Search

Hepatic artery pseudoaneurysm (HAP) is mostly encountered secondary to trauma or iatrogenic causes. HAP associated with cholangitic liver abscess is a rare complication. We present a case of gallstone disease and choledocholithiasis who developed moderate cholangitis and a liver abscess. A small HAP was detected incidentally on a biphasic CT done to evaluate the biliary system. Repeat CT after management with endoscopic retrograde cholangiopancreatography and antibiotics showed resolution of cholangitic abscess with spontaneous thrombosis of HAP.

Giant splenic artery aneurysms are rare and associated with high morbidity and mortality. Early detection is the key to decreasing morbidity and mortality. We present a giant splenic artery aneurysm which was managed by en bloc resection of the spleen, distal pancreas.

Introduction Rhinocerebral mucormycosis is extremely fatal, with mortality rates ranging from 85-93% despite the best treatment in immunocompromised patients. We emphasize the importance of early diagnosis, repeated debridement, and aggressive antifungal treatment to reduce mortality. Case summary We report six cases (five male and one female), with a mean age of 51 years who were diagnosed to have mucormycosis from 2017 to 2019. All patients were diabetic. Intracranial involvement and orbital involvement were found in four cases. Facial nerve palsy was seen in two cases, one without any apparent otological involvement. Aggressive serial debridement and amphotericin B was started. Posaconazole was added subsequently to the treatment in two cases. One patient succumbed to the disease five months after discharge. The other five patients are on regular follow-up for a mean duration of 14 months at the end of which two had residual disease which was under control. Discussion Repeated surgical debridement with an early aggressive and combination antifungal therapy can result in good outcomes even in advanced mucormycosis. Concurrent management of the underlying pathology, monitoring of liver and kidney functions, and therapeutic drug monitoring are useful to ensure smooth and effective treatment.

A 14-year-old male patient presented to the emergency room with fever, loose stools, shortness of breath and swelling over the right popliteal fossa for 5 days. He had no significant past medical history and received all the vaccinations according to the immunisation schedule. He had an oxygen

Background There is limited literature on the role of percutaneous transhepatic biliary drainage (PTBD) as an adjunct to endoscopic retrograde cholangiopancreatography (ERCP). This study evaluates the role of PTBD in patients with failed ERCP or post-ERCP cholangitis. Methods Retrospective evaluation of clinical and intervention records of patients with biliary obstruction referred for PTBD following failed ERCP or post-ERCP cholangitis was performed. The cause of biliary obstruction, baseline serum bilirubin, white blood cell (WBC) count, serum creatinine, and procalcitonin were recorded. Technical success and clinical success (resolution of cholangitis, reduction in bilirubin levels, WBC count, creatinine, and procalcitonin) were assessed. Results Sixty-three patients (35 females, mean age 51.4 years) were included. Indications for ERCP included malignant causes in 47 (74.6%) cases and benign causes in 16 (25.4%) cases. Indications for PTBD were failed ERCP in 21 (33.3%) and post-ERCP cholangitis in 42 (66.7%). PTBD was technically successful in all patients. Clinical success rate was 68.2% in the overall group. Mild hemobilia was noted in five (7.9%) patients. There were no major complications or PTBD related mortality. Cholangitis and acute kidney injury resolved following PTBD in 63.1% and 80% of the patients, respectively. Total serum bilirubin reduced by 47.8% and 69.4% after one week and one month of the PTBD, respectively. The average fall in procalcitonin was 5.17 ng/mL after one week of the PTBD. Conclusion PTBD is an important adjunctive drainage procedure in patients with ERCP failure or post-ERCP cholangitis.

The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0–5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management. Graphical abstract: [Figure not available: see fulltext.].

Post-traumatic direct carotid-cavernous fistulas may develop in patients with a closed head injury. The classical presentation is the Dandy’s triad—chemosis, pulsatile proptosis and orbital bruit. Associated findings may include orbital pain, dilated episcleral corkscrew vessels, vision deficit and cranial nerve palsies. Cranial nerves—oculomotor (III), trochlear (IV), ophthalmic (V1), and maxillary (V2) divisions of trigeminal and the abducens (VI) lie in close association of the cavernous sinus. Abducens nerve (VI) lies close to the intracavernous internal carotid artery, within the substance of the sinus and is hence easily susceptible to vascular insult. The two sinuses connect across the midline and communicate freely with each other. Back pressure changes can present with the same sided or bilateral cranial nerve palsies. We report a rare association of a long-standing left-sided carotid-cavernous fistula with right eye abduction deficit and contralateral abducens palsy.

With the technological advancement and changes in the working and lifestyles of people and industry, the rate of obsolesce of electrical and electronic equipment and gadgets, particularly computers and mobile phones, is high, posing a threat to health and environment creating a threat to sustainability for nations around the globe. Realizing the difficulties of e-waste management, many developed countries have started dumping the e-waste to developing nations that suffer from resources constraints, thus leading to hazardous activities mainly in the informal sector. Therefore, we are motivated to examine whether the awareness of the environment, attitudes, and beliefs, particularly knowledge (constructs), impact practices relating to management of e-waste in India. Analysis of the results of our survey of 180 respondents through SEM model show an insignificant association of these constructs with e-waste management practices. However, we find a significant mediating role of Environmental Knowledge in all these relationships.

Background: It is known that chronic idiopathic urticaria occasionally develops in association with Helicobacter pylori infection, but this relationship remains unproven. Also, many studies show. Materials and Methods: We investigated the role of H. pylori infection in patients of chronic idiopathic urticaria, other chronic skin disorders as well as healthy controls using urease breath test and immunoturbidimetry for anti H. pylori IgG antibodies. Three groups of eighty-nine patients each were taken as cases, controls and placebo controls respectively. All patients having IgG titer of 10U/ml or above and Urease Breath Test Positivity were considered positive. Results: The positive rate of anti H. Pylori IgG antibodies was 78.65% (70/89) in case group, 84.71% (22/89) in controls with other skin disorders and 32.58% (29/89) in placebo control group. While positive rate for Urease Breath Test were found to be 79.8% (71/89) in cases, 35.95% (32/89) in controls with other skin diseases and 32.58% (29/89) in placebo controls. Conclusion: In chronic idiopathic urticaria a high titer of anti H. pylori IgG and Urease Breath Test positivity suggests that inclusion of anti H. pylori therapy in it’s the management would be beneficial and would lead to lower rates of recurrence. Also, low positivity rates of Urease Breath Test and Anti H. pylori IgG in controls with other chronic skin diseases and placebo controls points towards no clear evidence to prove a causal relationship between these diseases and H. pylori infection. Keywords: Anti H pylori IgG Antibody, Chronic Idiopathic Urticaria, Helicobacter Pylori, Urease Breath Test, Chronic Skin Disorders

PurposeThis paper aims to develop a framework that aids in achieving the desired state of financial performance for corporate enterprises based on distinct configurations of corporate governance (CG) practices.Design/methodology/approachThis study uses a fuzzy-based system to arrive at a definitive configuration of CG practices that lead to a specific level of firm’s performance.FindingsThis analysis of the panel data of 92 National Stock Exchange–listed companies conducted for RONW on selected CG variables shows that eight fuzzy configurations lead to a particular state of RONW. The authors compare the results with the conventional regression-based scoring models.Originality/valueCorporate enterprises can use the derived bundles of CG practices leading to a specific set of financial performance (RONW) to aid the decision-making process in defining and implementing their governance structures. The regulators can modify or customize the law-mandated CG practices to reduce redundancies and promote the national agenda of economic efficiency.

Purpose Little is known on the beliefs, perceptions and practices of hypertension specialists in addressing non-adherence to therapy. Therefore, a survey was undertaken amongst healthcare professionals (HCPs) managing hypertension in the European Society of Hypertension (ESH) Centres of Excellence. Materials and methods Cross-sectional data were obtained between December 2020 and April 2021 using an online anonymous structured questionnaire including 26 questions/136 items, that was sent to all ESH Excellence centres. Results Overall 67 from 187 centres (37.3%) responded and 200 HCPs from 30 countries answered the questionnaire. Participants (60% men) were mainly physicians (91%) and nurses (8%) from University hospitals (77%). Among physicians, 83% had >10 years professional experience. Average time dedicated to discuss medications was 1-5 min in 48% and 6-10 min in 29% of cases. Interviews with patients about adherence were the most frequently used assessment method. Chemical detection of medications in urine was available in 36% of centres. One third of physicians involved their patients regularly in treatment decisions. The most frequent methods to improve adherence included simplification of medication therapy, more frequent visits, and home blood pressure monitoring. Conclusions: The level of implementation of tools to detect and improve adherence in hypertension management in ESH excellence centres is low. Structured educational activities and access to the newest objective measures to detect non-adherence might improve these deficits. Conclusions The level of implementation of tools to detect and improve adherence in hypertension management by HCPs in ESH excellence centres is low. Structured educational activities focussing on adherence management and access to the newest objective measures to detect non-adherence might improve these deficits.

Globally, the financial industry in the recent times has witnessed various forms of fraudulent activities in the financial markets creating dilemma for the professionals, and the auditors who owns responsibility of ensuring accuracy and transparency. This article aims at finding the emergence of Big Data technology to fraud and forensic accounting by practitioner accountants in India. A research model and hypotheses has been developed to examine the relationship between the awareness level of forensic accounting, Big Data and intentions to use it for fraud detection using structural equation modeling. Results indicate that awareness of forensic accounting has a positive influence on practitioners’ intentions to its use for fraud detection. Big data technologies mediate the relationship between awareness and intentions to use for fraud detection. The results of the study are useful in implementation of Big Data technologies into the forensic accounting domain that can facilitate combating fraud.

In the 21st century, humans are in battle against a deadly contagious disease COVID 19, first reported in Wuhan, China. Coronavirus Disease designated as COVID 19 is caused by SARS COV 2 virus from beta coronavirus family. Although, there are no specific anti-viral drugs and vaccines against this pandemic disease, however many medicines are being repurposed for COVID 19 management but have shown a limited success. Traditional medicine systems from ancient times were used for their immense efficacy with minimal adverse effects compared to allopathic medicines. Thus, for COVID 19 management, researchers are focused on traditional medicines from Ayurveda, Chinese medicine, Unani, Siddha, and Homeopathy as adjuvant therapy as per anecdotal data regarding their usage in the treatment of Infectious disease. In India, all the traditional medicine systems are under AYUSH ministry and government has been highlighting AYSUH medicines for improving immune system against COVID 19. In this review, the authors emphasize on historical background of AYUSH medicines in the prevention and treatment of infectious diseases and the medicines recommended by AYUSH ministry for combating against COVID 19 as immunity boosters.

OBJECTIVES Organ failure (OF) and infected necrosis (IN) are the most important predictors of mortality in necrotizing acute pancreatitis (AP). We studied the relationship between timing (onset and duration) and patterns of OF with mortality and the impact of IN on mortality. METHODS Consecutive patients with necrotizing AP between January 2017 and February 2020 were analyzed retrospectively for OF and its impact on outcome. Organ failure was divided as single OF, simultaneous multiple OF (SiMOF) and sequential multiple OF (SeMOF). Mortality was compared for timing of onset, total duration and patterns of OF. RESULTS Among 300 patients with necrotizing AP, 174 (58%) had OF. Mortality was not associated with onset of OF (P = 0.683) but with duration of OF (P = 0.006). Mortalities for single OF, SiMOF, and SeMOF were 11.8%, 30.4%, and 69.2% respectively (P < 0.001). On Cox proportional hazard analysis, adjusted hazard ratio of risk of mortality for OF with IN versus IN, SiMOF versus single OF and SeMOF versus single OF was 3.183, 2.878, and 8.956, respectively (P = 0.023

Purpose: To study the long-term efficacy and safety of local application of imiquimod 5% and fluorouracil 1% creams in complex eyelid basal cell carcinomas (BCCs). Methods: A retrospective, non-comparative study in biopsy-proven, complex (involving canthi or >50% of eyelid length) eyelid BCC patients who were medically unfit for surgical procedures. All patients were medically treated with either of the creams using fixed-dose regimens for a minimum of 3 months. All received oral vitamin C 500 mg QID for 3 months as an adjunct for collagen healing. A minimum of “post-treatment” follow-up of 12 months was observed. Results: Of total 30 patients, imiquimod 5% and fluorouracil 1% were used in 16 and 14 patients, respectively. The mean age of our patients was 70.5 years. The co-morbidities included – severe coronary artery disease using blood-thinners ( n = 19), poorly controlled diabetes ( n = 12), poorly controlled hypertension ( n = 6), on nebulization ( n = 3), and tuberculosis with pulmonary fibrosis ( n = 2). Complete clinical tumor resolution was noted in 10 and 8 patients over 12 and 16.5 weeks, respectively, in imiquimod and fluorouracil groups. Periocular skin erythema, chemical conjunctivitis, and skin depigmentation were seen in all the patients of imiquimod group. On the other hand, the local side-effect profile in fluorouracil patients was limited. Conclusion: The medical treatment of complex eyelid BCC is a useful alternative to surgery in the elderly with significant co-morbidities. It provides a promising long-term relief with a tolerable side-effect profile. A prospective, randomized, double-blinded trial would provide stronger evidence for the efficacy of these drugs.

Percutaneous catheter drainage (PCD) is an effective way of drainage in acute pancreatitis (AP) and its role in persistent organ failure (OF) has not been studied. This study assessed the outcome of severe AP managed with PCD.We retrospectively analysed outcome of AP patients undergoing PCD for persistent OF with respect to success of PCD, etiology, severity scores, OF, imaging features and PCD parameters. Success of PCD was defined as resolution of with PCD and survived without surgical necrosectomy.Between January 2016 and May 2018, 83 patients underwent PCD for persistent OF at a mean duration of 25.59 ± 21.2 days from pain onset with successful outcome in 47 (56.6%) patients. Among PCD failures, eleven (13.25%) patients underwent surgery. Overall mortality was 31 (37.3%). On multivariate analysis, pancreatic necrosis50% and absence of extrapancreatic infection (EPI) predicted the success of PCD. Presence of infected necrosis did not affect the outcome of PCD in organ failure.PCD improves the outcome in patients with OF even when done early irrespective of the status of infection of necrosis. Therefore, PCD may be considered early in the course of patients with OF.

Background & Aims Biannual ultrasound has poor sensitivity for hepatocellular carcinoma (HCC) screening. MRI is accurate for the detection of HCC, but a complete MRI is not feasible as a screening tool. Abbreviated MRI (AMRI) is an acceptable alternative. The diagnostic performance of different AMRI protocols is not known. We performed a systematic review to determine the diagnostic accuracy of AMRI for HCC screening. Methods We searched the MEDLINE and EMBASE databases for studies reporting the diagnostic accuracy of AMRI for HCC screening. The pooled sensitivity and specificity of different AMRI protocols were calculated based on a random intercept logistic regression model. The diagnostic performance of AMRI was compared with ultrasound. Study quality was assessed using the QUADAS-2 tool. Results Of the 11,327 studies screened by titles, 15 studies (3 prospective and 12 retrospective: 2,807 patients, 917 with HCC) were included in the final analysis. The pooled per-patient sensitivity and specificity were 86% (95% CI 84–88%, I2 0%) and 94% (95% CI 91–96%, I2 83%), respectively. Pooled per-lesion sensitivity was 77% (95% CI 74–81%, I2 8%). There was no influence of study type, screening setting, reference standard, and presence and etiology of cirrhosis on the performance of AMRI. The sensitivity of AMRI for detection of HCC Conclusions AMRI has high sensitivity and specificity for HCC screening. Different AMRI protocols have comparable diagnostic performance. Lay summary Abbreviated MRI (AMRI) has been suggested as an alternative to ultrasound and complete MRI for hepatocellular carcinoma (HCC) screening. Our study results showed that AMRI has a high per-patient and per-lesion sensitivity for HCC. Although the sensitivity of AMRI for detection of HCC

Introduction: Demodex mite is an external parasite which is implicated in various ocular conditions like anterior blepharitis, posterior blepharitis, meibomian gland dysfunction, chalazia and others. Although demodex has been shown to be a causative agent of chalazia, occurrence of a solitary inflammatory nodule due to demodex infestation has not been reported in literature. Case: Our case describes the occurrence of an upper eyelid mass in a 62-year-old female which was found to have an associated demodex infestation. Conclusion: This is the first report of demodex infestation presenting as a nodular eyelid mass. This parasite needs to be considered in the differential diagnosis of eyelid masses as this condition requires specific management.

Background Percutaneous ablation is an important part of management strategy for liver tumors. While radiofrequency ablation and microwave ablation are the most widely used ablative techniques, cryoablation (CA) has several technical advantages but has been underused till recently. In this study, we report the initial experience with percutaneous CA of liver tumors. Methods This was a retrospective evaluation of consecutive patients with liver tumors who underwent percutaneous CA between October 2018 and August 2019. The ablation procedures were performed under combined ultrasound and computed tomography guidance using argon-helium–based CA systems. The baseline tumor characteristics (including size and location), Barcelona Clinic Liver Cancer stage, and Child-Pugh score were recorded. Each patient underwent a follow-up after 1 month and at 3 months subsequently. Technical success, complete response, local tumor progression, and overall survival were evaluated. Results Nine patients (mean age, 62.4 years, median age, 66 years, five men and four women) with 10 liver tumors (mean size, 2.22 cm) underwent CA. Seven (77.8%) patients had hepatocellular carcinoma (HCC), and 2 patients had solitary liver metastasis. One patient with HCC had two lesions, while the rest had only one lesion. Of the two metastatic lesions, one was from carcinoma of the cervix and the other was from jejunal neuroendocrine tumor. Five tumors were located adjacent to the gallbladder, two lesions were adjacent to the right portal vein, two lesions were subcapsular, and one lesion was adjacent to the stomach. Technical success was achieved in all the patients. Complete response was achieved in 7 (77.8%) patients. The median follow-up period was 7 months (range, 3–12 months). There was no local tumor progression and no death during the follow-up period. No procedure-related complication was seen. Conclusion Percutaneous CA of hepatic tumors is technically feasible and is a safe and effective ablative technique.

In this paper, an experimental investigation carries out on poly-crystalline photovoltaic (PV) system for performance enhancement with the help of a thin acrylic sheet (thickness- 2 mm). There are three types of systems used under this experimental setup as (i) PV module under normal conditions/ without sheet (ii) PV module under the triangular shape of the transparent sheet (iii) PV module under rectangular shape transparent sheet. The performance analysis of all three systems has been monitored in terms of open-circuit voltage, short circuit current, power, efficiency. Simultaneously, a statistical measurement approach of sun irradiation with constant temperature is carried out during the single day experimental study. The performance of the (Triangular shaped transparent sheet) TSTS configuration found superior which provide 22.064 Watt power at 12 am, whereas (Rectangular shaped transparent sheet) RSTS configuration provide 20.4 W at the same time. The TSTS configuration provides 1.12A short circuit current at 12 am, whereas RSTS configuration provides 1.02A short circuit current at the same time. The TSTS configuration provides 8.92% better value. The TSTS configuration provides 20V open-circuit voltage at 12 am, whereas RSTS configuration provides 19.8V open-circuit voltage at the same time. The TSTS configuration provides 1% higher value. So that the TSTS configuration provides the maximum output of the solar PV panel.

We developed a three-dimensional (3D) synthetic animated mouse based on computed tomography scans that is actuated using animation and semirandom, joint-constrained movements to generate synthetic behavioral data with ground-truth label locations. Image-domain translation produced realistic synthetic videos used to train two-dimensional (2D) and 3D pose estimation models with accuracy similar to typical manual training datasets. The outputs from the 3D model-based pose estimation yielded better definition of behavioral clusters than 2D videos and may facilitate automated ethological classification.

There is increasing adoption of Liver Imaging Reporting and Data System (LI-RADS) treatment response (LR-TR) criteria. However, there is still a relative lack of evidence evaluating the performance of these criteria. We performed this study to assess the diagnostic accuracy of LI-RADS LR-TR criteria. A thorough search of PubMed, Embase, Scopus, and Cochrane Central Register of Controlled Trials for studies reporting diagnostic accuracy of LI-RADS LR-TR criteria was conducted through 30 June 2020. The meta-analytic summary of sensitivity, specificity, and diagnostic odds ratio of LI-RADS LR-TR criteria was computed using explant histopathology as the reference standard. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Four studies were found eligible for meta-analysis. The total number of LR-TR observations was 462 (240 patients, 82.5% males). Different locoregional therapies (LRTs), including bland embolization, chemoembolization, radiofrequency ablation, and microwave ablation, had been used. The mean time interval between LRT and liver transplantation ranged from 181 to 219 days. There was a moderate to good inter-reader agreement for LR-TR criteria. The pooled sensitivity and specificity of LR-TR criteria for viable disease were 62% (95% CI, 49–74%; I2 = 69%) and 87% (95% CI, 76–93%; I2 = 57%), respectively. The pooled diagnostic odds ratio and area under the curve were 9.83 (95% CI, 5.34–18.08; I2 = 19%) and 0.80. LI-RADS LR-TR criteria have acceptable diagnostic performance for the diagnosis of viable tumor after LRT. Well-designed prospective studies evaluating criteria of equivocal lesions and effect of different LRTs should be performed. • The pooled sensitivity and specificity of LI-RADS LR-TR criteria for the diagnosis of viable tumor were 62% and 87%, respectively. • The pooled diagnostic odds ratio and area under the curve were 9.83 and 0.80. • LR-TR criteria had a moderate to good inter-reader agreement.

Aim of the study This study aimed to evaluate the outcomes of patients with unresectable gallbladder cancer (GBC) with hilar involvement and cholangitis undergoing percutaneous transhepatic biliary drainage (PTBD). Material and methods This retrospective study comprised consecutive patients with unresectable GBC with cholangitis who underwent PTBD. The procedures were categorized as unilateral or bilateral. Bilateral PTBD was classified as simultaneous or sequential. The mean reduction in bilirubin at two weeks was recorded. Complications and mean overall survival were also recorded. Results Thirty-three patients (mean age 54.5 years, 12 males) were included. Thirty patients underwent unilateral drainage. Sequential drainage of the contralateral system was performed in 11 patients. Simultaneous bilateral PTBD was performed in 3 patients. PTBD was technically successful in all patients. Mean reduction in bilirubin was 41.5% in the unilateral group. The fall of bilirubin in the simultaneous bilateral PTBD group was 39%. The mean follow-up duration was 36.5 days. No major complications were encountered. At the last follow-up, 7 patients were alive. The mean overall survival was 34.6 days. Conclusions Patients with unresectable GBC and cholangitis frequently require bilateral drainage. However, prospective studies should be performed to evaluate whether a sequential or simultaneous PTBD should be performed.

The data regarding overall survival (OS) and progression-free survival (PFS) following irreversible electroporation (IRE) is scarce. We performed a systematic review of the safety and efficacy of IRE for liver malignancies. Searches of MEDLINE, EMBASE, and SCOPUS databases were performed through September 1, 2019. Studies reporting the survival data (OS and PFS) and complications (graded according to the Society of interventional Radiology classification) were included. A generalized linear mixed method with a random-effects model was used for assessing pooled incidence rates and corresponding 95% confidence intervals (CIs). A total of 25 studies (n = 776, 15 prospective, 10 retrospective) were included. Metastasis, hepatocellular carcinoma, and cholangiocarcinoma were present in 354, 285, and 100 patients, respectively. The pooled OS at 6, 12, 24, and 36 months was 93.28% (95% CI: 63.23–99.12, I2= 67%), 81.29% (95% CI: 69.80–89.22, I2 = 73%), 61.47% (95% CI: 52.81–69.46, I2 = 0%), and 40.88% (95% CI: 28.43–54.61, I2 = 64%), respectively. The pooled PFS at 6, 12, and 24 months was 79.72% (95% CI: 67.88–87.97, I2 = 70%), 64.19% (95% CI: 56.68–71.06, I2 = 57%), 49.05% (95% CI: 11.47–87.73, I2 = 96%), respectively. Overall complication rate was 23.7%. Major complications (grade C-F) occurred in 6.9% patients. IRE is associated with favorable OS and PFS. Although the overall complication rate is high, most complications are graded as minor. • The pooled OS and PFS at 6, 12, and 24 months for all the tumor types was 93.28% and 79.72%, 81.29% and 64.19%, and 61.47% and 49.05%, respectively. • HCC was associated with a better OS at 12 and 36 months. • The overall complication rate was 23.7%, with major complications (SIR grade C-F) comprising 6.9%.

Coronavirus Disease 2019 (COVID-19) is the most prevalent infectious human disease spreading in several parts of the world caused by SARS Coronavirus 2 (SARS-CoV-2). COVID-19 transmission is mainly spreading via the respiratory tract, personal contact, digestive tract and hospitalacquired infections. Health care workers particularly working in clinics practicing traditional medicine need to be in close contact with patients, so they have a higher risk of SARS-CoV-2 infection. In this paper, therefore, the personal-protective measures need to be followed by healthcare workers in traditional medicine clinics during COVID-19 pandemic are emphasized, to enlighten them about selfprotection and to improve the safety of such a special group of traditional healers.

Purpose: To report the computed tomography features of a case with complete luxation of the globe after a road traffic accident. Case Report: A 35-year-old male presented with pain, loss of vision, and bleeding from the left eye 48 hr after a road traffic accident. The ophthalmic examination of the left upper and lower eyelids showed edema with subcutaneous hematoma, crepitus, and complete blepharoptosis. On retracting the eyelids, the left eyeball was not visible and the patient was not able to perceive light. The left temporal region appeared filled with a soft, palpable globular structure situated beneath the temporalis muscle. A non-contrast computed tomography (NCCT) of the head and orbits showed a comminuted and displaced fracture of the floor, medial, and lateral orbital walls in addition to a displaced tripod fracture of the left zygomatic bone. The intact left eyeball was seen below the temporalis muscle without any optic nerve or extraocular muscle attachment. The virtual reality reconstruction highlighted a contributory supero-temporal defect in the bony orbit, which appeared large enough to accommodate the intact eyeball. Conclusion: The computed tomography of the orbits provided a detailed location of the luxated eyeball and provided guidance in further management of the case.

Percutaneous endoscopic gastrostomy (PEG) is one of the most commonly performed endoscopic procedures and a first-line treatment for the establishment of enteral access in those with intolerance or contraindication to oral feedings. A small amount of pneumoperitoneum in the immediate postprocedure period is well reported after PEG tube placement. However, pneumoperitoneum resulting from displaced gastric bumper within 24 hours postprocedure is uncommon and rarely reported in the literature. Timely diagnosis and early endoscopic management can help tackle such an unusual complication.

Introduction: Homoeopathy, one of the most commonly employed alternative medicines globally, has a wide range of role in the management of diabetes. Screening of the action of homoeopathic medicines in diabetes on animal model not only helps in validating their antidiabetic potential but also aids in understanding their effect on living systems and their mechanism of action. The present review focusses on the collection of results of pre-clinical studies carried out on homoeopathic medicines employed in the management of diabetes. Methodology: PubMed, HomBRex portal, and published literature such as library catalogue were searched up to November 2019. The search terms employed were 'Homoeopathy', 'Diabetes' and their MeSH variations in PubMed and in HomBrex search was made using the condition 'Diabetes'. Results: Fifteen studies were included in the review. Twenty medicines were evaluated for their antidiabetic efficacy either in vivo or in vitro. Most of the preclinical research on diabetes was carried out on Syzygium jambolanum and Cephalandra indica in mother tincture form and potencies, substantiating their effectiveness in the management of diabetes. Apart from the medicines discussed in the current review, there are many other medicines in Homoeopathy which are used to treat diabetes and these also should be validated scientifically for global acceptance by the scientific fraternity. Conclusion: Considering the hypoglycaemic potential, availability and cost-effectiveness of homoeopathic medicines, future research should focus on screening their effectiveness in the management of diabetic complications and other metabolic disorders.

Background There is a significant variability in the reported outcomes following endovascular embolization of arterial pseudoaneurysms in pancreatitis. The objective of this systematic review and meta-analysis is to evaluate the efficacy of endovascular embolization of pancreatitis-related pseudoaneurysms. Methods Searches of MEDLINE, EMBASE, and SCOPUS databases were performed through July 1, 2019 in accordance with PRISMA guidelines. All studies with ≥10 patients reporting technical success, clinical success, complications, and mortality were included. Generalized linear mixed method with random effects model was used for assessing pooled incidence rates and corresponding 95% confidence intervals (CIs). Results A total of 29 studies (n = 840 with 638 pseudoaneurysms) were included. The pooled incidence rates of pseudoaneurysms in acute and chronic pancreatitis were 0.05% and 0.03%, respectively (odds ratio, 0.91, 95% CI-0.24–3.43). The most common site of pseudoaneurysm was splenic artery (37.7%). The most common embolization agent was coil (n = 415). The follow up period was 54.7 months (range, 21 days to 40.5 months). Pooled technical success rate was 97% (95% CI-92-99%, I2 83%). Clinical success rates at ≤3 months, 3–12 months, and >12 months were 82% (95% CI-70-90%, I2 42%), 86% (95% CI-75-92%, I2 44%), and 88% (95% CI-83-91%, I2 0%), respectively. There was no significant difference in the technical or clinical success between acute and chronic pancreatitis on subgroup analysis. Mortality was lower in chronic pancreatitis (OR 4.27 (95% CI 1.35–13.53, I2 0%)). Splenic infarction was the most common complication (n = 47). Conclusion Endovascular embolization is associated with a high technical and clinical success.

Audio signals acquired during machining of Al-6061-T6 are demodulated using local mean decomposition technique, followed by fast Fourier transform (FFT). These decomposed signals are explored to extract tool chatter features by evaluating Chatter Index (CI). Further, prediction model of chatter severity has been developed using ANFIS. Good relationship between the experimental and predicted values establishes the efficacy of the proposed methodology.

Background Leicester was the first city in the UK to have ‘local lockdown’ measures imposed in response to high community rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. As part of this response, a directive was issued by NHS England to offer testing of asymptomatic healthcare workers (HCWs) at University Hospitals of Leicester NHS Trust (UHL) for SARS-CoV-2 infection. Methods Between 20 July and 14 August 2020, we invited all HCWs at UHL to attend for SARS-CoV-2 testing by nucleic acid amplification (NAAT). We combined the result of this assay with demographic information from the electronic staff record. Results A total of 1150 staff (~8% of the workforce) volunteered. The median age was 46 years (IQR 34–55), 972 (84.5%) were female; 234 (20.4%) were of South Asian and 58 (5.0%) of Black ethnicity; 564 (49.0%) were nurses/healthcare assistants. We found no cases of asymptomatic infection. In comparison, average community test positivity rate in Leicester city was 2.6%. Conclusions Within the context of local lockdowns due to high community transmission rates, voluntary testing of asymptomatic staff has low uptake and low yield and thus its premise and cost-effectiveness should be re-considered.

Objective Deficiency of adenosine deaminase 2 (DADA2) is a potentially fatal monogenic syndrome characterized by variable manifestations of systemic vasculitis, bone marrow failure, and immunodeficiency. Most cases are diagnosed by pediatric care providers, given the typical early age of disease onset. This study was undertaken to describe the clinical phenotypes and treatment response both in adults and in children with DADA2 in India. Methods A retrospective analysis of pediatric and adult patients with DADA2 diagnosed at various rheumatology centers across India was conducted. Clinical characteristics, diagnostic findings, and treatment responses were analyzed in all subjects. Results In total, 33 cases of DADA2 were confirmed in this cohort between April 2017 and March 2020. Unlike previous studies, nearly one-half of the confirmed cases presented during adulthood. All symptomatic patients exhibited features of vasculitis, whereas constitutional symptoms and anemia were more common in pediatric patients. Cutaneous and neurologic involvement were common, and 18 subjects had experienced at least one stroke. In addition, the clinical spectrum of DADA2 was expanded by recognition of novel features in these patients, including pancreatic infarction, focal myocarditis, and diffuse alveolar hemorrhage. Treatment with tumor necrosis factor inhibitors (TNFi) was initiated in 25 patients. All of the identified disease manifestations showed marked improvement after initiation of TNFi, and disease remission was achieved in 19 patients. Two cases were complicated by tuberculosis infection, and 2 deaths were reported. Conclusion This report presents the first case series of patients with DADA2 from India, diagnosed by adult and pediatric care providers. The findings raise awareness of this syndrome, particularly with regard to its presentation in adults.

Context: Functional constipation which has no underlying organic causes is difficult to be allopathic treatment for long term due to its side effects and undeniable effect, thus a natural balanced and compatible formulation needs to be validated. Objectives: Current study aimed to assess a poly-herbal formulation in management of functional constipation. Material and Methods: This study was 28 days, two armed, randomized, open labeled, prospective clinical study. 60 clinically confirmed cases of functional constipation patients randomized to receive orally either 2 teaspoonful of PP/JLN/107/09-10 Syrup or 1 teaspoonful of 5- 6 gm of Isabgol powder. Results were analyzed as per Rome II criteria and other associated symptoms like headache, acidity, belching, barborgysmy, flatulence and abdominal dis tension or bloating which are recorded on VAS score. Results: PP/JLN/107/09-10 scored over Isabgol on four out of six parameters of Rome II Criteria viz., frequency of bowel movement, straining at defecation, lumpy I har dstool formation, feeling of incomplete evacuation, feeling of ano-rectal blockage and manual maneuvers (p less than 0.001). Trial drugs showed comparable effects (p > 0.05) in reducing the mean scores of associated symptoms like headache, acidity, belching, borgorgysmy, flatulence and abdominal distension. However, trial drug was found to perform statistically significant result in more number of parameters in comparison to Isabgol. Conclusion: PP/JLN/107/09-10 was found to be effective and safe in reliving functional constipation.

Hypertension is one of the most important modifiable risk factor causing cardiovascular disease. Unfortunately, non-adherence to antihypertensive medications is frequently observed in hypertensive patients and can lead to an increase in morbidity and mortality. Until recently, there was no robust clinical method to objectively diagnose non-adherence. Recently, the detection of medications in urine or blood by mass spectrometry techniques such as liquid chromatography-tandem mass spectrometry (LC–MS-MS) has been accepted as the diagnostic method of choice for the detection of non-adherence. Despite this, it is unclear whether the concentration of urine can affect the detection of medications in urine. Therefore, this study aimed to assess the effect of urine concentration on detection of antihypertensive medications by LC–MS-MS in which urine creatinine is used as an independent marker of urine concentration. Biochemical adherence results for 22 different medications (1,709 prescriptions) in 463 different subjects were converted to an adherence score. The adherence score was defined as the ratio of the total number of subjects in which the drug was detected to the total number of subjects to whom the drug was prescribed. The adherence scores for each medication were correlated with urine creatinine concentration for each medication. Non-adherence was observed in 47.1% of samples with a mean urine creatinine concentration of these samples of 9.4 ± 7.1 mmol/L. There was no significant difference between the urine creatinine concentrations in the detected vs non-detected groups for each of the 22 medications. Furthermore, there are no differences in adherence scores across the urine creatinine concentration. This is the first study to demonstrate that urine creatinine concentration does not affect the results of the adherence screening by LC–MS-MS.

Acute pancreatitis (AP) is a common disorder with high mortality in severe cases. Several markers have been studied to predict development of severe AP (SAP) including serum resistin with conflicting results. This study aimed at assessing the role of baseline serum resistin levels in predicting SAP.This prospective study collected data from 130 AP patients from July 2017 to Nov 2018. Parameters measured included demographic profile, serum resistin at admission, severity scores, hospital stay, surgery, and mortality. Patients were divided into two groups, severe and non-severe AP. The two groups were compared for baseline characteristics, serum resistin levels, hospital stay, surgery and mortality.Among 130 patients, 53 patients had SAP. SAP patients had higher BMI, baseline CRP, APACHE II and CTSI scores (We found that serum resistin is not a useful marker for predicting the severity of AP and does not correlate with increasing body weight.

Aim and objective To study the effects of obesity on the pulmonary functions in male medical students of Amritsar. Materials and methods Pulmonary function tests (PFTs) of normal, healthy, male medical students of Amritsar were determined and were compared and correlated with other studies. Criteria for obesity in our study taken were according to WHO criteria of BMI. The PFTs were carried out with a computerized spirometer “Med-Spiror”. The data were collected; compiled, statistically analyzed, and valid conclusions were drawn. Higher lung volumes and flow rates were achieved. Results There was a statistically highly significant decline in forced vital capacity (FVC) in obese when compared with nonobese groups. The values of forced expiratory volume in first second (FEV1) in both groups when were compared showed significant changes. The ratio of FEV1/FVC, the values of peak expiratory flow rate (PEFR), and forced mid-expiratory flow (FEF25–75%) showed insignificant changes but maximum voluntary ventilation (MVV) when were compared showed highly significant changes. Conclusion There is a decline of various respiratory functions in obesity. The cause of the decline of various respiratory functions in obesity may be due to a decrease in distensibility of the chest wall or limited expansion of the thoracic cavity and is the cause for reduced ventilatory volumes and total lung capacity. How to cite this article Mahajan S, Hundal GS, Arora AK, et al. Effects of Obesity and Spirometric Ventilatory Status in Male Medical Students of Amritsar. AMEI's Curr Trends Diagn Treat 2020;4(2):74–77.

Background Majority of predictors of postoperative pancreatic fistula (POPF) use intraoperative variables. We aimed to study the role of preoperative ultrasound shear wave elastography (USWE) to predict POPF. Methods The consecutive patients who underwent pancreaticoduodenectomy (PD) between January 2019 to March 2020 were prospectively enrolled. All patients underwent USWE assessment at the pancreatic neck level. Intraoperative variables including pancreatic texture, pancreatic duct diameter, blood loss and histological grading of fibrosis were also recorded. Associations between USWE and intraoperative variables and histological grading with the development of POPF were analyzed. Results Of the 62 patients assessed, 50 patients (mean age: 53 ± 14 years; 31 males) were included. POPF and clinically relevant POPF (CRPOPF) were observed in 22 (44%) and 7 (14%) patients respectively. Soft pancreas was an independent predictor of CRPOPF (p = 0.04). The mean USWE valve was significantly lower in patients with CRPOPF as compared to no CRPOPF (9.7 Kpa vs. 12.8Kpa, p = 0.016). At receiver operating characteristic curve analysis, USWE value of 12.65Kpa yielded sensitivity and specificity of 100% and 47%, respectively, for prediction of CRPOPF. USWE showed significant correlation with intraoperative pancreatic texture (Spearman’s rank correlation coefficient (ρ) = 0.565, p = 0.001). Conclusion USWE helps in preoperative prediction of CRPOPF. This may further help to customize management strategy in high risk patients.

Science of Marma known as Marma Vigyanam is a dynamic part, specially described in Sushrut samhita and other Ayurvedic classics. According to Sushrut Mamsa, Sira, Snayu, Asthi, and Sandhi, these five elements collectively present at Marma point. This is the peculiarity of Marma.1 Marmas are the vital points on the body having importance regarding surgical procedure and traumatic effect. It is also known as Ayurvedic Accupressure. In this paper, three similar cases of pain and stiffness in shoulder joints are presented, who has attended OPD of District Hospital Shivaji Nagar, Bhopal. In during the clinical examination partially restriction of shoulder movement is also recorded. The case was initially treated with Marma therapy mainly the stimulation of bilateral Bahu Marma along withAmsa Marma for instant pain management. After the treatment of about ten minutes the patient got relief in pain and stiffness and felt lightness in surrounding area of painful place. Amsa Marma manipulation can be used to give instant relief from Shoulder pain effectively.

Background Although evidence suggests that demographic characteristics including minority ethnicity increase the risk of infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), it is unclear whether these characteristics, together with occupational factors, influence anti-SARS-CoV-2 IgG seroprevalence in hospital staff. Methods We conducted cross-sectional surveillance examining seroprevalence of anti-SARS-CoV-2 IgG amongst staff at University Hospitals of Leicester (UHL) NHS Trust. We quantified seroprevalence stratified by ethnicity, occupation and seniority of practitioner and used logistic regression to examine demographic and occupational factors associated with seropositivity. Results A total of 1148/10662 (10.8%) hospital staff members were seropositive. Compared to White staff (seroprevalence 9.1%), seroprevalence was higher in South Asian (12.3%) and Black (21.2%) staff. The occupations and department with the highest seroprevalence were nurses/healthcare assistants (13.7%) and the Emergency Department (ED)/Acute Medicine (17.5%), respectively. Seroprevalence decreased with seniority in medical/nursing practitioners. Minority ethnicity was associated with seropositivity on an adjusted analysis (South Asian: aOR 1.26; 95%CI: 1.07–1.49 and Black: 2.42; 1.90–3.09). Anaesthetics/ICU staff members were less likely to be seropositive than ED/Acute medicine staff (0.41; 0.27–0.61). Conclusions Ethnicity and occupational factors, including specialty and seniority, are associated with seropositivity for anti-SARS-Cov-2 IgG. These findings could be used to inform occupational risk assessments for front-line healthcare workers.

The incidence of a penetrating brain injury due to a pressure cooker blast is quite rare. We are presenting this case of a 24-year-old female who sustained anterior skull base injury, with the nozzle of the pressure cooker penetrating through left orbit on account of the blast. A combined multidisciplinary approach was utilized and the patient recovered uneventfully.

Background Post-intensive care survivors have decreased quality-of-life scores and prolonged cognitive dysfunction due to baseline factors and events related to intensive care unit admission, which remain largely unrecognized. Materials and methods A prospective observational cohort study to assess the quality of life and occurrence of cognitive dysfunction, 3 and 6 months following discharge from the intensive care unit, was carried out. We enrolled 136 adults presenting to the intensive care unit with no prior cognitive dysfunction or depression and followed up and assessed them with repeatable battery for the assessment of neuropsychological status (RBANS) and quality of life with short Form-36 (SF-36) health survey. Results The incidence and prevalence of cognitive dysfunction was 100% at 3 and 6 months, respectively, as assessed by RBANS with a global cognition scores at 3 and 6 months of 71 (IQR 68.5–73) and 74 (IQR 72–86), respectively. Higher Charlson's comorbidity score, increased severity of illness, longer duration of mechanical ventilation, pain, delirium, coma, and hospital stay were associated with statistically significant lower scores at 3 months. The median SF-36 mental component score (MCS) and physical component score (PCS) at 3 months were 38.4 and 32.5 and at 6 months were 38.2 and 32.6, respectively. Poor score was associated significantly with advancing age, poor functional parameters at baseline as evidenced by clinical frailty, poor baseline Katz ADL scores, increased severity of illness, longer duration of mechanical ventilation, occurrence and duration of delirium, coma, pain, and usage of sedatives with or without analgesics. Conclusion and clinical significance Patients discharged from the intensive care unit are at high risk for persistent cognitive impairment and poor quality of life score. Poor baseline patient characteristics and events occurring in ICU are associated with worse cognition and quality of life scores. There is an urgent need to prevent, diagnose, and manage these patients by optimizing intensive care practices. How to cite this article Balasubramanian V, Suri JC, Ish P, Gupta N, Behera D, Gupta P, et al. Neurocognitive and Quality-of-life Outcomes Following Intensive Care Admission: A Prospective 6-month Follow-up Study. Indian J Crit Care Med 2020;24(10):932–937.

Locoregional therapies play an important role in the management of hepatocellular carcinoma (HCC). Percutaneous ablation is one of the most commonly employed nonsurgical methods for treating very early and early HCC. For small HCC, ablation is potentially curative and competes with surgical resection. The widespread availability and the spectrum of ablative techniques mandate uniform approach among interventional radiologists. Thus, it is desirable to have a consensus regarding various aspects of the liver ablation. This article represents a consensus document of the experts from the Indian Society of Vascular and Interventional Radiology involved in the care of patients with HCC. The statements are presented in two parts.

Renal Doppler to assess renal resistive index (RRI) is an attractive option to prognosticate acute kidney injury (AKI) in acute pancreatitis (AP) as it is feasible within scope of point-of-care ultrasound. However, RRI has been infrequently evaluated in AP.Prospectively study diagnostic and prognostic performance of RRI in patients with AP.75 patients with AP were prospectively enrolled and followed till recovery/death. All patients were subjected to renal Doppler and RRI was compared between patients with and without AKI.Thirty six patients developed AKI and 39 patients did not develop AKI. AKI network stage 1, 2 and 3 AKI was seen in 7(19.4%), 12(33.3%) and 17 (47.2%) patients respectively. Prognostic scoring done at admission by SIRS, modified marshal score, and BISAP scores, as well as duration of hospitalization and mortality rates were significantly higher in patients with AKI. Mean peak systolic velocity and RRI at upper, middle and lower poles of bilateral kidneys were comparable between patients with and without AKI. The RRI was abnormal in 46 (66.6%) patients and it was0.6 in 35/46 (76%) and0.7 in 11/46 (24%) patients respectively. RRI0.6 was observed in 16 (53.3%) and 19 (48.7%) patients with and without AKI respectively (p = 0.80). RRI0.7 was observed in 4 (53.3%) and 7 (48.7%) patients with and without AKI respectively (p = 0.74).AKI is associated with poor prognosis in AP. RRI on renal Doppler at admission seems to have poor diagnostic as well as prognostic performance for AKI in patients with AP.

With massive growth in decision-making theory, representation of preference information plays an indispensable role. To rationally handle uncertainty, scholars presented different ideas of which hesitant fuzzy linguistic term set (HFLTS) is a good choice to represent hesitancy in decision makers’ (DMs) preferences. The challenge with HFLTS is that it cannot be used for representing complex linguistic terms. To better circumvent this challenge, double-hierarchy HFLTS (DHHFLTS) is presented. Motivated by the power of DHHFLTS in expressing complex linguistic terms by using two linguistic hierarchies, a decision framework is proposed under the DHHFLTS context. Initially, the framework presents a new aggregation operator called simple double-hierarchy frequency match aggregation operator for sensible aggregation of DMs’ preference information. Later, the mathematical programming model is extended under the DHHLTS context for rational estimation of attribute weight with partially known information. Also, the popular Vise Kriterijumska Optimizacija Kompromisno Resenje ranking method is extended under the DHHFLTS context for the selection of a suitable object from the set of objects. Finally, the proposed decision framework is validated for its practicality by demonstrating two numerical examples viz., green supplier selection problem and renewable energy source selection problem. Also, the strengths and weaknesses of the proposed framework are realized by comparison with other methods.

The Chakra is thought to be an energy point or node in the subtle of body. which is thought to flow among them along pathway called Nadis. There are six primary Chakras namely Muladhara, Swadhithana, Ma-nipura, Anahat, Visudha, Ajna Chakra. Sthana of Muladhara Chakra and Swadhithana Chakra is Ling and Gud which can be correlate with inferior hypogastric and sacral plexus. Sthana of Manipura Chakra is Nabhi and is represented by solar plexus. Hrudiya is the sthana of Anahat Chakra and it is represented by cardiac plexus. Sthana of Visuddha Chakra is kantha and is represented by cervical plexus. Sthana of Ajna chakra is between eyebrow and it is Avyakta (union of Prakriti and Purush) hence not related to any plexus. these are directly related to physiological as well as physic centers whose structures correspond more or less with traditional description.

Gastroduodenal tuberculosis is an uncommon form of abdominal tuberculosis.We report our experience with five cases of gastroduodenal tuberculosis and present results of a systematic review on gastroduodenal tuberculosis regarding clinical presentation, endoscopic, imaging findings, and the diagnostic and therapeutic approach.The presentation of gastroduodenal tuberculosis is diverse and may include nonspecific abdominal pain or dyspepsia like symptoms apart from gastric outlet obstruction. Endoscopy may show presence of growth, ulcer, narrowing, or fistula on endoscopy. Endoscopic biopsy, well-biopsy, or mucosal resection of an elevated lesion are helpful. On microscopy, granuloma with or without acid fast bacilli positivity can be found. For treatment, standard antitubercular therapy should be given for 6 months. In patients with tight stricture, endoscopic balloon dilatation can be helpful. Surgery is reserved for patient with diagnostic dilemma, refractory stricture, or complications like perforation or fistula. Future research should focus on improving diagnosis with use of modern microbiological techniques like PCR and Xpert MTB/RIF.

Hepatobiliary disorders are common in pregnancy and pose a management challenge. Minimally invasive interventional radiological (IR) techniques allow safe and effective management of these disorders. However, the available literature is scarce. Radiological interventions in this group of patients mandate a clear understanding of the risks of radiation to the fetus. The IR physician involved in the care of these patients should be aware of the measures to minimize the exposure to ionizing radiation. Additionally, the risk-benefit ratio should be clearly defined in a multidisciplinary discussion involving IR physicians, obstetricians, and gastroenterologists. This review is an effort to address issues related to the application of IR procedures for hepatobiliary disorders in pregnant patients.

Background and study aims Endoscopic dilation is first-line management for benign esophageal strictures (ES). Depth of involvement of the esophageal wall on endosonography using high frequency mini-probe (EUS-M) may predict response to dilation. This study evaluated EUS-M characteristics to predict response of ES to endoscopic dilation. Patients and methods EUS-M was used to measure the total esophageal wall thickness (EWT), involved EWT, percentage of involved wall and layers of wall involved in consecutive patients of benign ES. After a maximum of five sessions of endoscopic dilation, the cohort was divided into responders and refractory strictures. EUS-M characteristics were compared for underlying etiology as also between responders and refractory strictures. Results Of the 30 strictures (17 females, age: 47.16 ± 15.86 yrs.) 13 were anastomotic, eight corrosive, seven peptic and 2 others. Corrosive strictures had the highest involved EWT and percentage of involved wall (3.51 ± 1.36 mm; 76.38 %) followed by anastomotic (2.73 ± 1.7 mm; 65.54 %) and peptic (1.39 ± 0.62 mm; 40.71 %) (P = 0.026 and 0.021 respectively). After five dilations, 22 were classified as responders and eight as refractory. Wall involvement > 70 % had a greater proportion of refractory strictures (P = 0.019). Strictures with involved EWT of ≥ 2.85 mm required more dilations (P = 0.011). Fewer dilations were required for stricture resolution with only mucosal involvement compared to deeper involvement such as submucosa and muscularis propria (2.14 vs. 5.80; P = 0.001). Conclusion EUS-M evaluation shows that corrosive and anastomotic strictures have greater depth of involvement compared to peptic strictures. Depth of esophageal wall involvement in a stricture predicts response to dilation.