at a single tertiary care center. MRI was interpreted by two radiologists blinded to the clinical details, other investigations, and outcome of the patients. Diagnostic performance of MRI was determined using either histopathological examination (HPE) results as the reference standard in surgical cases (n = 39), or final clinical diagnosis at discharge and 3-months follow-up in non-operatively managed cases (n = 28).

Results: Sixty-seven patients comprising 42 males, 25 females including 1 pregnant patient were enrolled (median age 24 years; age range 6-70 years). The median acquisition duration of the MRI protocol was 12.5 min. In the analysis of the complete cohort including both surgical and non-operatively managed cases (n = 67), MRI showed sensitivity of 93.3% (95% CI 81.7-98.6%), specificity of 86.4% (95% CI 65.1-97.1%), and diagnostic accuracy of 91.0% (95% CI 81.5-96.6%) (p < 0.001). In the subset of surgical cases with HPE as the reference standard (n = 39), MRI showed sensitivity of 97.1% (95% CI 84.7-99.9%), specificity of 100% (95% CI 47.8-100%), and diagnostic accuracy of 98% (95% CI 87.5-100%) (p < 0.001).

Conclusion: MRI may be performed to diagnose acute appendicitis or alternative causes of right iliac fossa pain. An abbreviated MRI protocol consisting of only three sequences without IV contrast, patient preparation, or antiperistaltic agents could shorten the examination duration while retaining diagnostic accuracy.
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http://dx.doi.org/10.1007/s00261-021-03222-5DOI Listing
November 2021

Rapid Response Preparedness for Management of Post-Covid Invasive Rhino-Orbito-Cerebral Fungal Infections: Experience from a Tertiary Care Government Institute in India.

Indian J Otolaryngol Head Neck Surg 2021 Jul 18:1-3. Epub 2021 Jul 18.

Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India.

Sudden surge of Post Covid-19 Rhino-orbito-mucormycosis cases has left entire ENT fraternity in the center of a war room. We present a quick administrative preparedness for this situation in a tertiary care Government Institute in India. This model may serve as a reference for other centers.
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http://dx.doi.org/10.1007/s12070-021-02753-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286846PMC
July 2021

Adenocarcinoma of the fourth portion of duodenum presenting as intussusception: an unusual manifestation of rare pathology.

BMJ Case Rep 2021 Jul 14;14(7). Epub 2021 Jul 14.

Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India.

Primary adenocarcinoma of the fourth portion of the duodenum (D-IV) is reported infrequently than other parts of the duodenum. Its diagnosis is often late because of non-specific symptoms and signs. We encountered a 48-year-old male patient who was diagnosed as duodeno-duodenal intussusception, underwent segmental duodenal resection with duodenojejunal anastomosis and confirmed as adenocarcinoma of D-IV. He received adjuvant chemotherapy and is doing well at 1 year of follow-up. This report describes about the rare case of isolated adenocarcinoma of the D-IV presented as intussusception which is never reported before and successfully treated by segmental resection of the duodenum and jejunum.
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http://dx.doi.org/10.1136/bcr-2021-244034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280915PMC
July 2021

Predictors of Clinical Outcomes in Adult COVID-19 Patients Admitted to a Tertiary Care Hospital in India: an analytical cross-sectional study.

Acta Biomed 2021 07 1;92(3):e2021024. Epub 2021 Jul 1.

Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur.

Background: The outbreak ofsevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted inexponential rise in the number of patients getting hospitalised with corona virus disease 2019 (COVID-19). There is a paucity of data from South East Asian Region related to the predictors of clinical outcomes in these patients. This formed the basis of conducting our study.

Methods: This was an analytical cross-sectional study. Demographic, clinical, radiological and laboratory data of 125 patients was collected on admission. The study outcome was death or discharge after recovery. For univariate analysis, unpaired t-test, Chi-square and Fisher's Exact test were used. Receiver operating characteristic (ROC) curves were plotted for Sequential Organ Failure Assessment (SOFA) score and few laboratory parameters. Logistic regression was applied for multivariate analysis.

Results: Elderly age, ischemic heart disease and smoking were significantly associated with mortality. Elevated levels of D-dimer and lactate dehydrogenase (LDH) and reduced lymphocyte counts were the predictors of mortality. The ROCs for SOFA score curve showed a cut-off value ≥ 3.5 (sensitivity- 91.7% and specificity- 87.5%), for IL-6 the cut-off value was ≥ 37.9 (sensitivity- 96% and specificity- 78%) and for lymphocyte counts, a cut off was calculated to be less than and equal to 1.46 x 109per litre (sensitivity-75.2%and specificity- 83.3%).

Conclusion: Old age, smoking history, ischemic heart disease and laboratory parameters including elevated D-dimer, raised LDH and low lymphocyte counts at baseline are associated with COVID-19 mortality. A higher SOFA score at admission is a poor prognosticator in COVID-19 patients.
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http://dx.doi.org/10.23750/abm.v92i3.10630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343753PMC
July 2021

Role of radiology in RT-PCR negative COVID-19 pneumonia: Review and recommendations.

J Family Med Prim Care 2021 May 31;10(5):1814-1817. Epub 2021 May 31.

Department of Director and Professor Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan, India.

Currently, RT-PCR is the gold standard for diagnosing SARS-CoV-2 infection. However, due to the time-consuming laboratory tests and the low positivity rate of RT-PCR, it cannot be an ideal screening tool for infected population. In this review article, we have reviewed studies related to RT-PCR and CT chest and we would like to give our recommendations. Depending upon the patient's clinical symptoms and radiology imaging typical of viral pneumonia compatible with COVID-19 infection, clinicians need to consider isolation of these patients early even if the RT-PCR test is negative.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_2108_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208214PMC
May 2021

Rational use of PPE and preventing PPE related skin damage.

J Family Med Prim Care 2021 Apr 29;10(4):1547-1553. Epub 2021 Apr 29.

COVID-19 Committee Members: Director and CEO, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan, India.

On 31 December, 2019, an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared in Wuhan, China. On 24 March 2020, there was a nationwide lockdown for 21 days, followed by Janata curfew on 22 March. As the pandemic has developed and spread across continents, everyone including policy makers have realized shortage of personal protective equipment (PPE) such as N95 respirators, coverall, and face shields. This is one of the major factors putting healthcare workers not only at risk of infection but also to various side effects of prolonged use of PPE. Based on international experiences, new ideas in procuring and mass manufacturing, rational use of PPE equipment is the need of hour, especially for developing nations which lack adequate resources and infrastructure for manufacturing PPEs.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1772_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144757PMC
April 2021

Suraksha Chakra: A new scoring system to protect the healthcare workers from COVID.

J Family Med Prim Care 2021 Apr 29;10(4):1512-1514. Epub 2021 Apr 29.

Director and CEO, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan, India.

Doctors, nurses, house cleaning staff and hospital ward attendants are at increased risk of acquiring coronavirus disease 2019 (COVID-19) if there is a breach in the personal protection equipment. A new simple, easy to implement scoring system has been developed by our Suraksha Chakra team which can be used by the policy makers and hospital administrators. The scoring system is not to discourage anyone but constantly reinforce the healthcare workers for safe practices during patient care.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1768_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144755PMC
April 2021

Can combined multiparametric magnetic resonance imaging of the prostate and prostate-specific antigen density improve the detection of clinically significant prostate cancer: A prospective single-center cross-sectional study.

J Cancer Res Ther 2021 Apr-Jun;17(2):372-378

Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Objective: The objective of the study was to validate PIRADS v2 on 3T MRI with secondary assessment if combination of the PIRADS v2 and PSA density improves detection of clinically significant prostate cancer.

Materials And Methods: We conducted a prospective study evaluating 58 patients with PSA value of >4 ng/ml from July 2017 to December 2019. Transrectal ultrasonography (TRUS) guided targeted biopsy was performed via cognitive targeting followed by systemic 12 core biopsy. Two cognitive fusion-targeted biopsy cores were added for each lesion in patients who had suspicious or equivocal lesions on mpMRI. The PI-RADS scoring system version 2.0 (PI-RADS v2) was used to describe the MRI findings.

Results: Total of 112 lesions of 58 patients were assessed via mpMRI followed by TRUS guided biopsy. A PI-RADS v2 score of ≥4 irrespective of PSA density categories and a PI-RADS v2 score of 3 with PSA density of ≥0.15 ng/mL/cc, yielded the highest overall prostate cancer and clinically significant prostate cancer detection rate. Contrary to, a PI-RADS v2 score of ≤3 and a PSA densitay of <0.15 ng/ mL/mL(low risk group), which yielded no clinically significant prostate cancer.

Conclusion: Both PIRADS v2 score and PSA density are eminently sensitive and specific in the detection of clinically significant prostate cancers individually. However the combination of PIRADS v2 and PSA density significantly improved the accuracy of clinically significant prostate cancer detection. Patients with combination of PIRADS v2 score 3 and PSA density 0.15 ng/ml/cc should undergo prostate biopsy.
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http://dx.doi.org/10.4103/jcrt.JCRT_216_20DOI Listing
December 2021

Pseudo-pseudo Meigs' syndrome (PPMS) in chronic lupus peritonitis: a case report with review of literature.

Mod Rheumatol Case Rep 2021 07 10;5(2):300-305. Epub 2021 May 10.

Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India.

Gastrointestinal involvement in systemic lupus erythematosus (SLE) usually occurs in the form of mesenteric vasculitis, protein-losing enteropathy, intestinal pseudo-obstruction, and pancreatitis. We describe a 23-year-old female, a known case of SLE presented with significant ascites and pleural effusion. Further evaluation showed elevated CA-125 levels without evidence of malignancy. The patient was treated with corticosteroids, hydroxychloroquine, and azathioprine resulting in the resolution of ascites in 2 weeks. The triad of ascites, pleural effusion, and increased CA-125 is known as pseudo-pseudo Meigs' syndrome, which is rarely reported in the literature. Clinicians should be aware of this entity while evaluating an SLE patient with low serum-ascites albumin gradient (SAAG) ascites.
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http://dx.doi.org/10.1080/24725625.2021.1916160DOI Listing
July 2021

Chest-X-ray-Based Scoring, Total Leukocyte Count, and Neutrophil-to-Lymphocyte Ratio for Prediction of COVID-19 in Patients with Severe Acute Respiratory Illness.

Turk Thorac J 2021 Mar 1;22(2):130-136. Epub 2021 Mar 1.

Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India.

Objective: This study aimed to use chest-X-ray (CXR)-based scores along with total leukocyte count (TLC) and neutrophil-to-lymphocyte ratio (NLR) in the prediction of coronavirus disease 2019 (COVID-19) in patients presenting with clinical features of severe acute respiratory illness (SARI).

Material And Methods: This is a retrospective study involving all patients who presented with clinical features of SARI and who had undergone bedside chest X-ray (CXR), hemograms with TLC, NLR, and reverse transcriptase-polymerase chain reaction (RT-PCR) at our institute from May 1 to June 30, 2020.

Results: Of 204 patients, 115 tested RT-PCR-positive and 89 tested negative. The patients who presented with SARI, using CXR-based score of 4 or more, TLC of less than 8,700 cells/μL, and NLR of <7 had a statistically significant area under the curve (p<0.001) for diagnosing COVID-19. The sensitivity and specificity of the CXR score was 80.8% and 73.0%, of TLC was 70.1% and 74.7%, and of NLR was 70.1% and 59.0%, respectively, in diagnosing COVID-19 alone. The specificity further increased to 90.4% when we used the CXR score with NLR and to 92.8% when we used the CXR score with TLC. The post-test odds ("rule in" disease) of a positive test for having the disease were 3, 2.77, and 1.71 times with the use of either CXR score, TLC, or NLR criteria, respectively; whereas, combined use of CXR score and NLR increased the post-test odds by 5.53 times, and combination of CXR score with TLC increased the post-test odds by 7.5 times.

Conclusion: CXR score with TLC and NLR can predict COVID-19 infection among those who presented with features of SARI. This may help in the early isolation of the patient until the RT-PCR report becomes available.
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http://dx.doi.org/10.5152/TurkThoracJ.2021.20239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051298PMC
March 2021

COVID-19 pandemic: Cleaning and disinfection - What should the radiologist know?

Indian J Radiol Imaging 2021 Jan 23;31(Suppl 1):S207-S211. Epub 2021 Jan 23.

Director and CEO, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India.

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http://dx.doi.org/10.4103/ijri.IJRI_334_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996686PMC
January 2021

Rationalizing personal protective equipment (PPE) in radiology in the time of COVID-19.

Indian J Radiol Imaging 2021 Jan 23;31(Suppl 1):S204-S206. Epub 2021 Jan 23.

Department of Professor Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India.

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http://dx.doi.org/10.4103/ijri.IJRI_443_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996676PMC
January 2021

N95 respirator or triple layer surgical mask: Radiologist perspective.

Indian J Radiol Imaging 2021 Jan 23;31(Suppl 1):S198-S203. Epub 2021 Jan 23.

Director and CEO, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India.

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http://dx.doi.org/10.4103/ijri.IJRI_350_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996693PMC
January 2021

Predicting Malignancy in Adnexal Masses by the International Ovarian Tumor Analysis-Simple Rules.

J Midlife Health 2020 Oct-Dec;11(4):217-223. Epub 2021 Jan 21.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Background: Accurate prediction of adnexal tumors preoperatively is critical for optimal management of ovarian cancers. The International Ovarian Tumor Analysis Algorithms (IOTA) is a newer tool to characterize adnexal masses as benign or malignant.

Objective: This study is aimed to predict malignancy in adnexal masses and differentiates benign from malignant, applying the sonography features of simple rules given by IOTA.

Methodology: A prospective study was carried out at AIIMS Jodhpur for 1½ years. Women presenting with adnexal masses planned for surgery were recruited. Ultrasonography-transabdominal combined with transvaginal was done, and pelvic masses were characterized using IOTA simple rules. Patients underwent their planned surgery. Histopathology is considered the gold standard and was compared with the IOTA simple rules. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results: One hundred and seventy-four women were included in the study, of which the majority (82.75%) were benign, the rest being frankly malignant or borderline cancer. The sensitivity of IOTA is 96.6%, specificity of 92.3%, PPV of 72.5%, NPV of 99.2%, where indeterminate cases were considered malignant.

Conclusion: IOTA simple rule is an effective tool for identifying malignant adnexal masses. It also suggests that IOTA-simple rules can be used as a diagnostic criterion for differentiating adnexal masses into benign and malignant on an out-patient department basis.
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http://dx.doi.org/10.4103/jmh.JMH_103_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978049PMC
January 2021

MDCT evaluation of pancreatic contour variations in head, neck, body and tail: surgical and radiological significance.

Surg Radiol Anat 2021 Sep 18;43(9):1405-1412. Epub 2021 Mar 18.

Department of Surgical Oncology, AIIMS, Jodhpur, India.

Objective: The purpose of the study was to investigate the incidence of pancreatic contour variations on multidetector CT (MDCT) for abdominal examinations.

Methods: A retrospective analysis of 700 MDCT scans was performed in patients who underwent triple phase CT abdomen between October 2018 and January 2021. After excluding 176 patients, finally total of 524 patients were included in the study. For simplification, we classified the pancreatic contour variations as classified by Ross et al. and Omeri et al. Pancreatic head-neck variations was classified into Type I-anterior, Type II-posterior and Type III-horizontal variety. Pancreatic body-tail variation was divided into Type Ia-anterior projection; Ib-posterior projection and Type IIa-globular, IIb-lobulated, IIc-tapered, and IId-bifid pancreatic tail.

Results: The most common type of variation in the head was Type II (n = 112, 21.3%) followed by Type III (n = 37, 7%) and Type I (n = 21, 4%). The most common type of variation in the body of pancreas was Type Ia (n = 33, 6.2%) followed by Type Ib (n = 13, 2.4%). In the tail region of pancreas, the most common variation was Type IIb (n = 21, 4%) followed by Type IIa (n = 19, 3.6%).

Conclusion: Pancreatic contour variations are not very uncommon in daily practice. Knowledge of these variations is important for surgeons, radiologists and avoids misjudgement of normal pancreatic tissue as tumor or lymph node especially on unenhanced or single phase MDCT.
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http://dx.doi.org/10.1007/s00276-021-02735-4DOI Listing
September 2021

A Rare Complication of Feeding Jejunostomy: Murky Waters of the Surgeons.

Cureus 2021 Jan 27;13(1):e12945. Epub 2021 Jan 27.

Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND.

Feeding jejunostomy (FJ) is a common surgical procedure for patients presenting with absolute dysphagia. Jejunostomy tube-induced intussusception is an extremely rare complication associated with it and its recognition and proper management are necessary to prevent subsequent bowel ischemia of the intussusception. We present a rare case with simultaneous intussusception at two sites in a patient who underwent FJ with Foley's catheter one month back and subsequently managed by surgical reduction and repositioning of the FJ tube.
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http://dx.doi.org/10.7759/cureus.12945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920236PMC
January 2021

Preparing for a COVID-19 pandemic: Redefining roles of multidisciplinary team in a large tertiary hospital in Rajasthan.

J Family Med Prim Care 2020 Nov 30;9(11):5439-5444. Epub 2020 Nov 30.

COVID-19 Committee Member: Department of Director and CEO, Professor Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan, India.

Through this manuscript, we would like to share our experience with building a COVID hospital, allocating duties, planning and managing supplies during COVID-19 pandemic. This manuscript is prepared by the Doctors of various specialties with vast experience involved in actual planning of the infrastructure and resources. This comprehensive manuscript will help teams to prepare and train, stockpile necessary equipment and prepare their staff to deal with current crisis if there is a surge in infected cases.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1091_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842448PMC
November 2020
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