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7. Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of space occupying lesions of the pancreas

Author

S. Palaniappan, M. A. Arvind, Jothimani Dinesh, Srinivas Melpakam, Srinivasan Vijaya, Jayanthi Venkataraman, and Mohamed Rela

Subjects
endoscopic ultrasound, fine-needle aspiration, pancreatic lesion, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Introduction: Space occupying lesions (SOLs) of the pancreas are commonly encountered in day to day practice either as an incidental finding or during evaluation of symptomatic patients. The aim of the present study was to compare the final diagnosis at follow-up with diagnosis made at computed tomography (CT)/magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). Materials and Methods: Retrospective analysis of EUS data of 131 patients referred for tissue diagnosis of SOL in pancreas was done. The lesions were classified as malignant, benign, and nonneoplastic by both CT/MRI and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in conjunction with clinical presentation, biochemical parameters, and tumor markers. Follow-up cases with a final diagnosis alone were included for the comparative analysis. Statistical Analysis: Chi-square test, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) for CT/MRI and EUS-FNA were computed against the follow-up data. Results: Of the 131, there were 78 males (59.5%). The median age of presentation was 48 years (range: 11–82 years. Follow-up information on the final diagnosis was available for 54 patients. Confirmed diagnosis at follow-up was malignant lesion in 18, benign in 13 and 23 with a nonneoplastic lesion. When EUS-FNA outcome was compared with the definitive diagnosis of the 54 patients, it had a higher sensitivity for malignant (66.7% vs. 61.1%) and nonneoplastic lesions (78.3% vs. 73.9%) and was similar to CT/MRI for benign lesions (76.9% for both). EUS-FNA had a higher specificity (87.8% vs. 80.5%) with a good PPV for benign lesions (66.7% vs. 55.6%). CT/MRI was less accurate than EUS-FNA in predicting benign (79.6% vs. 85.2%) and nonneoplastic lesions (79.6% vs. 81.5%) compared to malignant lesions wherein it was similar at 81.5%. The high NPV with a lower PPV for both EUS/FNA and CT/MRI suggests that follow-up definitive diagnosis was superior to both –. Conclusions: Endoscopic ultrasound-guided fine-needle aspiration had a higher specificity, but low sensitivity for the both neoplastic and nonneoplastic lesion of the pancreas compared to the world literature. The overall EUS-FNA yield was low when compared to the follow-up definitive diagnosis.

Published
2014
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13. Religious Fasting: Impact on Liver Parameters

Author

Jothimani, Dinesh, primary, Palanichamy, Swetha, additional, Senthilnathan, Abinaya Thenmozhi, additional, Danielraj, Hasma, additional, Simon, Evangeline Benita, additional, Shareef, Mohammed Meeran, additional, Rana Pratap, D.S., additional, Kaliamoorthy, Ilankumaran, additional, and Rela, Mohamed, additional

Published
2022
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21. COVID-19 and Liver

Author

Jothimani, Dinesh, Venugopal, Radhika, Abedin, Mohammed Forhad, Kaliamoorthy, Ilankumaran, and Rela, Mohamed

Subjects
SARS-CoV-2, Liver Diseases, Pneumonia, Viral, COVID-19, ACE2, Comorbidity, Peptidyl-Dipeptidase A, Severity of Illness Index, Article, Betacoronavirus, Liver, Risk Factors, Humans, Angiotensin-Converting Enzyme 2, Coronavirus Infections, Pandemics
Abstract

The current pandemic coronavirus labelled as Severe Acute Respiratory Distress Syndrome Coronavirus -2 (SARS -CoV-2) is a significant public health threat over for past few months. Overall case fatality rates range between 2-6%; however, the rates are higher in patients with severe disease, advanced age and underlying comorbidities like diabetes, hypertension and heart disease. Recent reports showed about 2-11% of patients with COVID-19 had underlying chronic liver disease. Experience from previous SARS epidemic suggest that 60% of patients developed various degrees of liver damage. In the current COVID-19 pandemic, hepatic dysfunction was seen in 14-53% of patients, particularly in those with severe disease. Cases of acute liver injury have been reported, associated with higher mortality. Hepatic involvement in COVID-19 could be multifactorial related to any of direct cytopathic effect of the virus, uncontrolled immune reaction, sepsis or drug induced liver injury. The postulated mechanism of viral entry is through the host ACE2 receptors that are abundantly present in type 2 alveolar cells. Interestingly, the expression of ACE2 receptors were identified in the gastrointestinal tract, vascular endothelium and cholangiocytes of the liver. Liver transplant recipients with COVID-19 have been reported recently. Effects of COVID-19 on underlying chronic liver disease requires a detailed evaluation and currently data is lacking and further research is warranted in this area. With lack of definitive therapy, patient education, hand hygiene and social distancing appears to be the cornerstone in minimising the disease spread., Graphical abstract

Published
2020

22. Awareness and Concerns Among Adult Liver Transplant Recipients in the Current Pandemic Caused by Novel Coronavirus (COVID-19): Strategies to Safeguard a High-risk Population

Author

Hakeem, Abdul R., primary, Padmanaban, Hrishikesh, additional, Karthikeyan, Srinath, additional, Murugesan, Sivakumar, additional, Menon, Jagadeesh, additional, Shanmugam, Naresh, additional, Jothimani, Dinesh, additional, Reddy, Mettu S., additional, and Rela, Mohamed, additional

Published
2020
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23. Predictive Scores for Mortality in MAFLD-Related Acute-on-Chronic Liver Failure (MAFLD-ACLF): Development and Validation of MAFLD-MELD-Na and MAFLD-AARC Scores.

Author

Kumar, Ashish, Sarin, Shiv Kumar, Arora, Anil, Choudhury, Ashok, Arora, Vinod, Rela, Mohamed, Jothimani, Dinesh Kumar, Al Mahtab, Mamun, Devarbhavi, Harshad, Eapen, C.E., Goel, Ashish, Yaghi, Cesar, Ning, Qin, Chen, Tao, Jia, Jidong, Zhongping, Duan, Hamid, Saeed S., Butt, Amna Subhan, Wasim Jafri, Syed Muhammad, Shukla, Akash, Tan, Seok Siam, Kim, Dong Joon, Saraya, Anoop, Hu, Jinhua, Sood, Ajit, Goyal, Omesh, Midha, Vandana, Sahu, Manoj, Lee, Guan H., Treeprasertsuk, Sombat, Thanapirom, Kessarin, Mandot, Ameet, Maghade, Ravikiran, Lesmana, Laurentius A., Ghazinyan, Hasmik, Prasad, V.G.Mohan, Dokmeci, Abdulkadir, Sollano, Jose, Abbas, Zaigham, Shrestha, Ananta, Lau, George, Payawal, Diana, Shiha, Gamal, Duseja, Ajay K., Taneja, Sunil, Verma, Nipun, Rao, Padaki Nagaraja, Kulkarni, Anand, Karim, Fazal, Saraswat, Vivek Anand, Alam, Shahinul, Yokosuka, Osamu, Chowdhury, Debashis, Kedarisetty, Chandan Kumar, Saigal, Sanjiv, Sharma, Praveen, Prasad, Babita, Yattoo, Ghulam Nabi, Koshy, Abraham, Patwa, Ajay, Elbasiony, Mohamed, Rathi, Pravin, Maharshi, Sudhir, Dayal, V.M., Jha, Ashish, Kalista, Kemal, Gani, Rino A., Yuen, Man-Fung, Singh, Virendra, Singh, Ayaskanta, Violeta, Sargsyan, Huang, Chien-Hao, Mukewar, Saurabh, Xin, Shaojie, Rajaram, Ruveena, Panackel, Charles, Dadhich, Sunil, Sachdeva, Sanjeev, Behera, Sanatan, Kamani, Lubna, and Saithanyamurthi, Hemamala

Published
2023
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24. Liver Transplantation Society of India Guidelines for the Management of Acute Liver Injury Secondary to Yellow Phosphorus–Containing Rodenticide Poisoning Using the Modified Delphi Technique of Consensus Development

Author

Reddy, Mettu S., primary, Rajakumar, Akila, additional, Mathew, Johns S., additional, Venkatakrishnan, L., additional, Jothimani, Dinesh, additional, Sudhindran, S., additional, Jacob, Mathew, additional, Narayanasamy, Krishnasamy, additional, Venugopal, Radhika, additional, Mohanka, Ravi, additional, Kaliamoorthy, Ilankumaran, additional, Varghese, Joy, additional, Panackel, Charles, additional, Mohamed, Zubair, additional, Vij, Mukul, additional, Sachan, Deepti, additional, Pillay, V.V., additional, Saigal, Sanjiv, additional, Dhiman, Radhakrishna, additional, Soin, Arvinder S., additional, Gupta, Subhash, additional, Wendon, Julia, additional, Rela, Mohamed, additional, and Sarin, Shiv K., additional

Published
2020
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27. Erratum to ‘Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure’ [J Clin Exp Hepatol 10 (2020) 477-517]

Author

Anand, Anil C., Nandi, Bhaskar, Acharya, Subrat K., Arora, Anil, Babu, Sethu, Batra, Yogesh, Chawla, Yogesh K., Chowdhury, Abhijit, Chaoudhuri, Ashok, Eapen, Eapen C., Devarbhavi, Harshad, Dhiman, Radha K., Datta Gupta, Siddhartha, Duseja, Ajay, Jothimani, Dinesh, Kapoor, Dharmesh, Kar, Premashish, Khuroo, Mohamad S., Kumar, Ashish, Madan, Kaushal, Mallick, Bipadabhanjan, Maiwall, Rakhi, Mohan, Neelam, Nagral, Aabha, Nath, Preetam, Panigrahi, Sarat C., Pawar, Ankush, Philips, Cyriac A., Prahraj, Dibyalochan, Puri, Pankaj, Rastogi, Amit, Saraswat, Vivek A., Saigal, Sanjiv, Shalimar, Shukla, Akash, Singh, Shivaram P., Verghese, Thomas, and Wadhawan, Manav

Published
2022
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28. Patients with metabolic-dysfunction associated fatty liver disease (MAFLD) without associated etiologies and non-MAFLD non-alcoholic fatty liver disease (NAFLD) have similar liver disease severity - Data from Indian Consortium on NAFLD (ICON-D).

Author

Duseja, Ajay, De, Arka, Mehta, Manu, Singh, S.P., Mukewar, Shrikant, Mukewar, Sourabh, Goyal, Omesh, Shalimar, Venkataraman, Jayanthi, Devadas, Krishnadas, Mehta, Varun, Kar, Sanjib, Nagral, Aabha, Choudhary, Narendera, Ranjan, Piyush, Arora, Anil, Nijhawan, Sandeep, Praharaj, Dibyalochan, Shukla, Akash, Rao, P.N., Sharma, Brij, Narayanasamy, K., Mehta, Rajiv, Asati, Pankaj, Prasad, V.G.M., Rastogi, Mukul, Dadhich, Sunil, Saigal, Sanjiv, Koshy, Abraham, Alam, Seema, Madan, Kaushal, Mohan, Neelam, Pandey, Gaurav, Lal, Sadhna, Jothimani, Dinesh, Wadhawan, Manav, Agarwal, Swastik, Shah, Samir, Valsan, Arun, Chandail, Vijant, Shenoy, K.T., Gupta, Rohit, Choudhuri, Gourdas, Kalal, Chetan, Bhattacharya, Mallika, Kumar, Manoj, Tevethia, Harsh Vardhan, Dixit, V.K., and Sanyal, Arun J.

Published
2022
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29. Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of space occupying lesions of the pancreas

Author

MA Arvind, S. Palaniappan, Jayanthi Venkataraman, Srinivasan Vijaya, Jothimani Dinesh, Mohamed Rela, and Srinivas Melpakam

Subjects
Endoscopic ultrasound, medicine.medical_specialty, Lesion, 03 medical and health sciences, pancreatic lesion, 0302 clinical medicine, medicine, fine-needle aspiration, lcsh:RC799-869, General Environmental Science, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Benign lesion, Predictive value, medicine.anatomical_structure, Fine-needle aspiration, 030220 oncology & carcinogenesis, endoscopic ultrasound, Tissue diagnosis, 030211 gastroenterology & hepatology, lcsh:Diseases of the digestive system. Gastroenterology, Radiology, medicine.symptom, Pancreas, business
Abstract

Introduction: Space occupying lesions (SOLs) of the pancreas are commonly encountered in day to day practice either as an incidental finding or during evaluation of symptomatic patients. The aim of the present study was to compare the final diagnosis at follow-up with diagnosis made at computed tomography (CT)/magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). Materials and Methods: Retrospective analysis of EUS data of 131 patients referred for tissue diagnosis of SOL in pancreas was done. The lesions were classified as malignant, benign, and nonneoplastic by both CT/MRI and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in conjunction with clinical presentation, biochemical parameters, and tumor markers. Follow-up cases with a final diagnosis alone were included for the comparative analysis. Statistical Analysis: Chi-square test, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) for CT/MRI and EUS-FNA were computed against the follow-up data. Results: Of the 131, there were 78 males (59.5%). The median age of presentation was 48 years (range: 11–82 years. Follow-up information on the final diagnosis was available for 54 patients. Confirmed diagnosis at follow-up was malignant lesion in 18, benign in 13 and 23 with a nonneoplastic lesion. When EUS-FNA outcome was compared with the definitive diagnosis of the 54 patients, it had a higher sensitivity for malignant (66.7% vs. 61.1%) and nonneoplastic lesions (78.3% vs. 73.9%) and was similar to CT/MRI for benign lesions (76.9% for both). EUS-FNA had a higher specificity (87.8% vs. 80.5%) with a good PPV for benign lesions (66.7% vs. 55.6%). CT/MRI was less accurate than EUS-FNA in predicting benign (79.6% vs. 85.2%) and nonneoplastic lesions (79.6% vs. 81.5%) compared to malignant lesions wherein it was similar at 81.5%. The high NPV with a lower PPV for both EUS/FNA and CT/MRI suggests that follow-up definitive diagnosis was superior to both –. Conclusions: Endoscopic ultrasound-guided fine-needle aspiration had a higher specificity, but low sensitivity for the both neoplastic and nonneoplastic lesion of the pancreas compared to the world literature. The overall EUS-FNA yield was low when compared to the follow-up definitive diagnosis.

Published
2014

39. Hepatitis B Immunoglobulin Prophylaxis after Liver Transplantation: Experience in a Tertiary Transplant Centre

Author

Varghese, Joy, primary, Sachan, Deepti, additional, Reddy, Mettu S., additional, Cherian, Tom, additional, Jothimani, Dinesh, additional, Venugopal, Kota, additional, Arikichenin, Olithselvan, additional, Perumalla, Rajasekar, additional, Narasimhan, Gomathy, additional, Shanmugam, Vivekananthan, additional, Vijaya, Srinivasan, additional, Venkataraman, Jayanthi, additional, and Rela, Mohamed, additional

Published
2014
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49. Liver Transplantation Society of India Guidelines for the Management of Acute Liver Injury Secondary to Yellow Phosphorus–Containing Rodenticide Poisoning Using the Modified Delphi Technique of Consensus Development.

Author

Reddy, Mettu S., Rajakumar, Akila, Mathew, Johns S., Venkatakrishnan, L., Jothimani, Dinesh, Sudhindran, S., Jacob, Mathew, Narayanasamy, Krishnasamy, Venugopal, Radhika, Mohanka, Ravi, Kaliamoorthy, Ilankumaran, Varghese, Joy, Panackel, Charles, Mohamed, Zubair, Vij, Mukul, Sachan, Deepti, Pillay, V.V., Saigal, Sanjiv, Dhiman, Radhakrishna, and Soin, Arvinder S.

Subjects
*DELPHI method, *LIVER transplantation, *HOSPITAL admission & discharge, *MEDICAL personnel, *PLASMA exchange (Therapeutics)
Abstract

Acute liver failure caused by the ingestion of yellow phosphorus–containing rodenticide has been increasing in incidence over the last decade and is a common indication for emergency liver transplantation in Southern and Western India and other countries. Clear guidelines for its management are necessary, given its unpredictable course, potential for rapid deterioration and variation in clinical practice. A modified Delphi approach was used for developing consensus guidelines under the aegis of the Liver Transplantation Society of India. A detailed review of the published literature was performed. Recommendations for three areas of clinical practice, assessment and initial management, intensive care unit (ICU) management and liver transplantation, were developed. The expert panel consisted of 16 clinicians, 3 nonclinical specialists and 5 senior advisory members from 11 centres. Thirty-one recommendations with regard to criteria for hospital admission and discharge, role of medical therapies, ICU management, evidence for extracorporeal therapies such as renal replacement therapy and therapeutic plasma exchange, early predictors of need for liver transplantation and perioperative care were developed based on published evidence and combined clinical experience. Development of these guidelines should help standardise care for patients with yellow phosphorus poisoning and identify areas for collaborative research. [ABSTRACT FROM AUTHOR]

Published
2021
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50. Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure.

Author

Anand, Anil C., Nandi, Bhaskar, Acharya, Subrat K., Arora, Anil, Babu, Sethu, Batra, Yogesh, Chawla, Yogesh K., Chowdhury, Abhijit, Chaoudhuri, Ashok, Eapen, Eapen C., Devarbhavi, Harshad, Dhiman, Radha K., Datta Gupta, Siddhartha, Duseja, Ajay, Jothimani, Dinesh, Kapoor, Dharmesh, Kar, Premashish, Khuroo, Mohamad S., Kumar, Ashish, and Madan, Kaushal

Subjects
*LIVER failure, *PATHOLOGY, *HEPATIC encephalopathy, *CEREBRAL edema, *VIRAL hepatitis, *HEPATORENAL syndrome
Abstract

Acute liver failure (ALF) is not an uncommon complication of a common disease such as acute hepatitis. Viral hepatitis followed by antituberculosis drug–induced hepatotoxicity are the commonest causes of ALF in India. Clinically, such patients present with appearance of jaundice, encephalopathy, and coagulopathy. Hepatic encephalopathy (HE) and cerebral edema are central and most important clinical event in the course of ALF, followed by superadded infections, and determine the outcome in these patients. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a crucial role in the pathogenesis, and several therapies aim to correct this abnormality. The role of newer ammonia-lowering agents is still evolving. These patients are best managed at a tertiary care hospital with facility for liver transplantation (LT). Aggressive intensive medical management has been documented to salvage a substantial proportion of patients. In those with poor prognostic factors, LT is the only effective therapy that has been shown to improve survival. However, recognizing suitable patients with poor prognosis has remained a challenge. Close monitoring, early identification and treatment of complications, and couseling for transplant form the first-line approach to manage such patients. Recent research shows that use of dynamic prognostic models is better for selecting patients undergoing liver transplantation and timely transplant can save life of patients with ALF with poor prognostic factors. [ABSTRACT FROM AUTHOR]

Published
2020
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