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Article: A Rare Case of Isolated Cardiac Sarcoidosis With Negative Biopsy: Diagnosis by Clinical Criteria.

Le, Tiffany / Dayco, John / Ramaseshan, Karthik / Zunnu Rain, Mariam / Afonso, Luis C

2024 Volume 16, Issue 1, Page(s) e52088

Abstract: Cardiac sarcoidosis (CS) is a potentially life-threatening condition that can cause sudden, fatal conduction abnormalities, arrhythmias, and heart failure. The diagnosis of CS is challenging due to nonspecific symptoms and an unclear diagnostic criterion. ...

Abstract	Cardiac sarcoidosis (CS) is a potentially life-threatening condition that can cause sudden, fatal conduction abnormalities, arrhythmias, and heart failure. The diagnosis of CS is challenging due to nonspecific symptoms and an unclear diagnostic criterion. Although biopsy is the gold standard method, the sensitivity of biopsy is low. About a portion of CS cases are detected through imaging. A unique aspect of our case is that our definitive diagnosis was made based on clinical and imaging criteria alone despite a negative biopsy. Our diagnosis was confirmed further on follow-up with improvement in cardiac function on imaging after a treatment course with corticosteroids. This case highlights the need to have a broad differential and more awareness of this rare etiology and the value of clinical criteria to make a definitive diagnosis.
Language	English
Publishing date	2024-01-11
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.52088
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Article ; Online: Carcinoid heart disease: a potentially fatal complication of carcinoid syndrome.

Bdiwi, Mustafa / Ramaseshan, Karthik / Uddin, Mohammed / Goel, Mishita / Razzaq, Saman / Alrayyashi, Mohamed / Afonso, Luis

BMJ case reports

2023 Volume 16, Issue 12

Abstract: Carcinoid heart disease is a unique and serious cardiac complication of the neuroendocrine tumour that affects the right side of the heart, especially the tricuspid and pulmonic valves, eventually causing right heart failure. We present a middle-aged man ...

Abstract	Carcinoid heart disease is a unique and serious cardiac complication of the neuroendocrine tumour that affects the right side of the heart, especially the tricuspid and pulmonic valves, eventually causing right heart failure. We present a middle-aged man with a history of well-differentiated neuroendocrine tumours of the small intestine with extensive metastases to the liver, mesentery and spine who is receiving monthly octreotide therapy. He presented with generalised fatigue, severe ascites and worsening dyspnoea. Both the transthoracic echocardiography and transoesophageal echocardiography revealed severe tricuspid and pulmonic regurgitations. He was considered a poor surgical candidate, underwent transcatheter pulmonic valve replacement with two bioprosthetic valve-in-valve implantations and was discharged in a stable condition.
MeSH term(s)	Male ; Middle Aged ; Humans ; Carcinoid Heart Disease/complications ; Carcinoid Heart Disease/diagnostic imaging ; Pulmonary Valve/diagnostic imaging ; Echocardiography ; Octreotide/therapeutic use ; Echocardiography, Transesophageal ; Neuroendocrine Tumors/complications
Chemical Substances	Octreotide (RWM8CCW8GP)
Language	English
Publishing date	2023-12-06
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2023-255518
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Article ; Online: Morel-Lavallée lesion of the anterior leg: a rare anatomical presentation.

Ramaseshan, Karthik / Bauler, Laura D / Mastenbrook, Joshua

BMJ case reports

2020 Volume 13, Issue 2

Abstract: A Morel-Lavallée lesion (MLL) is a rare injury caused by blunt force trauma causing separation of subcutaneous tissue from the deep fascia. It is frequently seen in orthopaedic cases involving fractures of the hip or pelvis but is rare in the lower leg. ... ...

Abstract	A Morel-Lavallée lesion (MLL) is a rare injury caused by blunt force trauma causing separation of subcutaneous tissue from the deep fascia. It is frequently seen in orthopaedic cases involving fractures of the hip or pelvis but is rare in the lower leg. The rarity of this condition often leads to misdiagnosis. A 66-year-old man presented to the emergency department after a 300-pound safe sheered across his left anterolateral leg causing skin avulsion, tenderness, swelling, ecchymosis, and erythema. The patient was treated for suspected cellulitis with oral antibiotics, but the lesion evolved into a necrotic eschar necessitating surgical intervention. In hindsight, MLL is a more appropriate diagnosis based on injury mechanism, disease progression and intraoperative findings. A history of shearing trauma with diffuse ecchymosis and erythema should prompt consideration of MLL. Due to rampant misdiagnosis, this case aims to increase awareness, as early diagnosis of MLL will improve patient outcomes.
MeSH term(s)	Aged ; Degloving Injuries/classification ; Degloving Injuries/diagnosis ; Diagnostic Errors ; Ecchymosis/complications ; Edema/complications ; Erythema/complications ; Humans ; Leg Injuries/classification ; Leg Injuries/diagnosis ; Magnetic Resonance Imaging ; Male ; Necrosis ; Subcutaneous Tissue/pathology ; Ultrasonography, Doppler ; X-Rays
Language	English
Publishing date	2020-02-25
Publishing country	England
Document type	Case Reports
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2019-233295
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Article ; Online: Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Among Patients With Acute Coronary Syndrome.

Shafi, Irfan / Patel, Dhruvil Ashishkumar / Osman, Heba / Patel, Neel / Ramaseshan, Karthik / Goel, Mishita / Alraies, M Chadi

The American journal of cardiology

2023 Volume 204, Page(s) 115–121

Abstract: Intravascular ultrasound (IVUS) use in percutaneous coronary intervention (PCI) improves outcomes. However, data on outcomes of IVUS-guided PCI in patients presenting with acute coronary syndrome (ACS) is scarce. Therefore, we sought to study the ... ...

Abstract	Intravascular ultrasound (IVUS) use in percutaneous coronary intervention (PCI) improves outcomes. However, data on outcomes of IVUS-guided PCI in patients presenting with acute coronary syndrome (ACS) is scarce. Therefore, we sought to study the utilization rate and outcomes of IVUS-guided PCI in patients with ACS. Using the National Readmission database, we identified all patients with ACS who underwent PCI from 2016 to 2019. We used a 1:1 propensity-matched analysis to compare the outcome of patients with ACS who underwent PCI with and without IVUS. In 1,263,997 patients with ACS, 563,521 (44.6%) underwent PCI without IVUS and 40,095 (3.17%) underwent IVUS-guided PCI. A Propensity scored matched comparison of PCI with and without IVUS showed IVUS-guided PCI was associated with a lower risk of in-hospital mortality (odds ratio 0.74, 95% confidence interval 0.64 to 0.85, p <0.01) compared with PCI without IVUS. The utilization of IVUS increased from 2.64% in 2016 to 4.10% in 2019, p <0.001. In conclusion, IVUS-guided PCI is associated with lower in-hospital mortality in patients with ACS, yet the current utilization of IVUS-guided PCI remains low across the United States.
MeSH term(s)	Humans ; Percutaneous Coronary Intervention ; Acute Coronary Syndrome/surgery ; Treatment Outcome ; Ultrasonography, Interventional ; Time Factors ; Coronary Angiography ; Coronary Artery Disease
Language	English
Publishing date	2023-08-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.07.014
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Article ; Online: Hyper-modulation of brain networks by the amygdala among women with Borderline Personality Disorder: Network signatures of affective interference during cognitive processing.

Soloff, Paul H / Abraham, Kristy / Ramaseshan, Karthik / Burgess, Ashley / Diwadkar, Vaibhav A

Journal of psychiatric research

2016 Volume 88, Page(s) 56–63

Abstract: Emotion dysregulation is a core characteristic of patients with Borderline Personality Disorder (BPD), and is often attributed to an imbalance in fronto-limbic network function. Hyperarousal of amygdala, especially in response to negative affective ... ...

Abstract	Emotion dysregulation is a core characteristic of patients with Borderline Personality Disorder (BPD), and is often attributed to an imbalance in fronto-limbic network function. Hyperarousal of amygdala, especially in response to negative affective stimuli, results in affective interference with cognitive processing of executive functions. Clinical consequences include the impulsive-aggression, suicidal and self-injurious behaviors which characterize BPD. Dysfunctional interactions between amygdala and its network targets have not been well characterized during cognitive task performance. Using psychophysiological interaction analysis (PPI), we mapped network profiles of amygdala interaction with key regulatory regions during a Go No-Go task, modified to use negative, positive and neutral Ekman faces as targets. Fifty-six female subjects, 31 BPD and 25 healthy controls (HC), completed the affectively valenced Go No-Go task during fMRI scanning. In the negative affective condition, the amygdala exerted greater modulation of its targets in BPD compared to HC subjects in Rt. OFC, Rt. dACC, Rt. Parietal cortex, Rt. Basal Ganglia, and Rt. dlPFC. Across the spectrum of affective contrasts, hypermodulation in BPD subjects observed the following ordering: Negative > Neutral > Positive contrast. The amygdala seed exerted modulatory effects on specific target regions important in processing response inhibition and motor impulsiveness. The vulnerability of BPD subjects to affective interference with impulse control may be due to specific network dysfunction related to amygdala hyper-arousal and its effects on prefrontal regulatory regions such as the OFC and dACC.
MeSH term(s)	Adolescent ; Adult ; Amygdala/diagnostic imaging ; Amygdala/physiopathology ; Borderline Personality Disorder/diagnostic imaging ; Borderline Personality Disorder/pathology ; Brain Mapping ; Cognition/physiology ; Female ; Humans ; Image Processing, Computer-Assisted ; Inhibition (Psychology) ; Magnetic Resonance Imaging ; Middle Aged ; Mood Disorders/etiology ; Mood Disorders/pathology ; Neural Pathways/diagnostic imaging ; Neural Pathways/physiopathology ; Oxygen/blood ; Psychophysics ; Reflex, Startle/physiology ; Young Adult
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2016-12-22
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	3148-3
ISSN	1879-1379 ; 0022-3956
ISSN (online)	1879-1379
ISSN	0022-3956
DOI	10.1016/j.jpsychires.2016.12.016
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Article ; Online: Impulsivity and aggression mediate regional brain responses in Borderline Personality Disorder: An fMRI study.

Soloff, Paul H / Abraham, Kristy / Burgess, Ashley / Ramaseshan, Karthik / Chowdury, Asadur / Diwadkar, Vaibhav A

Psychiatry research. Neuroimaging

2016 Volume 260, Page(s) 76–85

Abstract: Fronto-limbic brain networks involved in regulation of impulsivity and aggression are abnormal in Borderline Personality Disorder (BPD). However, it is unclear whether, or to what extent, these personality traits actually modulate brain responses during ... ...

Abstract	Fronto-limbic brain networks involved in regulation of impulsivity and aggression are abnormal in Borderline Personality Disorder (BPD). However, it is unclear whether, or to what extent, these personality traits actually modulate brain responses during cognitive processing. Using fMRI, we examined the effects of trait impulsivity, aggression, and depressed mood on regional brain responses in 31 female BPD and 25 control subjects during a Go No-Go task using Ekman faces as targets. First-level contrasts modeled effects of negative emotional context. Second-level regression models used trait impulsivity, aggression and depressed mood as predictor variables of regional brain activations. In BPD, trait impulsivity was positively correlated with activation in the dorsal anterior cingulate cortex, orbital frontal cortex (OFC), basal ganglia (BG), and dorsolateral prefrontal cortex, with no areas of negative correlation. In contrast, aggression was negatively correlated with activation in OFC, hippocampus, and BG, with no areas of positive correlation. Depressed mood had a generally dampening effect on activations. Effects of trait impulsivity on healthy controls differed from effects in BPD, suggesting a disorder-specific response. Negative emotional context and trait impulsivity, but not aggression or depression, diminished task performance across both groups. Negative emotional context may interfere with cognitive functioning in BPD through interaction with the neurobiology of personality traits.
MeSH term(s)	Adult ; Aggression/psychology ; Borderline Personality Disorder/diagnostic imaging ; Borderline Personality Disorder/psychology ; Brain/diagnostic imaging ; Female ; Humans ; Impulsive Behavior/physiology ; Magnetic Resonance Imaging ; Middle Aged ; Neuropsychological Tests ; Young Adult
Language	English
Publishing date	2016-12-16
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	445361-x
ISSN	1872-7506 ; 1872-7123 ; 0925-4927 ; 0165-1781
ISSN (online)	1872-7506 ; 1872-7123
ISSN	0925-4927 ; 0165-1781
DOI	10.1016/j.pscychresns.2016.12.009
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Article: Dorsal anterior cingulate cortex modulates supplementary motor area in coordinated unimanual motor behavior.

Asemi, Avisa / Ramaseshan, Karthik / Burgess, Ashley / Diwadkar, Vaibhav A / Bressler, Steven L

Frontiers in human neuroscience

2015 Volume 9, Page(s) 309

Abstract: Motor control is integral to all types of human behavior, and the dorsal Anterior Cingulate Cortex (dACC) is thought to play an important role in the brain network underlying motor control. Yet the role of the dACC in motor control is under-characterized. ...

Abstract	Motor control is integral to all types of human behavior, and the dorsal Anterior Cingulate Cortex (dACC) is thought to play an important role in the brain network underlying motor control. Yet the role of the dACC in motor control is under-characterized. Here we aimed to characterize the dACC's role in adolescent brain network interactions during a simple motor control task involving visually coordinated unimanual finger movements. Network interactions were assessed using both undirected and directed functional connectivity analysis of functional Magnetic Resonance Imaging (fMRI) Blood-Oxygen-Level-Dependent (BOLD) signals, comparing the task with a rest condition. The relation between the dACC and Supplementary Motor Area (SMA) was compared to that between the dACC and Primary Motor Cortex (M1). The directed signal from dACC to SMA was significantly elevated during motor control in the task. By contrast, the directed signal from SMA to dACC, both directed signals between dACC and M1, and the undirected functional connections of dACC with SMA and M1, all did not differ between task and rest. Undirected coupling of dACC with both SMA and dACC, and only the dACC-to-SMA directed signal, were significantly greater for a proactive than a reactive task condition, suggesting that dACC plays a role in motor control by maintaining stimulus timing expectancy. Overall, these results suggest that the dACC selectively modulates the SMA during visually coordinated unimanual behavior in adolescence. The role of the dACC as an important brain area for the mediation of task-related motor control may be in place in adolescence, continuing into adulthood. The task and analytic approach described here should be extended to the study of healthy adults to examine network profiles of the dACC during basic motor behavior.
Language	English
Publishing date	2015-06-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2425477-0
ISSN	1662-5161
ISSN	1662-5161
DOI	10.3389/fnhum.2015.00309
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Article ; Online: Affective context interferes with brain responses during cognitive processing in borderline personality disorder: fMRI evidence.

Soloff, Paul H / White, Richard / Omari, Amro / Ramaseshan, Karthik / Diwadkar, Vaibhav A

Psychiatry research

2015 Volume 233, Issue 1, Page(s) 23–35

Abstract: Emotion dysregulation in borderline personality disorder (BPD) is associated with loss of cognitive control in the face of intense negative emotion. Negative emotional context may interfere with cognitive processing through the dysmodulation of brain ... ...

Abstract	Emotion dysregulation in borderline personality disorder (BPD) is associated with loss of cognitive control in the face of intense negative emotion. Negative emotional context may interfere with cognitive processing through the dysmodulation of brain regions involved in regulation of emotion, impulse control, executive function and memory. Structural and metabolic brain abnormalities have been reported in these regions in BPD. Using novel fMRI protocols, we investigated the neural basis of negative affective interference with cognitive processing targeting these regions. Attention-driven Go No-Go and X-CPT (continuous performance test) protocols, using positive, negative and neutral Ekman faces, targeted the orbital frontal cortex (OFC) and the anterior cingulate cortex (ACC), respectively. A stimulus-driven Episodic Memory task, using images from the International Affective Pictures System, targeted the hippocampus (HIP). Participants comprised 23 women with BPD, who were compared with 15 healthy controls. When Negative>Positive faces were compared in the Go No-Go task, BPD subjects had hyper-activation relative to controls in areas reflecting task-relevant processing: the superior parietal/precuneus and the basal ganglia. Decreased activation was also noted in the OFC, and increased activation in the amygdala (AMY). In the X-CPT, BPD subjects again showed hyper-activation in task-relevant areas: the superior parietal/precuneus and the ACC. In the stimulus-driven Episodic Memory task, BPD subjects had decreased activation relative to controls in the HIP, ACC, superior parietal/precuneus, and dorsal prefrontal cortex (dPFC) (for encoding), and the ACC, dPFC, and HIP for retrieval of Negative>Positive pictures, reflecting impairment of task-relevant functions. Negative affective interference with cognitive processing in BPD differs from that in healthy controls and is associated with functional abnormalities in brain networks reported to have structural or metabolic abnormalities. Task demands exert a differential effect on the cognitive response to negative emotion in BPD compared with control subjects.
MeSH term(s)	Adult ; Borderline Personality Disorder/physiopathology ; Borderline Personality Disorder/psychology ; Brain/physiopathology ; Brain Mapping/methods ; Cognition/physiology ; Emotions/physiology ; Female ; Gyrus Cinguli/physiopathology ; Humans ; Magnetic Resonance Imaging/methods ; Memory, Episodic ; Neuropsychological Tests ; Young Adult
Language	English
Publishing date	2015-07-30
Publishing country	Ireland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	445361-x
ISSN	1872-7123 ; 1872-7506 ; 0925-4927 ; 0165-1781
ISSN (online)	1872-7123 ; 1872-7506
ISSN	0925-4927 ; 0165-1781
DOI	10.1016/j.pscychresns.2015.04.006
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Article ; Online: Functional dynamics of hippocampal glutamate during associative learning assessed with in vivo

Stanley, Jeffrey A / Burgess, Ashley / Khatib, Dalal / Ramaseshan, Karthik / Arshad, Muzamil / Wu, Helen / Diwadkar, Vaibhav A

NeuroImage

2017 Volume 153, Page(s) 189–197

Abstract: fMRI has provided vibrant characterization of regional and network responses associated with associative learning and memory; however, their relationship to functional neurochemistry is unclear. Here, we introduce a novel application of in vivo proton ... ...

Abstract	fMRI has provided vibrant characterization of regional and network responses associated with associative learning and memory; however, their relationship to functional neurochemistry is unclear. Here, we introduce a novel application of in vivo proton functional magnetic resonance spectroscopy (
MeSH term(s)	Adult ; Association Learning/physiology ; Female ; Glutamic Acid/metabolism ; Hippocampus/metabolism ; Humans ; Male ; Mental Recall/physiology ; Proton Magnetic Resonance Spectroscopy ; Young Adult
Chemical Substances	Glutamic Acid (3KX376GY7L)
Language	English
Publishing date	2017-03-29
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	1147767-2
ISSN	1095-9572 ; 1053-8119
ISSN (online)	1095-9572
ISSN	1053-8119
DOI	10.1016/j.neuroimage.2017.03.051
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Article ; Online: Brain network dysfunction in youth with obsessive-compulsive disorder induced by simple uni-manual behavior: The role of the dorsal anterior cingulate cortex.

Friedman, Amy L / Burgess, Ashley / Ramaseshan, Karthik / Easter, Phil / Khatib, Dalal / Chowdury, Asadur / Arnold, Paul D / Hanna, Gregory L / Rosenberg, David R / Diwadkar, Vaibhav A

Psychiatry research. Neuroimaging

2016 Volume 260, Page(s) 6–15

Abstract: In an effort to elucidate differences in functioning brain networks between youth with obsessive-compulsive disorder and controls, we used fMRI signals to analyze brain network interactions of the dorsal anterior cingulate cortex (dACC) during visually ... ...

Abstract	In an effort to elucidate differences in functioning brain networks between youth with obsessive-compulsive disorder and controls, we used fMRI signals to analyze brain network interactions of the dorsal anterior cingulate cortex (dACC) during visually coordinated motor responses. Subjects made a uni-manual response to briefly presented probes, at periodic (allowing participants to maintain a "motor set") or random intervals (demanding reactive responses). Network interactions were assessed using psycho-physiological interaction (PPI), a basic model of functional connectivity evaluating modulatory effects of the dACC in the context of each task condition. Across conditions, OCD were characterized by hyper-modulation by the dACC, with loci alternatively observed as both condition-general and condition-specific. Thus, dynamically driven task demands during simple uni-manual motor control induce compensatory network interactions in cortical-thalamic regions in OCD. These findings support previous research in OCD showing compensatory network interactions during complex memory tasks, but establish that these network effects are observed during basic sensorimotor processing. Thus, these patterns of network dysfunction may in fact be independent of the complexity of tasks used to induce brain network activity. Hypothesis-driven approaches coupled with sophisticated network analyses are a highly valuable approach in using fMRI to uncover mechanisms in disorders like OCD.
MeSH term(s)	Adolescent ; Brain Mapping ; Child ; Female ; Gyrus Cinguli/diagnostic imaging ; Gyrus Cinguli/physiopathology ; Humans ; Magnetic Resonance Imaging ; Male ; Memory ; Nerve Net/diagnostic imaging ; Nerve Net/physiopathology ; Obsessive-Compulsive Disorder/diagnostic imaging ; Obsessive-Compulsive Disorder/physiopathology ; Psychomotor Performance/physiology ; Young Adult
Language	English
Publishing date	2016-12-13
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	445361-x
ISSN	1872-7506 ; 1872-7123 ; 0925-4927 ; 0165-1781
ISSN (online)	1872-7506 ; 1872-7123
ISSN	0925-4927 ; 0165-1781
DOI	10.1016/j.pscychresns.2016.12.005
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