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Byline: Amar. Shah, Anirudh. Shah Micturating cystourethrography (MCUG) is a very commonly performed diagnostic procedure in pediatric urology. Although considered to be simple, safe, and cost-effective, it can incur some [...]

Purpose The purpose of this study was to determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is detectable in the aqueous of asymptomatic individuals presenting for ophthalmic surgery. Design Prospective cross-sectional study. Methods Setting and participants: all patients undergoing anterior segment surgery at an ambulatory surgical center (ASC) belonging to a tertiary academic center in South Florida during a 102-day period between June and September 2020 received nasal swab testing for SARS-CoV-2 and underwent a relevant review of symptoms prior to surgery, with negative results required for both in order to proceed with surgery. Main outcomes and measurements: a small sample of aqueous humor (approximately 0.2 cc) was acquired at the beginning of anterior segment surgery from all participants. Aqueous humor was analyzed for SARS-CoV-2 viral ribonucleic acid (RNA) using real-time reverse transcriptase polymerase chain reaction. Demographic information was acquired from participants for secondary analyses. Results A total of 70 samples were acquired. Of those, 39 samples were excluded due to insufficient material or inconclusive results. Of 31 samples that were successfully analyzed, 6 (19.4%) demonstrated detectable SARS-CoV-2 RNA. None of the 6 individuals (0%) with detectable viral RNA in aqueous humor reported symptoms during the year, compared to 2 of 25 individuals (8%) with negative samples (P = 1). Positive samples were distributed throughout the study period, including both the first and the last days of enrollment. Conclusions The presence of SARS-CoV-2 viral RNA in aqueous despite negative nasal swab testing confirmed its presence beyond the blood-ocular barrier in asymptomatic individuals and raises the possibility that the virus may persist in immunoprivileged spaces despite an absence of symptoms.

Byline: Mitul. Jasani, Alpa. Jasani, Anirudh. Shah, Amar. Shah Context: Postoperative fever is known to occur after all surgical procedures irrespective of the type of anesthesia. Thermometry devices that work [...]

Byline: Amar. Shah Dr. Nikhilesh Bhattacharjee was born on April 1, 1945. He completed his MBBS from Gauhati Medical College in 1966. He did his MS General Surgery in 1971 [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2016.10.015 Byline: Jesse Clanton (a), Aimee Gardner (b), Michael Subichin (a), Patrick McAlvanah (c), William Hardy (d), Amar Shah (d), Joel Porter (a)(d) Abstract: As residency work hour restrictions have tightened, transitions of care have become more frequent. Many institutions dedicate significant time and resources to patient handoffs despite the fact that the ideal method is relatively unknown. We sought to compare the effect of a rigorous formal handoff approach to a minimized but focused handoff process on patient outcomes. Author Affiliation: (a) Summa Akron City Hospital, Department of Surgery, USA (b) UT Southwestern Medical Center, Department of Surgery, USA (c) Federal Trade Commission, Bureau of Economics, USA (d) Northeast Ohio Medical University, USA Article History: Received 6 April 2016; Revised 15 August 2016; Accepted 20 October 2016

Byline: Amar. Shah, Khalid. Mahmud, Anirudh. Shah Generalized lymphangioma of tongue is a rare cause of macroglossia in children. It causes mechanical discomfort and functional and psychological disturbances. We report [...]

Byline: Amar. Shah, Anirudh. Shah Segmental dilatation of the intestine is a rare disease and mostly involves the ileal segment. It commonly presents in the neonatal period and early infancy [...]

While there is no single diagnostic test for heart failure (HF), imaging plays a supportive role beginning with confirmation of HF, especially by detecting ventricular dysfunction (). Ejection fraction (EF) is important in HF classification, and imaging plays a subsequent role in differentiation between HF with reduced EF (HFrEF) versus preserved EF (HFpEF) (). Once HFrEF is identified, distinction between ischemic and nonischemic etiologies with imaging support () facilitates further planning. Imaging approaches which are usually appropriate include: both resting transthoracic echocardiography (TTE) and chest radiography for ; resting TTE and/or MRI (including functional, without absolute need for contrast) for ; and for , a. Coronary CTA or coronary arteriography (if high pretest probability/symptoms for ischemic disease) for coronary assessment; b. Rest/vasodilator stress SPECT/CT, PET/CT, or MRI for myocardial perfusion assessment; c. Rest/exercise or inotropic stress TTE for myocardial contraction assessment; or d. MRI (including morphologic with contrast) for myocardial characterization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Chronic chest pain (CCP) of a cardiac etiology is a common clinical problem. The diagnosis and classification of the case of chest pain has rapidly evolved providing the clinician with multiple cardiac imaging strategies. Though scintigraphy and rest echocardiography remain as appropriate imaging tools in the diagnostic evaluation, new technology is available. Current evidence supports the use of alternative imaging tests such as coronary computed tomography angiography (CCTA), cardiac MRI (CMRI), or Rb-82 PET/CT. Since multiple imaging modalities are available to the clinician, the most appropriate noninvasive imaging strategy will be based upon the patient's clinical presentation and clinical status. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Byline: Mitul. Jasani, Anirudh. Shah, Amar. Shah Littoral cell angioma is a rare primary splenic vascular tumor, originating from the littoral cells lining the red pulp sinuses of the spleen, [...]

Byline: Mitul. Jasani, Amar. Shah, Anirudh. Shah Primary chylopericardium is a rare entity in the pediatric population, which is characterized by chyle accumulation in the pericardial sac. Treatment of this [...]

To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1016/j.jacr.2017.02.027 Byline: Jacobo Kirsch, MD [kirschj@gmail.com] (a,*), Richard K.J. Brown, MD (b), Travis S. Henry, MD (c), Cylen Javidan-Nejad, MD (d), Clinton Jokerst, MD (e), Paul R. Julsrud, MD (f), Jeffrey P. Kanne, MD (g), Christopher M. Kramer, MD (h), Jonathon A. Leipsic, MD (i), Kalpesh K. Panchal, MD (j), James G. Ravenel, MD (k), Amar B. Shah, MD (l), Tan-Lucien Mohammed, MD (m), Pamela K. Woodard, MD (n), Suhny Abbara, MD (o) Expert Panels on Cardiac and Thoracic Imaging: Key Words Appropriateness Criteria; Appropriate Use Criteria; AUC; DVT; pulmonary CTA; pulmonary embolism; V/Q scan Abstract Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion scans remain largely accurate and useful in certain settings. Lower-extremity ultrasound can substitute by demonstrating deep vein thrombosis; however, if negative, further studies to exclude PE are indicated. In all cases, correlation with the clinical status, particularly with risk factors, improves not only the accuracy of diagnostic imaging but also overall utilization. Other diagnostic tests have limited roles. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Author Affiliation: (a) Principal Author, Cleveland Clinic, Weston, Florida (b) University Hospital, Ann Arbor, Michigan (c) University of California San Francisco, San Francisco, California (d) Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri (e) Banner University Medical Center, Tucson, Arizona (f) Mayo Clinic, Rochester, Minnesota (g) University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (h) University of Virginia Health System, Charlottesville, Virginia; American College of Cardiology (i) St. Paul's Hospital, Vancouver, British Columbia, Canada (j) University of Cincinnati Hospital, Cincinnati, Ohio (k) Medical University of South Carolina, Charleston, South Carolina (l) Westchester Medical Center, Valhalla, New York (m) Specialty Chair, University of Florida College of Medicine, Gainesville, Florida (n) Specialty Chair, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri (o) Panel Chair, UT Southwestern Medical Center, Dallas, Texas * Corresponding author: Jacobo Kirsch, MD, Attn: Division of Radiology, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL 33331-3625. (footnote) The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. (footnote) Reprint requests to: publications@acr.org (footnote) The authors have no conflicts of interest related to the material discussed in this article. (footnote) Disclaimer: The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.

To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1016/j.jacr.2017.01.032 Byline: Jens Vogel-Claussen, MD [jclauss1@jhmi.edu] (a,*), Amany S.M. Elshafee, BCh, MB (b), Jacobo Kirsch, MD (c), Richard K.J. Brown, MD (d), Lynne M. Hurwitz, MD (e), Cylen Javidan-Nejad, MD (f), Paul R. Julsrud, MD (g), Christopher M. Kramer, MD (h), Rajesh Krishnamurthy, MD (i), Archana T. Laroia, MD (j), Jonathon A. Leipsic, MD (k), Kalpesh K. Panchal, MD (l), Amar B. Shah, MD (m), Richard D. White, MD (n), Pamela K. Woodard, MD (o), Suhny Abbara, MD (p) Expert Panel on Cardiac Imaging: Key Words Appropriateness Criteria; Appropriate Use Criteria; AUC; cardiac arrhythmia; dyspnea; heart failure; ischemia; pericardial disease; valvular heart disease Abstract This article discusses imaging guidelines for five dyspnea variants: (1) dyspnea due to heart failure, ischemia not excluded; (2) dyspnea due to suspected nonischemic heart failure, ischemia excluded; (3) dyspnea due to suspected valvular heart disease, ischemia excluded; (4) dyspnea due to suspected cardiac arrhythmia, ischemia excluded; and (5) dyspnea due to suspected pericardial disease, ischemia excluded. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Author Affiliation: (a) Principal Author, Johns Hopkins Hospital, Baltimore, Maryland, and Medizinische Hochschule Hannover, Hannover, Germany (b) Research Author, Medizinische Hochschule Hannover, Hannover, Germany, and Mansoura University Hospitals, Mansoura, Egypt (c) Cleveland Clinic Florida, Weston, Florida (d) University Hospital, Ann Arbor, Michigan (e) Duke University Medical Center, Durham, North Carolina (f) Mallinckrodt Institute of Radiology; Washington University School of Medicine, Saint Louis, Missouri (g) Mayo Clinic, Rochester, Minnesota (h) University of Virginia Health System, Charlottesville, Virginia; American College of Cardiology (i) Nationwide Children's Hospital, Columbus, Ohio (j) University of Iowa Hospitals and Clinics, Iowa City, Iowa (k) St. Paul's Hospital, Vancouver, British Columbia, Canada (l) University of Cincinnati Hospital, Cincinnati, Ohio (m) Westchester Medical Center, Valhalla, New York (n) The Ohio State University Wexner Medical Center, Columbus, Ohio (o) Specialty Chair, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri (p) Panel Chair, UT Southwestern Medical Center, Dallas, Texas * Corresponding author: Jens Vogel-Claussen, MD, Department of Radiology, JHOC, Johns Hopkins Hospital, 601 N Caroline Street, Baltimore, MD 21287-0006. (footnote) The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. (footnote) Reprint requests: publications@acr.org (footnote) Dr. Vogel-Claussen reports grants and personal fees from Novartis, grants from Boehringer Ingelheim, grants from Siemens, personal fees from Parexel, outside the submitted work. Dr. Kramer reports personal fees from Bayer, outside the submitted work; Dr. Jonathon A. Leipsic reports personal fees from Speaker's Bureau GE Healthcare. The other authors have no conflicts of interest related to the material discussed in this article. (footnote) Disclaimer: The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.

ABSTRACT The definition and management of borderline resectability for periampullary pancreatic adenocarcinoma are evolving. In this case report, we discuss the presentation, workup, and therapeutic management of a 40-year-old man [...]

Byline: Amar, Shah; Girish, Jawaheer Laparoscopic repair of Morgagni hernia has been described in adults and children. In the published reports, the crux of the repair consists of suturing the [...]

Byline: Amar. Shah, Rakesh. Thakur, Karan. Parashar Juvenile dermatomyositis classically manifests as necrotising vasculitis in multiple organs. It mainly involves the vessels of skin and muscle and is associated with [...]

The article discusses the key aspects and features of the safety report by the National Patient Safety Agency (NPSA) on prescribing and monitoring of lithium therapy for the treatment of bipolar disorder and refractory depression. The main problems associated with the treatment and what needs to be done to improve the same is highlighted.

Last April, I created o charity project called the World Cup Legends Challenge, which involved getting my collection of Adidas World Cup match balls signed by World Cup winners from [...]