Publications by authors named "Mansi Verma"

62 Publications

Anomalous subaortic course of brachiocephalic vein: Evaluation on multidetector computed tomography angiography.

J Card Surg 2021 Oct 12. Epub 2021 Oct 12.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

Aim: To evaluate the morphology and associated cardiovascular abnormalities in patients with an anomalous subaortic course of brachiocephalic vein on multidetector computed tomography (CT) angiography.

Material And Methods: A retrospective study was performed at a tertiary referral institute to identify patients with subaortic brachiocephalic vein on multidetector CT (MDCT) angiography using dual source CT scanner between January 2014 and July 2021. The morphology of the subaortic brachiocephalic vein along with the cardiovascular anatomy and associated anomalies were evaluated.

Results: Out of 4349 patients who had undergone MDCT angiography for evaluation of congenital heart diseases, we identified 126 (2.9%) patients with subaortic brachiocephalic vein. The subaortic brachiocephalic vein was left-sided in 125 patients while a right-sided subaortic brachiocephalic vein was identified in a patient with left isomerism. Common cardiovascular associations included tetralogy of Fallot (109/126; 88.1%), double outlet right ventricle (8/126; 6.3%) and common arterial trunk (5/126; 3.9%). The presence of a right aortic arch was seen in 78/126 (62%) patients. Some degree of right ventricular outflow obstruction was present in 119/126 (94.4%) patients; pulmonary stenosis was seen in 78 (62%) patients while pulmonary atresia was seen in 41 (32.5%) patients.

Conclusion: A subaortic brachiocephalic vein can coexist with various complex congenital heart diseases, most commonly tetralogy of Fallot and commonly associated with right aortic arch and pulmonary stenosis/atresia. It is important to identify this anomalous course of brachiocephalic vein before performing surgical procedures or venous catheterization to avoid potential complications.
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http://dx.doi.org/10.1111/jocs.16068DOI Listing
October 2021

Periaortic air in native and post-operative aorta on computed tomography.

Br J Radiol 2021 Sep 30:20210878. Epub 2021 Sep 30.

Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

Periaortic air can be seen in various conditions which can be a benign imaging finding or harbinger of a catastrophic event. The causes vary in native aorta and post-operative aorta. A radiologist has an important part in the management process of these patients, as the treatment varies from conservative to radical surgery based on the aetiology. The presence of periaortic air seen in the light of various clinical, laboratory and radiological findings can guide the radiologist towards a particular aetiology. Cross-sectional imaging, mainly computed tomography, is an indispensable tool in recognising ectopic periaortic air and to identify the associated findings and eventually make an accurate diagnosis. We present a pictorial review of various causes of the periaortic air in native and postoperative aorta, the salient features and management of the described conditions.
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http://dx.doi.org/10.1259/bjr.20210878DOI Listing
September 2021

Venous vascular ring: Duplicated left brachiocephalic vein with preaortic and retroesophageal course.

Ann Thorac Surg 2021 Sep 21. Epub 2021 Sep 21.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi.

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http://dx.doi.org/10.1016/j.athoracsur.2021.08.027DOI Listing
September 2021

Early Surgical Intervention Followed by Antifungals in Rhino-Orbital Mucormycosis in Patients With COVID-19 Favors Clinical Outcome: A Case Series.

Cureus 2021 Aug 14;13(8):e17178. Epub 2021 Aug 14.

Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, IND.

Mucormycosis is an invasive fungal infection occurring in patients with or without preexisting medical illnesses. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal coinfections among some COVID-19 patients with preexisting comorbid illnesses such as diabetes and hypertension, with mucormycosis being one of them. The management of this dreaded fungal infection demands early and prompt surgical intervention to thoroughly remove the infected tissue and necrotic material to reduce the tissue burden of this invasive organism. This should be accompanied by expeditious initiation of amphotericin B along with supportive therapy. Here we present five cases of rhino-orbital mucormycosis in patients with COVID-19, all of whom presented with orbital and facial swelling (three had symptoms of impending blindness) under the backdrop of COVID-19 symptoms in the form of intermittent fever and slight dyspnea. Our treatment strategy comprised an expeditious use of early surgical intervention and amphotericin B along with the control of cytokine storm and hyperglycemia. This treatment strategy eventually resulted in an improved clinical outcome.
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http://dx.doi.org/10.7759/cureus.17178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437210PMC
August 2021

Imaging Spectrum of Valvular and Paravalvular Complications of Prosthetic Heart Valve at CT Angiography.

Radiol Cardiothorac Imaging 2021 Aug 19;3(4):e210159. Epub 2021 Aug 19.

Department of Cardiovascular Radiology & Endovascular Interventions (M.V., N.N.P., S.K.) and Department of Cardiology (S.R.), All India Institute of Medical Sciences, New Delhi 110029, India.

Prosthetic heart valve (PHV) dysfunction is an uncommon but potentially life-threatening condition. In routine practice, transthoracic echocardiography and cinefluoroscopy comprise first-line imaging for the diagnostic evaluation of PHV dysfunction. In cases in which the findings of echocardiography and cinefluoroscopy remain inconclusive or are contradictory, CT angiography can resolve these conflicts. CT angiography also provides incremental diagnostic information about patients with suspected PHV obstruction and endocarditis, in which case it can demonstrate the anatomic substrate and extent of involvement. Additionally, information regarding the coronary arteries, cardiac dimensions, and retrosternal space may be obtained in cases in which repeat surgery is planned. This imaging essay describes the imaging spectrum of valvular and paravalvular complications of PHV at CT angiography and how the knowledge regarding the spectrum of complications can be incorporated into multimodality imaging for guiding clinical management. Prosthetic Heart Valve Dysfunction, Prosthetic Heart Valve Thrombosis, Pannus, Paravalvular Leak, CT Angiography, Cardiac, Valves Supplemental material is available for this article. © RSNA, 2021.
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http://dx.doi.org/10.1148/ryct.2021210159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415148PMC
August 2021

Phytocompounds of , , and Inhibit Spike Protein of SARS-CoV-2 Binding to ACE2 Receptor: In Silico Approach.

Curr Pharmacol Rep 2021 Jul 15:1-15. Epub 2021 Jul 15.

Faculty of Applied Sciences and Biotechnology, Shoolini University, Pin, Solan, Himachal Pradesh 173212 India.

COVID-19, the disease caused by SARS-CoV-2, has been declared as a global pandemic. Traditional medicinal plants have long history to treat viral infections. Our in silico approach suggested that unique phytocompounds such as emodin, thymol and carvacrol, and artemisinin could physically bind SARS-CoV-2 spike glycoproteins (6VXX and 6VYB), SARS-CoV-2 B.1.351 South Africa variant of Spike glycoprotein (7NXA), and even with ACE2 and prevent the SARS-CoV-2 binding to the host ACE2, TMPRSS2 and neutrapilin-1 receptors. Since Chloroquine has been looked as potential therapy against COVID-19, we also compared the binding of chloroquine and artemisinin for its interaction with spike proteins (6VXX, 6VYB) and its variant 7NXA, respectively. Molecular docking study of phytocompounds and SARS-CoV-2 spike protein was performed by using AutoDock/Vina software. Molecular dynamics (MD) simulation was performed for 50ns. Among all the phytocompounds, molecular docking studies revealed lowest binding energy of artemisinin with 6VXX and 6VYB, with E -10.5 KJ mol and -10.3 KJ mol respectively. Emodin showed the best binding affinity with 6VYB with E -8.8 KJ moland SARS-CoV-2 B.1.351 variant (7NXA) with binding energy of -6.4KJ mol. Emodin showed best interactions with TMPRSS 2 and ACE2 with E of -7.1 and -7.3 KJ mol respectively, whereas artemisinin interacts with TMPRSS 2 and ACE2 with E of -6.9 and -7.4 KJ mol respectively. All the phytocompounds were non-toxic and non-carcinogenic. MD simulation showed that artemisinin has more stable interaction with 6VYB as compared to 6VXX, and hence proposed as potential phytochemical to prevent SARS-CoV-2 interaction with ACE-2 receptor.

Supplementary Information: The online version contains supplementary material available at 10.1007/s40495-021-00259-4.
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http://dx.doi.org/10.1007/s40495-021-00259-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279807PMC
July 2021

Mycotic aneurysms of pulmonary artery secondary to pulmonary valve endocarditis in a child.

J Card Surg 2021 Sep 6;36(9):3388-3389. Epub 2021 Jun 6.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

We present the case of a 7-year-old child with mycotic aneurysms of bilateral lower lobe pulmonary arteries secondary to pulmonary valve endocarditis. The child underwent pulmonary vegetectomy with ventricular septal defect closure and left lower lobe pulmonary lobectomy via midline sternotomy.
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http://dx.doi.org/10.1111/jocs.15713DOI Listing
September 2021

An unusual case of Shone's complex in an adult depicted on computed tomography angiography.

J Card Surg 2021 Aug 1;36(8):2956-2957. Epub 2021 Jun 1.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

We present a case of a 22-year-old male with dyspnea on exertion where computed tomography revealed complete Shone's complex. This case highlights the complementary role of computed tomography in the anatomical evaluation of patients with complex heart diseases.
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http://dx.doi.org/10.1111/jocs.15635DOI Listing
August 2021

Misplaced hemodialysis catheter in aortic root.

Asian Cardiovasc Thorac Ann 2021 Oct 26;29(8):852. Epub 2021 May 26.

Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1177/02184923211019853DOI Listing
October 2021

Evaluation of cardiovascular morphology and airway-related abnormalities in tetralogy of fallot with absent pulmonary valve syndrome on multidetector computed tomography angiography.

J Card Surg 2021 Aug 16;36(8):2697-2704. Epub 2021 May 16.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Aim: To evaluate the cardiovascular, tracheobronchial and pulmonary abnormalities associated with tetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) on multidetector computed tomograpgy (MDCT) angiography.

Materials And Methods: We conducted a retrospective review of our electronic database from January, 2014 to December, 2020 to identify pediatric patients diagnosed with TOF-APVS on MDCT angiography. Pulmonary anatomy, associated tracheobronchial and coronary compression, compression of intrapulmonary bronchi, lung parenchymal changes and other associated cardiovascular abnormalities were evaluated.

Results: Forty-seven patients with TOF-APVS were included in the study. Compression of the airways was observed at multiple levels; 4 (8.5%) patients had carinal compression while right main bronchus and left main bronchus compression was seen in 12 (25.5%) and 16 (34.0%) patients, respectively. Forty-three (91.5%) patients showed abnormal pulmonary arterial branching at the segmental level and compression at the level of intrapulmonary bronchi was seen in 24 (51.1%) patients. Some degree of air trapping was seen in 35 (74.5%) patients whereas atelectasis was observed in 15 (31.9%) patients. Mild coronary arterial compression was seen in 3 (6.4%) patients.

Conclusion: TOF-APVS is characterized by aneurysmal dilatation of pulmonary arteries leading to a varying degree of airway compression. However, even in the absence of compression of the trachea and main bronchi, there can be distal bronchial compression secondary to abnormal pulmonary arterial branching resulting in lung abnormalities in the majority of these patients. This study highlights the importance of dedicated airway assessment in addition to cardiovascular morphological assessment by MDCT angiography, before planning surgery.
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http://dx.doi.org/10.1111/jocs.15639DOI Listing
August 2021

A rare pediatric case of bilateral bronchopulmonary vascular malformations and right isomerism.

J Card Surg 2021 Aug 24;36(8):2937-2938. Epub 2021 Apr 24.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

We present an unusual case of an 18-day-old term neonate with coexistent bilateral bronchopulmonary vascular malformations and right isomerism. This case highlights the importance of computed tomography angiography in depicting such complex anomalies and classifying them according to components involved providing a systematic approach for evaluation of the disease process.
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http://dx.doi.org/10.1111/jocs.15573DOI Listing
August 2021

Anomalies of coronary arteries in tetralogy of Fallot: Evaluation on multidetector CT angiography using dual-source scanner.

J Card Surg 2021 Jul 19;36(7):2373-2380. Epub 2021 Apr 19.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Objectives: The present study sought to determine the prevalence and evaluate the patterns of various anomalies of coronary arteries in patients with tetralogy of Fallot (TOF) on multidetector CT angiography using a dual-source CT scanner.

Methods: We retrospectively reviewed CT angiographies of 955 pediatric patients, diagnosed with TOF between 1st January 2015 and 31st December 2019 and having an optimal evaluation of coronary arteries, with respect to the origin, course, and termination of the coronary arteries and associated cardiovascular anomalies.

Results: Anomalies of coronary arteries were observed in 8.27% (79/955) patients with TOF. Origin of accessory/proper left anterior descending (LAD) artery from right coronary artery (RCA) or right coronary sinus was the most common anomalous pattern, seen in 3.14% (30/955) patients, followed by the presence of hypertrophied conal artery seen in 2.62% (25/955) patients. The anomalous coronary artery was crossing the right ventricular outflow tract (RVOT) in all cases where the LAD artery was arising from RCA or right coronary sinus or where RCA was arising from the LAD artery. Coronary arterial anomalies were seen in a significantly higher proportion of patients with an atrial septal defect compared to those without (7/25 [28%] vs. 72/930 [7.74%]; p = .0003).

Conclusion: The prevalence of anomalies of coronary arteries increases significantly in the presence of TOF as compared to the general population. Majority of these anomalous coronary arteries course anterior to the RVOT which can potentially pose technical difficulties with a risk of adverse surgical outcomes and increased morbidity and mortality, rendering their diagnosis crucial before surgery.
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http://dx.doi.org/10.1111/jocs.15572DOI Listing
July 2021

Pulmonary-to-systemic venous collateral in obstructed supracardiac totally anomalous pulmonary venous connection: Blood finds a way!

J Card Surg 2021 Aug 16;36(8):2935-2936. Epub 2021 Apr 16.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

We describe a rare variant of obstructed supracardiac totally anomalous venous connection in a 7-day-old boy where the vertical vein was occluded and the entire pulmonary venous return was draining through a large tortuous pulmonary-systemic venous collateral. The case highlights the importance of computed tomography angiography in demonstrating such complex anatomies in congenital heart diseases.
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http://dx.doi.org/10.1111/jocs.15568DOI Listing
August 2021

Retroesophageal left brachiocephalic vein in tetralogy of fallot: an anomalous course depicted on computed tomography angiography.

Acta Cardiol 2021 Apr 8:1-2. Epub 2021 Apr 8.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1080/00015385.2021.1909277DOI Listing
April 2021

Bilingualism and Its Implications for Neuropsychological Evaluation.

Arch Clin Neuropsychol 2021 Mar 27. Epub 2021 Mar 27.

Department of Neurology, All India Institute of Medical Sciences, Delhi, India.

Objective: In the background of a large population of bilinguals globally, the study aimed to develop standards of neuropsychological testing in the context of bilingualism. Because bilingualism is known to affect cognitive processes, bilinguals and monolinguals were compared on their performance on cognitive tests, to investigate the possibility of the need for separate normative data for the two groups.

Method: A comprehensive neuropsychological test battery, standardized across five Indian languages: the Indian Council of Medical Research-Neuro Cognitive Tool Box (ICMR-NCTB) was administered to 530 participants (267 monolingual and 263 bilinguals matched for age and education). A systematic method of testing cognition in bilinguals was developed; to identify the appropriate language for testing, ensure language proficiency of examiner, and to interpret the bilingual responses. Additionally, the performance of bilinguals on the ICMR-NCTB was compared with monolinguals.

Results: Cognitive testing in the bilingual context was performed in the most proficient language of the participants, by examiners well versed with the language. Results from the language-based tests suggested that the frequent occurrence of borrowed- and language-mixed words required consideration while scoring. The reported bilingual effect on cognitive processes did not reflect as differences in the performance between bilinguals and monolinguals.

Conclusions: Observations from the study provide robust recommendations for neuropsychological testing in the context of bilingualism. Results indicate that separate normative data may not be required for bilinguals and monolinguals. The study will be relevant and provide a reference framework to address similar issues in the large population of bilinguals in other societies.
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http://dx.doi.org/10.1093/arclin/acab012DOI Listing
March 2021

Comparative Genomics and Integrated Network Approach Unveiled Undirected Phylogeny Patterns, Co-mutational Hot Spots, Functional Cross Talk, and Regulatory Interactions in SARS-CoV-2.

mSystems 2021 Feb 23;6(1). Epub 2021 Feb 23.

The Energy and Resources Institute, New Delhi, India

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in 92 million cases in a span of 1 year. The study focuses on understanding population-specific variations attributing its high rate of infections in specific geographical regions particularly in the United States. Rigorous phylogenomic network analysis of complete SARS-CoV-2 genomes (245) inferred five central clades named a (ancestral), b, c, d, and e (subtypes e1 and e2). Clade d and subclade e2 were found exclusively comprised of U.S. strains. Clades were distinguished by 10 co-mutational combinations in Nsp3, ORF8, Nsp13, S, Nsp12, Nsp2, and Nsp6. Our analysis revealed that only 67.46% of single nucleotide polymorphism (SNP) mutations were at the amino acid level. T1103P mutation in Nsp3 was predicted to increase protein stability in 238 strains except for 6 strains which were marked as ancestral type, whereas co-mutation (P409L and Y446C) in Nsp13 were found in 64 genomes from the United States highlighting its 100% co-occurrence. Docking highlighted mutation (D614G) caused reduction in binding of spike proteins with angiotensin-converting enzyme 2 (ACE2), but it also showed better interaction with the TMPRSS2 receptor contributing to high transmissibility among U.S. strains. We also found host proteins, MYO5A, MYO5B, and MYO5C, that had maximum interaction with viral proteins (nucleocapsid [N], spike [S], and membrane [M] proteins). Thus, blocking the internalization pathway by inhibiting MYO5 proteins which could be an effective target for coronavirus disease 2019 (COVID-19) treatment. The functional annotations of the host-pathogen interaction (HPI) network were found to be closely associated with hypoxia and thrombotic conditions, confirming the vulnerability and severity of infection. We also screened CpG islands in Nsp1 and N conferring the ability of SARS-CoV-2 to enter and trigger zinc antiviral protein (ZAP) activity inside the host cell. In the current study, we presented a global view of mutational pattern observed in SARS-CoV-2 virus transmission. This provided a who-infect-whom geographical model since the early pandemic. This is hitherto the most comprehensive comparative genomics analysis of full-length genomes for co-mutations at different geographical regions especially in U.S. strains. Compositional structural biology results suggested that mutations have a balance of opposing forces affecting pathogenicity suggesting that only a few mutations are effective at the translation level. Novel HPI analysis and CpG predictions elucidate the proof of concept of hypoxia and thrombotic conditions in several patients. Thus, the current study focuses the understanding of population-specific variations attributing a high rate of SARS-CoV-2 infections in specific geographical regions which may eventually be vital for the most severely affected countries and regions for sharp development of custom-made vindication strategies.
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http://dx.doi.org/10.1128/mSystems.00030-21DOI Listing
February 2021

Anomalous origin of left subclavian artery from ascending aorta in a right aortic arch: A case report with review of literature.

J Card Surg 2021 Mar 13;36(3):1130-1133. Epub 2021 Jan 13.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

We present a case of an 11-year-old boy with a double-outlet right ventricle and a right-sided aortic arch showing anomalous origin of the left subclavian artery from the ascending aorta as the first branch. This case highlights the importance of knowledge of this aberrant anatomy before planning any surgical or endovascular intervention.
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http://dx.doi.org/10.1111/jocs.15323DOI Listing
March 2021

Validation of Indian Council of Medical Research Neurocognitive Tool Box in Diagnosis of Mild Cognitive Impairment in India: Lessons from a Harmonization Process in a Linguistically Diverse Society.

Dement Geriatr Cogn Disord 2020 7;49(4):355-364. Epub 2021 Jan 7.

Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India.

Background/aims: In a linguistically diverse country such as India, challenges remain with regard to diagnosis of early cognitive decline among the elderly, with no prior attempts made to simultaneously validate a comprehensive battery of tests across domains in multiple languages. This study aimed to determine the utility of the Indian Council of Medical Research-Neurocognitive Tool Box (ICMR-NCTB) in the diagnosis of mild cognitive impairment (MCI) and its vascular subtype (VaMCI) in 5 Indian languages.

Methods: Literate subjects from 5 centers across the country were recruited using a uniform process, and all subjects were classified based on clinical evaluations and a gold standard test protocol into normal cognition, MCI, and VaMCI. Following adaptation and harmonization of the ICMR-NCTB across 5 different Indian languages into a composite Z score, its test performance against standards, including sensitivity and specificity of the instrument as well as of its subcomponents in diagnosis of MCI, was evaluated in age and education unmatched and matched groups.

Results: Variability in sensitivity-specificity estimates was noted between languages when a total of 991 controls and 205 patients with MCI (157 MCI and 48 VaMCI) were compared due to a significant impact of age, education, and language. Data from a total of 506 controls, 144 patients with MCI, and 46 patients with VaMCI who were age- and education-matched were compared. Post hoc analysis after correction for multiple comparisons revealed better performance in controls relative to all-cause MCI. An optimum composite Z-score of -0.541 achieved a sensitivity of 81.1% and a specificity of 88.8% for diagnosis of all-cause MCI, with a high specificity for diagnosis of VaMCI. Using combinations of multiple-domain 2 test subcomponents retained a sensitivity and specificity of >80% for diagnosis of MCI.

Conclusions: The ICMR-NCTB is a "first of its kind" approach at harmonizing neuropsychological tests across 5 Indian languages for the diagnosis of MCI due to vascular and other etiologies. Utilizing multiple-domain subcomponents also retains the validity of this instrument, making it a valuable tool in MCI research in multilingual settings.
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http://dx.doi.org/10.1159/000512393DOI Listing
May 2021

'Spontaneous aneurysm of left testicular artery with an anomalous origin': detection of a rare entity on CT.

BMJ Case Rep 2021 Jan 6;14(1). Epub 2021 Jan 6.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, Delhi, India

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http://dx.doi.org/10.1136/bcr-2020-240456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789439PMC
January 2021

Cardiac Magnetic Resonance Imaging in Coronavirus Disease 2019 (COVID-19): A Systematic Review of Cardiac Magnetic Resonance Imaging Findings in 199 Patients.

J Thorac Imaging 2021 Mar;36(2):73-83

Departments of Cardiovascular Radiology & Endovascular Interventions.

Objective: Cardiac magnetic resonance imaging (CMR) with its new quantitative mapping techniques has proved to be an essential diagnostic tool for detecting myocardial injury associated with coronavirus disease 2019 (COVID-19) infection. This systematic review sought to assess the important imaging features on CMR in patients diagnosed with COVID-19.

Materials And Methods: We performed a systematic literature review within the PubMed, Embase, Google Scholar, and WHO databases for articles describing the CMR findings in COVID-19 patients.

Results: A total of 34 studies comprising 199 patients were included in the final qualitative synthesis. Of the CMRs 21% were normal. Myocarditis (40.2%) was the most prevalent diagnosis. T1 (109/150; 73%) and T2 (91/144; 63%) mapping abnormalities, edema on T2/STIR (46/90; 51%), and late gadolinium enhancement (LGE) (85/199; 43%) were the most common imaging findings. Perfusion deficits (18/21; 85%) and extracellular volume mapping abnormalities (21/40; 52%), pericardial effusion (43/175; 24%), and pericardial LGE (22/100; 22%) were also seen. LGE was most commonly seen in the subepicardial location (81%) and in the basal-mid part of the left ventricle in inferior segments. In most of the patients, ventricular functions were normal. Kawasaki-like involvement with myocardial edema without necrosis/LGE (4/6; 67%) was seen in children.

Conclusion: CMR is useful in assessing the prevalence, mechanism, and extent of myocardial injury in COVID-19 patients. Myocarditis is the most common imaging diagnosis, with the common imaging findings being mapping abnormalities and myocardial edema on T2, followed by LGE. As cardiovascular involvement is associated with poor prognosis, its detection warrants prompt attention and appropriate treatment.
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http://dx.doi.org/10.1097/RTI.0000000000000574DOI Listing
March 2021

An unusual pediatric case of tuberculosis-associated mediastinal fibrosis with concomitant pulmonary arterial and venous occlusion.

J Card Surg 2021 Feb 1;36(2):698-700. Epub 2020 Dec 1.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

We present a case of a 4-year-old boy with tuberculosis-associated mediastinal fibrosis with concomitant pulmonary arterial and venous occlusion, highlighting the role computed tomography angiography in identification of the disease process, coexistent vascular abnormalities and associated complications.
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http://dx.doi.org/10.1111/jocs.15218DOI Listing
February 2021

Developmental anomalies of the superior vena cava and its tributaries: What the radiologist needs to know?

Br J Radiol 2021 Feb 16;94(1118):20200856. Epub 2020 Nov 16.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Deviations from the normal process of embryogenesis can result in various developmental anomalies of the superior vena cava (SVC). While these anomalies are often asymptomatic, they assume clinical importance during interventions such as central venous catheterisations and pacemaker implantations and during cardiothoracic surgeries while instituting cardiopulmonary bypass and for creation of cavo-pulmonary connections. Role of imaging in identifying these anomalies is indispensable. Cross-sectional imaging techniques like CT venography and magnetic resonance (MR) venography allow direct visualisation and consequently increased detection of anomalies. CT venography plays an important role in detection of SVC anomalies as it is readily available, has excellent spatial resolution, short acquisition times and potential for reconstruction of images in multiple planes. This pictorial review focuses on the developmental anomalies of the SVC and its tributaries highlighting their embryological basis, imaging appearances on CT venography and potential clinical implications, where relevant.
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http://dx.doi.org/10.1259/bjr.20200856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934304PMC
February 2021

Endurant Iliac Limb Trimming and Resheathing with Deployment via Axillary Conduit for Emergent Abdominal Aortic Repair.

J Vasc Interv Radiol 2020 Oct;31(10):1668-1669

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi 110029, India.

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http://dx.doi.org/10.1016/j.jvir.2020.05.009DOI Listing
October 2020

Development and validation of a computed tomography index for assessing outcomes in patients with acute pancreatitis: "SMART-CT" index.

Abdom Radiol (NY) 2021 04 16;46(4):1618-1628. Epub 2020 Sep 16.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Purpose: The existing CT indices do not allow quantitative prediction of clinical outcomes in acute pancreatitis (AP). The aim of this study was to develop and validate a revised CT index using a nomogram-based approach.

Methods: This retrospective study comprised consecutive patients with AP who underwent contrast-enhanced CT between June 2017 and March 2019. 123 CT scans were randomly divided into training (n = 103) and validation groups (n = 20). Two radiologists analyzed CT scans for findings described in modified CT severity index and additional exploratory items (13 items). Seven items (pancreatic necrosis, number of collections, size of collections, ascites, pleural effusion, celiac artery involvement, and liver steatosis) found to be statistically significant were used for development of index. Synthetic minority oversampling technique (SMOTE) was employed to balance representation of minority classes and hence this index was named "SMOTE Application for Reading CT in AcuTe Pancreatitis (SMART-CT index)". Binomial logistic regression was used for development of prediction algorithm. Nomograms were then created and validated for each outcome.

Results: The new CT index had area under the curve (AUC) of 0.79 [95% CI 0.65-0.93], 0.66 (95% CI 0.54-0.77), 0.75 (95% CI 0.65-0.85), 0.83 (95% CI 0.69-0.96), 0.70 (95% CI 0.60-0.81), and 0.64 (95% CI 0.53-0.75) for mortality, intensive care unit (ICU) stay, length of hospitalization, length of ICU stay, number of admissions, and severity, respectively. The AUC of validation cohort was comparable to the training cohort.

Conclusion: The novel nomogram-based index predicts occurrence of clinical outcome with moderate accuracy.
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http://dx.doi.org/10.1007/s00261-020-02740-yDOI Listing
April 2021

Comparative Genomic Analysis of Rapidly Evolving SARS-CoV-2 Reveals Mosaic Pattern of Phylogeographical Distribution.

mSystems 2020 Jul 28;5(4). Epub 2020 Jul 28.

The Energy and Resources Institute, New Delhi, India

The outbreak of coronavirus disease 2019 (COVID-19) that started in Wuhan, China, in December 2019 has spread worldwide, emerging as a global pandemic. The severe respiratory pneumonia caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has so far claimed more than 0.38 million lives and has impacted human lives worldwide. However, as the novel SARS-CoV-2 virus displays high transmission rates, the underlying genomic severity is required to be fully understood. We studied the complete genomes of 95 SARS-CoV-2 strains from different geographical regions worldwide to uncover the pattern of the spread of the virus. We show that there is no direct transmission pattern of the virus among neighboring countries, suggesting that its spread is a result of travel of infected humans to different countries. We revealed unique single nucleotide polymorphisms (SNPs) in nonstructural protein 13 (nsp13), nsp14, nsp15, and nsp16 (ORF1b polyproteins) and in the S-protein within 10 viral isolates from the United States. These viral proteins are involved in RNA replication and binding with the human receptors, indicating that the viral variants that are circulating in the population of the United States are different from those circulating in the populations of other countries. In addition, we found an amino acid addition in nsp16 (mRNA cap-1 methyltransferase) of a U.S. isolate (GenBank accession no. MT188341.1) leading to a shift in the amino acid frame from position 2540 onward. Through comparative structural analysis of the wild-type and mutant proteins, we showed that this addition of a phenylalanine residue renders the protein in the mutant less stable, which might affect mRNA cap-1 methyltransferase function. We further analyzed the SARS-CoV-2-human interactome, which revealed that the interferon signaling pathway is targeted by orf1ab during infection and that it also interacts with NF-κB-repressing factor (NKRF), which is a potential regulator of interleukin-8 (IL-8). We propose that targeting this interaction may subsequently improve the health condition of COVID-19 patients. Our analysis also emphasized that SARS-CoV-2 manipulates spliceosome machinery during infection; hence, targeting splicing might affect viral replication. In conclusion, the replicative machinery of SARS-CoV-2 is targeting interferon and the notch signaling pathway along with spliceosome machinery to evade host challenges. The COVID-19 pandemic continues to storm the world, with over 6.5 million cases worldwide. The severity of the disease varies with the territories and is mainly influenced by population density and age factor. In this study, we analyzed the transmission pattern of 95 SARS-CoV-2 genomes isolated from 11 different countries. Our study also revealed several nonsynonymous mutations in ORF1b and S-proteins and the impact on their structural stability. Our analysis showed the manipulation of host system by viral proteins through SARS-CoV-2-human protein interactome, which can be useful to understand the impact of virus on human health.
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http://dx.doi.org/10.1128/mSystems.00505-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394360PMC
July 2020

Retroesophageal left brachiocephalic vein with an ectatic aberrant left subclavian artery: A rare double vascular loop.

J Card Surg 2020 Sep 27;35(9):2355-2356. Epub 2020 Jul 27.

Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

We hereby present a rare variant course of left brachiocephalic vein coexisting with an aberrant right subclavian artery in a patient with a ventricular septal defect with pulmonary atresia. This case highlights the importance of CT angiography in diagnosing associated aortic arch and systemic venous anomalies in complex congenital heart diseases.
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http://dx.doi.org/10.1111/jocs.14700DOI Listing
September 2020

Persistent left superior vena cava with absent right superior vena cava in the setting of viscero-atrial situs solitus: a rare systemic venous drainage.

Acta Cardiol 2021 Oct 24;76(8):918-919. Epub 2020 Jul 24.

Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

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http://dx.doi.org/10.1080/00015385.2020.1796033DOI Listing
October 2021
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