Yash Vaidya

Bio: Yash Vaidya is an academic researcher from State University of New York Upstate Medical University. The author has contributed to research in topics: Coronary artery disease & Rib cage. The author has an hindex of 4, co-authored 16 publications receiving 33 citations. Previous affiliations of Yash Vaidya include Gandhi Medical College & Mahatma Gandhi Medical College & Research Institute.

Ductal Carcinoma In Situ of the Breast

Abstract: Ductal carcinoma in situ (DCIS) of the breast is a potentially invasive neoplasm. Risk factors include high estrogen states such as use of oral contraceptive (OC) pills, nulliparity, advanced age at first birth, and also family history and genetic mutations. The incidence of this usually clinically silent condition has risen in the past few decades due to widespread screening and diagnostic mammography, with final diagnosis confirmed by biopsy. At present, treatment options include total or simple mastectomy or lumpectomy with radiation. Adjuvant therapy includes antiestrogens like tamoxifen and human epidermal growth factor receptor 2 (HER2) suppression therapy. With the latest advances in chemotherapy and better understanding on the pathogenesis of the lesion, it is anticipated that more effective modalities of treatment may soon be available.

Coronary artery fistula

Abstract: Background Coronary artery fistula is a rare anomaly of the coronary arteries which results from an abnormal connection between a coronary artery with a cardiac chamber or vessel. Coronary steal phenomenon can lead to functional ischemia of the myocardium. The condition has been described extensively, however, the modalities for diagnosing this condition continue to advance. Methods This review summarizes the approach to managing this uncommon condition. Results We discuss the various surgical options, including the technique involved in treating specific types of fistulas. Conclusion We also review minimally-invasive options and trans-catheter closure along with indications for use of the different modalities.

Left Ventricular Assist Devices (LVAD)

Abstract: Heart failure (HF) is a frequent cause of inpatient admissions. The Framingham study in 1993 described the risk factors for heart failure and showed unacceptably high five-year mortality rates of 25% in men and 38% in women . The American Heart Association reported the prevalence of HF to be 5.1 million in the United States in 2006 . The worldwide prevalence has been estimated to be 23 million .HF can be categorized based on the left ventricular ejection fraction (LVEF) into systolic and diastolic HF. The former group includes patients with LVEF less than or equal to 40%, also termed heart failure with reduced ejection fraction (HFrEF). Heart failure with preserved ejection fraction (HFpEF) includes those with LVEF greater than or equal to 40%. The multiple modalities of treatment available to treat HF include but are not limited to lifestyle modifications, pharmacologic agents, device therapies such as implantable cardioverter-defibrillator (ICD), and cardiac resynchronization therapy (CRT). At times, failure to improve could necessitate short-term mechanical circulatory support with the use of an intra-aortic balloon pump (IABP) or even extracorporeal membrane oxygenation (ECMO). However, a large population of patients continues to have advanced heart failure with worsening LVEF despite maximal therapy.Circulatory support with the use of a left ventricular assist device (LVAD) is an emerging field. The landmark REMATCH trial that compared LVADs with optimal medical therapy in class IV HF patients found a 48% reduction in mortality from any cause . There was also a significant increase in the survival rates at one year (52% versus 25%) and two years (23% versus 8%). The definitive treatment for advanced HF (class II and IV) is cardiac transplantation . However, with the limited number of donor hearts available, LVADs are life-saving.

Lipomatous hypertrophy of the interventricular septum.

Abstract: Background and aims Lipomatous hypertrophy of the interatrial septum is an uncommon type of cardiac adipose tumor. It is extremely rare for these lesions to be located in the interventricular septum. Methods We report this case of incidentally diagnosed lipomatous hypertrophy of the interventricular septum with right ventricular outflow obstruction which caused minimal symptoms and Wolff-Parkinson-White pattern on EKG. Conclusion We also discuss the diagnosis and management of this condition.

The early prediction of mortality in acute pancreatitis : a large population-based study. Commentary

Abstract: Background: Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome. Methods: Using Classification and Regression Tree (CART) analysis, a clinical scoring system was developed for prediction of in-hospital mortality in AP. The scoring system was derived on data collected from 17 992 cases of AP from 212 hospitals in 2000-2001. The new scoring system was validated on data collected from 18 256 AP cases from 177 hospitals in 2004-2005. The accuracy of the scoring system for prediction of mortality was measured by the area under the receiver operating characteristic curve (AUC). The performance of the new scoring system was further validated by comparing its predictive accuracy with that of Acute Physiology and Chronic Health Examination (APACHE) II. Results: CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 h: blood urea nitrogen (BUN) >25 mg/dl; impaired mental status; systemic inflammatory response syndrome (SIRS); age >60 years; or the presence of a pleural effusion (BISAP). Mortality ranged from >20% in the highest risk group to <1% in the lowest risk group. In the validation cohort, the BISAP AUC was 0.82 (95% Cl 0.79 to 0.84) versus APACHE II AUC of 0.83 (95% Cl 0.80 to 0.85). Conclusions: A new mortality-based prognostic scoring system for use in AP has been derived and validated. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.