Ravi Sharma

Karolinska University Hospital

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Surinder Singh Rana

Post Graduate Institute of Medical Education and Research

114

Rajesh Gupta

Post Graduate Institute of Medical Education and Research

Vishal Sharma

Post Graduate Institute of Medical Education and Research

Deepak K. Bhasin

Hochschule Düsseldorf University of Applied Sciences

Puneet Chhabra

Calderdale and Huddersfield NHS Foundation Trust

Mandeep Kang

Post Graduate Institute of Medical Education and Research

Lovneet Dhalaria

Post Graduate Institute of Medical Education and Research

Vivianne Malmström

Karolinska University Hospital

Naresh Sachdeva

Post Graduate Institute of Medical Education and Research

Vinita Chaudhary

Sardar Patel Medical College

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Post Graduate Institute of Medical Education and Research

149

All India Institute of Medical Sciences

Creative Commons

University of Pittsburgh

Institute of Post Graduate Medical Education and Research

Karolinska University Hospital

Karolinska Institutet

King Saud Medical City

Chandigarh University

King George's Medical University

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An unusual cause of dysphagia: Isolated IgG 4-related esophageal disease

Endoscopic Ultrasound (2016)

SurinderSingh Rana Ritambhra Nada Ravi Sharma Lovneet Dhalaria Harpreet Singh

A 60-year-male presented with progressively increasing dysphagia accompanied with loss of weight. He denied ingestion of corrosive or any medication. Upper gastrointestinal endoscopy revealed a nonnegotiable stricture at 32 cm from the incisors [Figure 1] and multiple endoscopic biopsies from the mouth of the stricture were noncontributory. Barium swallow confirmed the presence of lower esophageal stricture [Figure 2]. Contrast enhanced computed tomography revealed marked wall thickening of the esophagus at the site of narrowing [Figure 3]. High-frequency endoscopic ultrasound (EUS) at 20 MHz revealed marked thickening of the wall of the esophagus with the loss of wall stratification (maximum thickness 11.2 mm) [Figure 4]. No significant mediastinal lymph nodes were detected on EUS. Endoscopic bougie dilatation of the esophageal stricture was done, and the patient had transient improvement in dysphagia. Positron emission tomography revealed flourodeoxyglucose (FDG) avid esophageal wall thickening (SUVmax 2.3) [Figure 5]. No significant FDG uptake was observed anywhere else in the body. Because of the possibility of hidden malignancy, the patient underwent esophagectomy with gastric pull-up. The resected specimen revealed ulcerated esophageal mucosa and dense submucosal fibro-inflammatory reaction which had storiform pattern and IgG4 rich plasma cell infiltration [Figures 6 and 7]. Serum IgG4 levels done postoperatively were within normal limits. The patient had an anastomotic leak that was successfully managed with endoscopic dilatation and patient is asymptomatic at 8 months of follow-up.Figure 1: Upper gastrointestinal endoscopy: Nonnegotiable stricture in lower esophagusFigure 2: Barium swallow: Lower esophageal strictureFigure 3: Contrast enhanced computed tomography: Marked wall thickening of the esophagus at the site of narrowingFigure 4: High-frequency endoscopic ultrasound: Marked thickening of the wall of the esophagus with loss of wall stratificationFigure 5: Positron emission tomography-computed tomography: Flourodeoxyglucose avid esophageal wall thickening (SUVmax 2.3)Figure 6: Microphotograph: Fibro-inflammatory reaction with storiform pattern and plasma rich infiltrate (H and E, ×40)Figure 7: Immunohistochemistry: IgG4 rich plasma cells (×40)The IgG4 related disease usually involves pancreas with the involvement of biliary tract, salivary glands, lymph nodes, thyroid, kidneys, lung, skin, prostate, and aorta also reported in the literature.[12] Involvement of upper gastrointestinal tract by IgG4-related inflammatory cells is very rare and there are very few case reports describing IgG4-related esophageal disease with the majority of patients being treated with surgery.[234] In spite of rarity, IgG4 related esophageal disease should be considered in the differential diagnosis of unexplained esophageal strictures. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Esophageal stricture

Esophageal dilatation

Esophageal disease

Endoscopic Ultrasound

Esophagectomy

10.4103/2303-9027.195872

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Citations (9)

Su1423 HIGH-FREQUENCY MINIPROBES AND 3-DIMENSIONAL EUS FOR EVALUATION OF OESOPHAGEAL STRICTURES OF UNKNOWN ETIOLOGY

Gastrointestinal Endoscopy (2018)

Surinder Singh Rana Ravi Sharma Rajesh Gupta

Etiology

Endoscopic Ultrasound

Esophageal stricture

10.1016/j.gie.2018.04.1753

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Su1423 – Gastrointestinal Failure is a Predictor of Poor Outcome in Patients with Acute Pancreatitis

Gastroenterology (2019)

Roshan Agarwala Surinder Singh Rana Ravi Sharma Mandeep Kang Rajesh Gupta

10.1016/s0016-5085(19)38251-4

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Primary gastric tuberculosis mimicking a submucosal tumor

Journal of Digestive Endoscopy (2015)

Vishal Sharma Surinder Singh Rana Deepak Gunjan Puneet Chhabra Ravi Sharma

Abstract Gastric tuberculosis is very rare and is usually associated with pulmonary tuberculosis. Endoscopically, it usually resembles peptic ulcer disease or malignancy. We present a 28-year-old female who had a submucosal lesion in the body of the stomach that mimicked a submucosal tumor. Endoscopic ultrasound guided fine needle aspiration yielded caseous material, and the cytological examination confirmed the diagnosis of tuberculosis.

Endoscopic Ultrasound

10.4103/0976-5042.165723

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Role of Thrombophilia in Splanchnic Venous Thrombosis in Acute Pancreatitis

Gastroenterology (2017)

Sobur Uddin Ahmed Surinder Singh Rana Jasmina Ahluwalia Neelam Varma Rajesh Gupta

10.1016/s0016-5085(17)31251-9

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Contrast-Enhanced Endoscopic Ultrasound for Evaluation of Common Bile Duct in Presence of Portal Cavernoma

Journal of Digestive Endoscopy (2020)

Surinder Singh Rana Ravi Sharma Rajesh Gupta

Abstract Endoscopic ultrasound (EUS) is an excellent imaging modality for the evaluation of common bile duct (CBD) because of its close proximity to the transducer placed in duodenum. However, in the presence of portal cavernoma, identification and proper evaluation of CBD become difficult because of presence of numerous venous collaterals. In these circumstances, the evaluation of CBD is more difficult if it is nondilated. In these difficult situations, contrast-enhanced EUS can provide better and clear images of CBD and therefore seems to be an excellent modality to evaluate nondilated CBD in the presence of portal cavernoma.

Endoscopic Ultrasound

Contrast-enhanced ultrasound

10.1055/s-0040-1716790

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Biased TCR gene usage in citrullinated Tenascin C specific T-cells in rheumatoid arthritis

Research Square (Research Square) (2021)

Ravi Sharma Sanjay V. Boddul Niyaz Yoosuf Sara Turcinov Anatoly Dubnovitsky

Abstract Objectives To search for common features in the autoreactive T cell receptor (TCR)-repertoire in patients with rheumatoid arthritis (RA), focusing on the newly identified candidate antigen citrullinated Tenascin C (cit-TNC). Methods Mononuclear cells from peripheral blood or synovial fluid of eight RA-patients positive for the RA-associated HLA-DRB1*04:01 allele were in-vitro cultured with recently identified citrullinated peptides from Tenascin C. Antigen-specific T cells were isolated using peptide-HLA tetramer staining and subsequently single-cell sequenced for paired alpha/beta TCR analyses by bioinformatic tools. TCRs were re-expressed for further studies of antigen-specificity and T cell responses. Results Autoreactive T cell lines could be grown out from both peripheral blood and synovial fluid. We demonstrate the feasibility of retrieving true autoreactive TCR sequences by validating antigen-specificity in T cell lines with re-expressed TCRs. One of the Tenascin C peptides, cit-TNC22, gave the most robust T cell responses including biased TCR gene usage patterns. The shared TCR-beta chain signature among the citTNC22-specific TCRs was evident in blood and synovial fluid of different patients. Conclusion The identification of common elements in the autoreactive TCR repertoire gives promise to the possibility of both immune monitoring of the autoimmune components in RA and of future antigen- or TCR-targeted specific intervention in subsets of patients.

10.21203/rs.3.rs-956289/v1

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A Single Case Study OfAyurvedic Management Of Ankylosing Spondylitis W.S.R. To Amavata

International Research Journal of Ayurveda & Yoga (2021)

Falguni Joshi Ravi Sharma Ruhi Zahir

Ankylosing spondylitis (AS) is a type of rheumatic disease known as spondyloarthropathies (SpA), and it has a significant link to the HLA-B27 genetic marker.The involvement of spinal joints, particularly the sacroiliac joint, is gradual and insidious.Inflammatory back pain and stiffness are common in the early stages of the disease, but in the later stages of the disease, severe pain and axial immobility or deformity can occur.In this disease, the lack of a successful biomedical treatment results in irreversible malformation.In these instances, several Panchakarma procedures and Ayurvedic medications have shown to be beneficial.The therapy includes rigorous dietary restrictions as well as lifestyle changes.The Ayurvedic method aims to reduce disability while also easing symptoms.Here, we discuss a case of Amavata that was effectively treated with Ayurvedic medicine.

10.47223/irjay.2021.4806

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Esophageal foreign body in neonates: How do they get it?

Journal of Pediatrics & Neonatal Care (2024)

Sunita Ojha Sanket Goyal Anupam Chaturvedi Rajiv Bansal Ravi Sharma

Esophageal foreign body is common in pediatric age group but is rare in neonatal period. A 5-days old newborn presented to us with provisional diagnosis of Esophageal atresia (EA) with or without Tracheo-esophageal fistula (TEF). Child had drooling of saliva and inability to feed. Surprisingly X-ray showed radiopaque shadow in esophagus. Esophagoscopy revealed an impacted stone with a large ulcer. Stone was mobilized by endoscopy but could not be retrieved above cricopharynx due to proximal esophageal oedema. Stone was pushed into stomach and was retrieved by gastrotomy. Literature search from 1955-2022(67 years), identified thirty-nine neonates with wide variety of esophageal FB. Details are discussed with different modalities used for removal of FB and their outcome.

Pediatric endocrinology

10.15406/jpnc.2024.14.00568

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Abstract 12554: Association of Left Ventricular Diffuse Fibrosis and Scar Assessed by Cardiac Magnetic Resonance Imaging With Depolarization and Repolarization on 12-Lead Electrocardiography: MESA (Multi-Ethnic Study of Atherosclerosis)

Circulation (2015)

Yuko Inoue Hiroshi Ashikaga Bharath Ambale‐Venkatesh Gustavo Jardim Volpe Nathan Mewton

Introduction: Left ventricular (LV) interstitial diffuse fibrosis and scar (replacement fibrosis) affect ventricular depolarization and repolarization parameters on an electrocardiogram (ECG) through local electrophysiology as well as LV global structure. The aim of this study is to examine the association between the two different types of fibrosis and ECG indices. Methods: A total of 1,669 participants (aged 54 to 94 years, 50% women) free of prior myocardial infarction or conduction delay underwent cardiac magnetic resonance with late gadolinium enhancement (LGE), and 1,136 participants without an LGE-defined scar were analyzed using T1 mapping. The associations of LV diffuse fibrosis or scar with ECG parameters [QRS Sokolow-Lyon and Cornell voltage, QRS duration, and corrected QT (QTcorr) interval] were evaluated using multivariable regression analyses adjusted for cardiovascular risk factors, LV end-diastolic volume, and LV mass. Results: Lower post-contrast T1 time at 12 min and 25 min, indicating greater diffuse fibrosis, was significantly associated with lower QRS Sokolow-Lyon voltage, lower QRS Cornell voltage, and shorter QRS duration (all P<0.05). Greater extracellular volume fraction (ECV) was also significantly associated with lower QRS Sokolow-Lyon voltage (β=-38.9, P<0.001) and Cornell voltage (β=-23.5, P<0.001). By contrast, the presence of LV scar (n=106) was associated with longer QTcorr interval (β=4.2, P=0.034). Conclusions: In middle-aged multi-ethnic population, LV diffuse fibrosis assessed by T1 mapping was significantly associated with lower QRS voltage and shorter QRS duration, whereas LV scar was associated with longer QT interval; independent of cardiovascular risk factors and LV structure. Our results reveal the potential of 12-lead ECG of evaluating two different type of fibrosis.

Cardiac magnetic resonance

Mesa

10.1161/circ.132.suppl_3.12554

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Citations (1)