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Sarin A, Agarwal A, Dodagoudar C, Baghmar S, Qureshi S, Raj A, Kailey N, Hasthavaram N, Kumar R, Potsangbam L, Bansal R, Bhardwaj S, Rajpurohit S, Vaibhav V, Handoo A, Dadu T, Mittal A, Gupta N, Aggarwal S. 285P Reticulocyte hemoglobin equivalent as an early predictor of iron deficiency anemia in cancer patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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2
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Luna A, Gupta A, Aggarwal S. Comparison of a ketamine-propofol combination and etomidate for anaesthesia induction on haemodynamic parameters in patients undergoing coronary artery bypass grafting. Southern African Journal of Anaesthesia and Analgesia 2022. [DOI: 10.36303/sajaa.2022.28.4.2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Luna
- Department of Anaesthesiology and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital,
India
| | - A Gupta
- Department of Anaesthesiology and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital,
India
| | - S Aggarwal
- Department of Anaesthesiology and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital,
India
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3
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Nayar K, Gupta S, Sanan S, Aggarwal S, Kant G, Nayar K, Sharma H. P-070 Comparison of Microfluidic Sperm Sorting (MFSS) versus Physiological Intracytoplasmic Sperm Injection (PICSI) versus Density Gradient versus Swim Up in high DNA fragmentation index sperm samples. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
To evaluate the effectiveness of using Microfluidic Sperm Sorting (MFSS) over other technique in patient with high DNA fragmentation index (DFI) sperm samples?
Summary answer
Microfluidic is not only correlated with better DNA integrity but also with the better reproductive outcome.
What is known already
DNA damage is unrecognisable in living sperm prior to insemination and an increased sperm DNA fragmentation index has been associated with lower fertilization rates, impaired embryo development and reduced pregnancy rates. Standard semen processing techniques are associated with centrifugation, which may induce reactive oxygen species and DNA damage.
In strategies to minimize sperm DNA fragmentation, Physiological ICSI can relatively reduce sperm DNA fragmentation by 67.9% (Parmegiani et al., 2010) while new technique Microfluidic sperm sorter technique also demonstrate sperm selection with significantly reduced DNA damage
Study design, size, duration
A prospective randomised study was conducted from 1st January 2019 to 1st December 2021. Four hundred patients were randomised by computer generated list and divided into 4 groups. Group A (n = 100) , in which sperm were processed by microfluidic sperm sorter (MFSS) while in group B (n = 100), sperm were selected by Physiological Intracytoplasmic Sperm Injection (PICSI), Group C (n = 100), sperm were processed by density gradient and Group D (n = 100), sperm were processed by swim-up technique.
Participants/materials, setting, methods
The study period included all normozoospermic patients with high DNA fragmentation index (>25%) while oligospermic, asthenozoospermic samples, patients with poor ovarian reserve and advanced age were excluded from the study. All A grade embryos were vitrified and transferred in frozen embryo replacement cycle. All the 3 groups were compared on the basis of fertilisation rate, day 3 grade A embryo development rate, clinical pregnancy rate and miscarriage rate.
Main results and the role of chance
Cycle characteristics (female age, length of stimulation, gonadotrophin dose, number of oocytes and number of transferred embryos) were similar among all 4 groups.
Among 4 groups, There was a statistically significant increase observed in Group A (Microfluidic Sperm Sorting), day 3 grade A embryo development rate (60% vs. 42% vs. 38% vs. 40%, p-0.016) and clinical pregnancy rate (62% vs. 46% vs. 41% vs 43%, p-0.049), while no statistical significant difference observed in fertilisation rate (82% vs. 78% vs. 76% vs. 78%, p-0.80) comparing group B, group C and group D. But significantly higher miscarriage rate (12% vs. 11% vs. 25%, 12%) observed in density gradient (Group C) technique.
Limitations, reasons for caution
Larger randomised control studies are needed to strengthen these results.
Wider implications of the findings
We have demonstrated that sperm sorted by microfluidic helps in selection of sperm with better DNA integrity over Physiological ICSI, Density Gradient and Swim-up techniues. Using it in routine practice can help in reducing the negative effect of reactive oxygen species and thus improve pregnancy rate and live birth rate.
Trial registration number
MCDH/2019/35
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Affiliation(s)
- K.D Nayar
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine , New Delhi, India
| | - S Gupta
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine , New Delhi, India
| | - S Sanan
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine , New Delhi, India
| | - S Aggarwal
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine , New Delhi, India
| | - G Kant
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine , New Delhi, India
| | - K Nayar
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine , New Delhi, India
| | - H Sharma
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine , New Delhi, India
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4
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Sen B, Aggarwal S, Nath R, Sehgal R, Singh R, Agrawal K, Shashidhara AN, Rastogi A, Bajpai M, Pamecha V, Trehanpati N, Ramakrishna G. Secretome of senescent hepatoma cells modulate immune cell fate by macrophage polarization and neutrophil extracellular traps formation. Med Oncol 2022; 39:134. [PMID: 35726030 DOI: 10.1007/s12032-022-01732-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/09/2022] [Indexed: 01/07/2023]
Abstract
Presence of dysfunctional senescent hepatocytes is a hallmark feature of liver cirrhosis which finally culminates in liver cancer. We now report the presence of senescent hepatocytes (p21 and p53 positive) in the vicinity of infiltrated immune cells in hepatocellular carcinoma tissue specimens by immunohistochemistry. Hence, we evaluated in vitro, the relevance of senescent hepatoma cells in altering the fate of monocytes and neutrophils by assaying for macrophage polarization and extracellular trap (NETs) formation, respectively. Premature senescence was induced in hepatoma cells (HepG2 and Huh7 cells) by treating cells with doxorubicin. Senescent hepatoma cells showed strong inflammatory phenotype with induced expression of cytokines (IL1β, IL6, IL8 and IL13) as evaluated by flow cytometry. The senescent secretome from hepatoma cells when incubated with healthy monocytes caused it to differentiate predominantly towards M2 fate (CD80low CD86low CD163high CD206high) when analysed by flow cytometry. This was corroborated by the finding in clinical samples where human hepatocellular carcinoma harbouring senescent hepatocytes showed presence of M2 macrophages, while M1 macrophages were predominant in non-tumorous region. Additionally, the senescent secretome from Huh7 cells enhanced the NETs formation, while HepG2 secretome had an inhibitory effect. In conclusion, the "pro-inflammatory" senescent secretome drives non-inflammatory type M2 macrophage polarization and modulated neutrophil traps which in turn can influence the tumor microenvironment.
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Affiliation(s)
- Bijoya Sen
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India.,Buck Institute for Research on Aging, Novato, CA, USA
| | - Savera Aggarwal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | - Rhisita Nath
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | - Rashi Sehgal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | - Ravinder Singh
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | - Khushboo Agrawal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | | | - Archana Rastogi
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Meenu Bajpai
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Viniyendra Pamecha
- Department of Hepatopancreatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | - Gayatri Ramakrishna
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India.
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5
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Aggarwal S, Trehanpati N, Nagarajan P, Ramakrishna G. The Clock-NAD + -Sirtuin connection in nonalcoholic fatty liver disease. J Cell Physiol 2022; 237:3164-3180. [PMID: 35616339 DOI: 10.1002/jcp.30772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/10/2022]
Abstract
Nonalcoholic or metabolic associated fatty liver disease (NAFLD/MAFLD) is a hepatic reflection of metabolic derangements characterized by excess fat deposition in the hepatocytes. Identifying metabolic regulatory nodes in fatty liver pathology is essential for effective drug targeting. Fatty liver is often associated with circadian rhythm disturbances accompanied with alterations in physical and feeding activities. In this regard, both sirtuins and clock machinery genes have emerged as critical metabolic regulators in maintaining liver homeostasis. Knockouts of either sirtuins or clock genes result in obesity associated with the fatty liver phenotype. Sirtuins (SIRT1-SIRT7) are a highly conserved family of nicotinamide adenine dinucleotide (NAD+)-dependent deacetylases, protecting cells from metabolic stress by deacetylating vital proteins associated with lipid metabolism. Circadian rhythm is orchestrated by oscillations in expression of master regulators (BMAL1 and CLOCK), which in turn regulate rhythmic expression of clock-controlled genes involved in lipid metabolism. The circadian metabolite, NAD+ , serves as a crucial link connecting clock genes to sirtuin activity. This is because, NAMPT which is a rate limiting enzyme in NAD+ biosynthesis is transcriptionally regulated by the clock genes and NAD+ in turn is a cofactor regulating the deacetylation activity of sirtuins. Intriguingly, on one hand the core circadian clock regulates the sirtuin activity and on the other hand the activated sirtuins regulate the acetylation status of clock proteins thereby affecting their transcriptional functions. Thus, the Clock-NAD+-Sirtuin connection represents a novel "feedback loop" circuit that regulates the metabolic machinery. The current review underpins the importance of NAD+ on the sirtuin and clock connection in preventing fatty liver disorder.
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Affiliation(s)
- Savera Aggarwal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Perumal Nagarajan
- Department of Experimental Animal Facility, National Institute of Immunology, New Delhi, India
| | - Gayatri Ramakrishna
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
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6
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Williamson T, Drogos L, Arena R, Aggarwal S, Campbell T, Rouleau C. SEX DIFFERENCES IN THE IMPACT OF SYMPTOMS OF ANXIETY AND DEPRESSION ON CARDIAC REHABILITATION PARTICIPATION AND OUTCOMES. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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7
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Chan E, Chirico D, Arena R, Feng Y, Liang Z, Ahmed SB, Colbert J, Aggarwal S. Sex-based differences in program completion and clinical outcomes in patients following outpatient cardiac rehabilitation. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Females have greater reduction in mortality compared to males, following completion of a cardiac rehabilitation (CR) program, yet they continue to have lower referral rates and program completion. Since 1996, a local rehabilitation program has been the main provider of CR in our health zone. A standardized rapid referral program was implemented in 2008 to improve referral rates of hospitalized patients. Since then, the relationship between sex and CR completion is unknown.
Purpose
To evaluate the relationship between sex and CR completion and to evaluate the association between CR completion and clinical outcomes, stratified by sex.
Methods: We included consecutive patients who were referred to CR and who
1) were hospitalized for an acute coronary syndrome (ACS) or stable angina between 2008 and 2016; 2) had angiographic evidence of at least one-vessel coronary disease; and 3) had revascularization with percutaneous intervention, coronary artery bypass or medical management. The outcomes of interest were CR completion, anxiety and depression categories, exercise capacity, death, and need for revascularization. Logistics regression models were used to determine the association between sex and CR completion. The association between sex, CR completion, and the outcomes of interest were assessed using multivariable cox proportional hazards models.
Results
A total of 726 females and 2645 males were included in this study. The rate of CR completion was lower in females compared to males (64.6% vs 69.98%, p = 0.006). Following adjustment for baseline characteristics, female sex independently predicted lower rates of CR completion, OR 0.81 (95%CI 0.67-0.97).
Both sexes displayed improvements in peak metabolic equivalents (METs) achieved during exercise testing (W: initial 5.99 ± 1.93; 12-week 7.22 ± 1.92; M: initial 7.62 ± 2.04; 12-week 8.81 ± 1.93, p = 0.001). Amongst CR completers, one-year mortality was similar between sex (W: 1.84% vs M: 3.27%, p = 0.118), as was revascularization (W: 14.29% vs M: 11.97%, p = 0.193), however both sexes had higher one-year mortality in CR non-completers.
Conclusion
Despite a standardized CR referral protocol, a sex-difference in CR completion remains. In CR completers, one-year mortality and revascularization was similar in both sexes, however mortality was higher in CR non-completers. Our study suggests that addressing the causes of female CR non-completion following ACS or stable angina may improve outcomes.
Outcomes by CR Completion and Sex All NC (n = 1051) W-NC (n = 257) M-NC (n = 794) p-value All C (n = 2320) W-C (n = 469) M-C (n = 1851) p-value Revascularization-1 year (%) 146 (14.94) 28 (11.72) 118 (15.59) 0.107 267 (12.44) 62 (14.29) 205 (11.97) 0.193 Death-1 year (%) 67 (6.86) 19 (7.95) 48 (6.50) 0.442 64 (2.98) 8 (1.84) 56 (3.27) 0.118 W = Women;M = Men;NC = Non-Completers;C = Completers
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Affiliation(s)
- E Chan
- Libin Cardiovascular Institute, Calgary, Canada
| | - D Chirico
- TotalCardiologyTM Rehabilitation, Calgary, Canada
| | - R Arena
- University of Illinois at Chicago, Department of Physical Therapy, Chicago, United States of America
| | - Y Feng
- University of Calgary, Department of Medicine, Cumming School of Medicine, Calgary, Canada
| | - Z Liang
- University of Calgary, Department of Medicine, Cumming School of Medicine, Calgary, Canada
| | - SB Ahmed
- Libin Cardiovascular Institute, Calgary, Canada
| | - J Colbert
- Libin Cardiovascular Institute, Calgary, Canada
| | - S Aggarwal
- Libin Cardiovascular Institute, Calgary, Canada
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8
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Aggarwal S, Hakovirta M. Supercritical carbon dioxide drying of municipal sewage sludge - Novel waste-to-energy valorization pathway. J Environ Manage 2021; 285:112148. [PMID: 33588163 DOI: 10.1016/j.jenvman.2021.112148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
Eighty percent of the world's wastewater is discharged back into nature without reuse and further treatment and solid byproduct of wastewater is either spread on land or landfilled. The valorization of municipal sewage sludge for energy use is a major opportunity for sustainable energy applications. This includes effective dewatering and drying of the sludge in addition to producing biogas during the anaerobic digestion. Supercritical CO 2 extraction process was investigated for the purpose of drying municipal sewage sludge. Remarkably our results showed that after sCO2 processing the higher heating value (HHV) of sludge at wet basis moisture content of 52% was 14 MJ/kg and thus higher than the HHV of brown coal with similar moisture level (12 MJ/kg). Our research also shows that under specific conditions sCO2 extraction reduces the moisture content of the municipal sludge from 89% to 53% in 15 min. Although, more research is needed this dewatering process could be considerably less energy intensive than conventional thermal and other drying processes. Another benefit is extraction of micro pollutants by sCO2 treatment and thus making the dried sludge more useable in energy applications as per regulations. Our results show an alternative and novel pathway for highly effective dewatering and drying of municipal and other types of sludge.
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Affiliation(s)
- S Aggarwal
- Department of Forest Biomaterials, North Carolina State University, Raleigh, USA
| | - M Hakovirta
- Department of Forest Biomaterials, North Carolina State University, Raleigh, USA.
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9
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Conradson H, Williamson T, Aggarwal S, Arena R, King-Shier K, Hauer T, Austford L, Wilton S, Campbell T, Chirico D. Women’s Improvements In Cardiorespiratory Fitness Following Cardiac Rehabilitation Differs By Body Mass Index Category. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Rohatgi N, Munshi A, Bajpai P, Singh M, Sahai S, Ahmad M, Singh K, Singh H, Parikh PM, Aggarwal S. Practical consensus recommendations on Her2 +ve breast cancer with solitary brain mets. South Asian J Cancer 2020; 7:118-122. [PMID: 29721477 PMCID: PMC5909288 DOI: 10.4103/sajc.sajc_116_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Breast cancer is a common cause of brain metastases, with metastases occurring in at least 10-16% of patients. Longer survival of patients with metastatic breast cancer and the use of better imaging techniques are associated with an increased incidence of brain metastases. Current therapies include surgery, whole-brain radiation therapy, stereotactic radiosurgery, chemotherapy and targeted therapies. However, the timing and appropriate use of these therapies is controversial and careful patient selection by using available prognostic tools is extremely important. Expert oncologist discussed on the mode of treatment to extend the OS and improve the quality of life ofHER2-positivebreast cancer patients with Solitary brain metastases. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- Nitesh Rohatgi
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - A Munshi
- Department of Radiation Oncology, Fortis Hospital, Gurugram, Haryana, India
| | - P Bajpai
- Department of Medical Oncology, Manipal Super Specialty Hospital, New Delhi, India
| | - M Singh
- Department of Medical Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India
| | - S Sahai
- Department of Radiation Oncology, Fortis Hospital, Gurugram, Haryana, India
| | - M Ahmad
- Department of Radiation Oncology, Jolly Grant Himalayan Institute, Dehradoon, Uttarakhand, India
| | - K Singh
- Department of Radiation Oncology, MAMS, New Delhi, India
| | - H Singh
- Department of Radiaton Oncology, Action Balajee Cancer Center, New Delhi, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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11
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Sarin R, Somsekhar SP, Kumar R, Pawan G, Sumeet J, Pramoj J, Vaishali Z, Firoz P, Parikh PM, Aggarwal S, Koul R. Practical consensus recommendations for tumor margins and breast conservative surgery. South Asian J Cancer 2020; 7:72-78. [PMID: 29721467 PMCID: PMC5909299 DOI: 10.4103/sajc.sajc_105_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
My suggestion: There is no difference in survival of breast cancer patients treated with either mastectomy or with breast conservation therapy combined with external beam radiotherapy. A positive margin (s) is an important factor contributing to the increased risk of local recurrence. However, in published literature, there is a lack of consensus on the definition of acceptable margin (s). As a result decision process about need for re-excision after positive margins remains uncrear.
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Affiliation(s)
- R Sarin
- Department of Surgical Oncology, Apollo Indraprastha Hospital, New Delhi, India
| | - S P Somsekhar
- Department of Surgical Oncology, Manipal Hospital, Bengaluru, Karnataka, India
| | - R Kumar
- Department of Surgical Oncology, Rajiv Gandhi Cancer Hospital, New Delhi, India
| | - Gupta Pawan
- Department of Surgical Oncology, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - Jain Sumeet
- Department of Surgical Oncology, Fortis Hospital, Mohali, Punjab, India
| | - Jindal Pramoj
- Department of Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Zamre Vaishali
- Department of Surgical Oncology, Max Hospital, New Delhi, India
| | - Pasha Firoz
- Department of Surgical Oncology, Apollo Indraprastha Hospital, New Delhi, India
| | - P M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - R Koul
- Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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12
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Basade M, Singhal M, Rathi AK, Nandi M, Minhas S, Goswami C, Shinde S, Parikh PM, Aggarwal S. Practical consensus recommendations regarding the management of HER2 neu positive metastatic breast cancer. South Asian J Cancer 2020; 7:146-150. [PMID: 29721483 PMCID: PMC5909294 DOI: 10.4103/sajc.sajc_123_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Metastatic breast cancer (MBC) is cancer that has spread from the breast to another part of the body or has come back in another distant location. Treatment options for MBC depend on several factors, including where the cancer has spread, the patient's overall health, and the levels of hormone receptors and HER2 in the tumour. Over-expression of HER2 is generally considered to be a negative prognostic feature because it accompanies an increase in breast cancer mortality. However, the development of agents that specifically target HER2 has improved the management of patients with these tumours.[7],[8],[9],[10] This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of these agents and the management of HER2 positive MBC for the benefit of community oncologists.
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Affiliation(s)
- M Basade
- Department of Medical Oncology, Saifee Hospital, Mumbai, Maharashtra, India
| | - M Singhal
- Department of Medical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - A K Rathi
- Department of Radiation Oncology, MAMC, New Delhi, India
| | - M Nandi
- Department of Medical Oncology, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - S Minhas
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - C Goswami
- Department of Medical Oncology, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - S Shinde
- Department of Radiation Oncology, Medica Superspecialty Hospital, Kolkata, West Bengal, India
| | - P M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Radiation Oncology, Medica Superspecialty Hospital, Kolkata, West Bengal, India
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13
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Bajpai J, Majumdar A, Satwik R, Rohatgi N, Jain V, Gupta D, Agarwal R, Mittal S, Verma SK, Parikh PM, Aggarwal S. Practical consensus recommendations on fertility preservation in patients with breast cancer. South Asian J Cancer 2020; 7:110-114. [PMID: 29721475 PMCID: PMC5909286 DOI: 10.4103/sajc.sajc_113_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Expert oncologists along with reproductive medicine specialists discuss fertility preservation options in this chapter since fertility preservation is becoming a priority for young women with breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Majumdar
- Center of IVF and Human Reproduction, Sir Gangaram Hospital, New Delhi, India
| | - R Satwik
- Center of IVF and Human Reproduction, Sir Gangaram Hospital, New Delhi, India
| | - N Rohatgi
- Department of Medical Oncology, Max Saket Hospital, New Delhi, India
| | - V Jain
- Department of Gynaecology and Obstretics, Ludhiana Medicity Hospital, Ludhiana, Punjab, India
| | - D Gupta
- Department of Medical Oncology, Dharamshila Cancer Hospital, New Delhi, India
| | - R Agarwal
- Department of Surgical Oncology, Medanta Hospital, Gurugram, Haryana, India
| | - S Mittal
- Department of Medical Oncology, Action Balajee Cancer Center, New Delhi, India
| | - S K Verma
- Department of Medical Oncology, Jolly Grant Himalayan Institute, Dehradoon, Uttarakhand, India
| | - P M Parikh
- Department of Oncology, Shalby Cancer and Research Institutes, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Gangaram Hospital, New Delhi, India
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Kabra V, Aggarwal R, Vardhan S, Singh M, Khandelwal R, Jain S, Sahani S, Saini S, Deo N, Kaul R, Parikh PM, Aggarwal S. Practical consensus recommendations regarding the management of sentinel lymph node issues in early breast cancer. South Asian J Cancer 2020; 7:132-136. [PMID: 29721480 PMCID: PMC5909291 DOI: 10.4103/sajc.sajc_120_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Axillary lymph node involvement is a very important poor prognostic factor in the clinical staging and management of breast cancer patients. Traditionally, axillary lymph node dissection (ALND) has been used for determining the status of the axillary lymph nodes. More recently the sentinel lymph node biopsy (SLNB) procedure has gained wider acceptance as the standard of care, having the advantage of being less invasivewhile providing good accuracy. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of the two different procedures and other issues in patients with early breast cancer for the benefit of community oncologists.
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Affiliation(s)
- Vedant Kabra
- Department of Surgical Oncology, Manipal Super Specialty Hospital, New Delhi, India
| | - R Aggarwal
- Department of Surgical Oncology, Medanta Hospital, Gurugram, Haryana, India
| | - S Vardhan
- Department of Surgical Oncology, Mool Chand Hospital, New Delhi, India
| | - M Singh
- Department of Surgical Oncology, Fortis Hospital, New Delhi, India
| | - R Khandelwal
- Department of Surgical Oncology, W Pratiksha Hospital, Gurugram, Haryana, India
| | - S Jain
- Department of Surgical Oncology, DMCH Cancer Care Centre, Ludhiana, Punjab, India
| | - S Sahani
- Department of Surgical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - S Saini
- Department of Surgical Oncology, Jolly Grant Himalayan Institute, Dehradun, Uttarakhand, India
| | - N Deo
- Department of Surgical Oncology, Amit Jaggi Memorial Hospital, Agra, Uttar Pradesh, India
| | - R Kaul
- Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - P M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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15
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Somsekhar SP, Geeta K, Jain R, Nayyer R, Halder S, Malik VK, Parikh P, Aggarwal S, Koul R. Practical consensus recommendations regarding role of mastectomy in metastatic breast cancer. South Asian J Cancer 2020; 7:79-82. [PMID: 29721468 PMCID: PMC5909300 DOI: 10.4103/sajc.sajc_106_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Whether to recommend mastectomy in metastatic disease or not has been a matter of debate. Is local therapy, such as mastectomy, of any benefit in advanced breast cancer is the main question. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- S P Somsekhar
- Department of Surgical Oncology, Manipal Hospital, Bengaluru, Karnataka, India
| | - K Geeta
- Department of Surgical Oncology, Max Hospital, New Delhi, India
| | - R Jain
- Department of Surgical Oncology, Action Cancer Hospital, New Delhi, India
| | - R Nayyer
- Department of Surgical Oncology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - S Halder
- Department of Radiation Oncology, BLK Super Specialty Hospital, New Delhi, India
| | - V K Malik
- Department of Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Purvish Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - R Koul
- Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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16
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Singh D, Saini G, Koul R, Gupta V, Abrol D, De S, Kulshrestha P, Hukku SN, Lakshmi SJ, Parikh PM, Aggarwal S. Practical consensus recommendations regarding role of postmastectomy radiation therapy. South Asian J Cancer 2020; 7:87-90. [PMID: 29721470 PMCID: PMC5909302 DOI: 10.4103/sajc.sajc_108_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The use of radiation therapy after mastectomy (PMRT) has been limited to those patients who are at significant risk of cancer recurring in the chest wall or in the nodal basins. The use of PMRT has been widely accepted for patients with four or more positive lymph nodes,[1],[2] but there is still controversy regarding the value of PMRT for those with one to three positive nodes. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- D Singh
- Department of Radiation Oncology, Max Hospital, Noida, Uttar Pradesh, India
| | - G Saini
- Department of Radiation Oncology, Max Hospital, Noida, Uttar Pradesh, India
| | - R Koul
- Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - V Gupta
- Department of Surgical Oncology, BLK Super Specialty Hospital, New Delhi, India
| | - D Abrol
- Department or Radiation Oncology, Jammu Medical College, Jammu, Jammu and Kashmir, India
| | - S De
- Department of Radiation Oncology, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - P Kulshrestha
- Department of Radiation Oncology, Metro Hospital and Cancer Institute, New Delhi, India
| | - S N Hukku
- Department of Radiation Oncology, BLK Super Specialty Hospital, New Delhi, India
| | - S J Lakshmi
- Department of Radiation Oncology, Artemis Hospital, Gurugram, Haryana, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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17
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Bhattacharyya GS, Walia M, Nandi M, Murli A, Salim S, Rajpurohit S, Shinde S, Aggarwal S, Parikh PM. Practical consensus recommendations for neo-adjuvant chemotherapy in triple negative breast cancer. South Asian J Cancer 2020; 7:156-158. [PMID: 29721485 PMCID: PMC5909296 DOI: 10.4103/sajc.sajc_126_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This manuscript provides a practical and easy to use consensus recommendation to community oncologists on how to use neoadjuvant chemotherapy in triple negative breast cancer patients.
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Affiliation(s)
- G S Bhattacharyya
- Department of Medical Oncology, Fortis Hospital, Kolkata, West Bengal, India
| | - M Walia
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - M Nandi
- Department of Medical Oncology, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - A Murli
- Department of Medical Oncology, Sarvodaya Hospital, Faridabad, Haryana, India
| | - S Salim
- Department of Oncology, Hakim Sanaullah Cancer Center, Sopore, Jammu and Kashmir, India
| | - S Rajpurohit
- Department of Medical Oncology, RGCI, New Delhi, India
| | - S Shinde
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - P M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
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18
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Sekhon JS, Naik N, Bansal P, Bansal I, Dhull A, Goel A, Ramachandran CS, Shinde S, Aggarwal S, Parikh PM. Practical consensus recommendations for gestational breast cancer. South Asian J Cancer 2020; 7:115-117. [PMID: 29721476 PMCID: PMC5909287 DOI: 10.4103/sajc.sajc_115_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This manuscript provides a practical and easy to use consensus recommendation to community oncologists on how to manage gestational breast cancer.
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Affiliation(s)
- J S Sekhon
- Department of Medical Oncology, Fortis Hospital, Ludhiana, Punjab, India
| | - N Naik
- Department of Surgical Oncology, Dharamshila Cancer Hospital, New Delhi, India
| | - P Bansal
- Department of Medical Oncology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - I Bansal
- Department of Radiation Oncology, Artemis Hospital, Gurugram, Haryana, India
| | - A Dhull
- Department of Radiation Oncology, PGIMS, Rohtak, Haryana, India
| | - A Goel
- Department of Surgical Oncology, Max Hospital, New Delhi, India
| | | | - S Shinde
- Department of Medical Oncology, NCR, New Delhi, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - P M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
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Bharatuar A, Kar M, Khatri S, Goswami V, Sarin R, Dawood S, Iyenger R, Ganvir M, Parikh PM, Aggarwal S, Talwar V. Practical consensus recommendaton for adjuvant bone-modifying agents in breast cancer. South Asian J Cancer 2020; 7:91-95. [PMID: 29721471 PMCID: PMC5909303 DOI: 10.4103/sajc.sajc_109_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Bone-modifying therapy is a primary research interest in breast cancer. Several features contribute to the importance of the bone environment in the management of breast cancer. Firstly, bone metastases represent the most common site of breast cancer metastases and secondly, the emergence of cancer treatment-induced bone loss (CTIBL) among breast cancer survivors and patients is of increasing concern. In the adjuvant setting, bisphosphonates can be given to prevent and treat tumor therapy-induced bone loss in premenopausal and postmenopausal women and, owing to their beneficial effect on bone turnover, have also been evaluated for prevention of bone metastases occurrence. Expert oncologists discusses on the update on the approaches of Bone-modifying Agents and its treatment options. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- A Bharatuar
- Department of Medical Oncology, Patel Hospital, Jallandhar, Punjab, India
| | - M Kar
- Department of Medical Oncology, Peerless Hospital, Kolkata, West Bengal, India
| | - S Khatri
- Department of Medical Oncology, SMH Curie Cancer Center, New Delhi, India
| | - V Goswami
- Department of Medical Oncology, Max Hospital, Noida, Uttar Pradesh, India
| | - R Sarin
- Department of Surgical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - S Dawood
- Department of Medical Oncology, Dubai Health Authority, Dubai, UAE
| | - R Iyenger
- Department of Medical Oncology, Mazumdar Shaw Cancer Center, Bengaluru, Karnataka, India
| | - M Ganvir
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vineet Talwar
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India
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20
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Singhal M, Sahoo TP, Aggarwal S, Singhvi A, Kaushal V, Rajpurohit S, Parthasarthi KM, Vora A, Ganvir M, Gupta S, Parikh PM. Practical consensus recommendations on ovarian suppression in early breast cancer (adjuvant). South Asian J Cancer 2020; 7:151-155. [PMID: 29721484 PMCID: PMC5909295 DOI: 10.4103/sajc.sajc_125_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Substantial survival benefits exist for patients with early-stage breast cancer who undergo treatment with single-modality ovarian suppression, but its value is uncertain. Expert oncologist discussed to determine whether additional benefits exist with ovarian suppression plus multiple adjuvant therapy which provides a new treatment option that reduces the risk of recurrence in early breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- M Singhal
- Department of Medical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - T P Sahoo
- Department of Medical Oncology, Chirayu Cancer Hospital, Bhopal, Madhya Pradesh, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - A Singhvi
- Department of Medical Oncology, Choitram Hospital, Indore, Madhya Pradesh, India
| | - V Kaushal
- Department of Radiation Oncology, RCC, Rohtak, Haryana, India
| | - S Rajpurohit
- Department of Medical Oncology, RGCI, New Delhi, India
| | - K M Parthasarthi
- Department of Medical Oncology, Dharamshila Cancer Hospital, New Delhi, India
| | - A Vora
- Department of Medical Oncology, Hope Clinic, New Delhi, India
| | - M Ganvir
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - S Gupta
- Department of Medical Oncology, Tata Memorial Center, Mumbai, Maharashtra, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
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21
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Aggarwal S, Vaid A, Ramesh A, Parikh PM, Purohit S, Avasthi B, Gupta S, Ranjan S, Kaushal V, Salim S, Singh R, Minhas S, Doval D. Practical consensus recommendations on management of HR + ve early breast cancer with specific reference to genomic profiling. South Asian J Cancer 2020; 7:96-101. [PMID: 29721472 PMCID: PMC5909304 DOI: 10.4103/sajc.sajc_110_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Breast cancer is a heterogeneous disease and patients are managed clinically based on ER, PR, HER2 expression, and key risk factors. The use of gene expression assays for early stage disease is already common practice. These tests have found a place in risk stratifying the heterogeneous group of stage I–II breast cancers for recurrence, for predicting chemotherapy response, and for predicting breast cancer-related mortality. Most guidelines for hormone receptor (HR)–positive early breast cancer recommend addition of adjuvant chemotherapy for most women, leading to overtreatment, which causes considerable morbidity and cost. Expert oncologist discussed about strategies of gene expression assays and aid in chemotherapy recommendations for treatment of HR + ve EBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - A Vaid
- Department of Medical Oncology, Medanata Hospital, Gurugram, Haryana, India
| | - A Ramesh
- Department of Medical Oncology, HCG Cancer Center, Chennai, Tamil Nadu, India.,Department of Medical Oncology, SMH Curie Cancer Center, New Delhi, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Purohit
- Department of Medical Oncology, Artemis Hospital, Gurugram, Haryana, India
| | - B Avasthi
- Department or Radiation Oncology, Fortis Hospital, New Delhi, India
| | - S Gupta
- Department of Medical Oncology, Sarvodaya Hospital, Faridabad, Haryana, India
| | - S Ranjan
- Department of Medicine, INHS Sanjivani, Kochi, Kerala, India
| | - V Kaushal
- Department of Radiation Oncology, RCC, Rohtak, Haryana, India
| | - S Salim
- Department of Oncology, Hakim Sanaullah Cancer Center, Baramulla, Jammu and Kashmir, India
| | - R Singh
- Department of Medical Oncology, Army Hospital R and R, New Delhi, India
| | - S Minhas
- Department of Medical Oncology, Medanata Hospital, Gurugram, Haryana, India
| | - D Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India
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22
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Babu G, Goel A, Agarwal S, Gupta S, Kumar P, Smruti BK, Goel V, Sarangi R, Gairola M, Aggarwal S, Parikh PM. Practical consensus recommendations regarding the management of hormone receptor positive early breast cancer in elderly women. South Asian J Cancer 2020; 7:123-126. [PMID: 29721478 PMCID: PMC5909289 DOI: 10.4103/sajc.sajc_117_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Breast cancer is a leading cause of death among women, and its incidence increases with age. Currently the treatment of breast cancer in older patients is almost identical to their younger counterparts. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists regarding the management of early breast cancer specifically in elderly women.
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Affiliation(s)
- Govind Babu
- Department of Medical Oncology, KMIO, Bengaluru, Karnataka, India
| | - A Goel
- Department of Surgical Oncology, Max Hospital, New Delhi, India
| | - S Agarwal
- Department of Radiation Oncology, Max Hospital, New Delhi, India
| | - S Gupta
- Department of Medical Oncology, Sarvodaya Hospital, Faridabad, Haryana, India
| | - P Kumar
- Department of Radiation Oncology, Ram Murti Medical College, Bareilly, Uttar Pradesh, India
| | - B K Smruti
- Department of Medical Oncology, Bombay Hospital, Mumbai, Maharashtra, India
| | - V Goel
- Department of Radiation Oncology, Max Hospital, New Delhi, India
| | - R Sarangi
- Department of Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - M Gairola
- Department of Radiation Oncology, RGCI, New Delhi, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
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23
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Rajappa S, Bajpai J, Basade M, Ganvir M, Goswami C, Murali A, Rathi AK, Kaushal V, Jain S, Parikh PM, Aggarwal S. Practical consensus recommendations regarding the use of hormonal therapy in metastatic breast cancer. South Asian J Cancer 2020; 7:137-141. [PMID: 29721481 PMCID: PMC5909292 DOI: 10.4103/sajc.sajc_121_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Metastatic breast cancer (MBC) is cancer that has spread from the breast to another part of the body or has come back in another distant location. Treatment options for MBC depend on several factors. One of these factors is the levels of hormone receptors (HRs) in the tumor. Cancers with high levels of HRs, called HR-positive, use the hormones estrogen and progesterone to grow and spread. Hormonal therapy is a type of treatment specifically for HR-positive breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of hormonal therapy and the management of HR-positive MBC for the benefit of community oncologists.
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Affiliation(s)
- Senthil Rajappa
- Department of Medical Oncology, IACH, Hyderabad, Telangana, India
| | - J Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - M Basade
- Department of Medical Oncology, Saifee Hospital, Mumbai, Maharashtra, India
| | - M Ganvir
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - C Goswami
- Department of Radiation Oncology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - A Murali
- Department of Medical Oncology, Sarvodaya Hospital, Faridabad, India
| | - A K Rathi
- Department of Medical Oncology, Sarvodaya Hospital, Faridabad, India
| | - V Kaushal
- Department of Radiation Oncology, MAMC, New Delhi, India
| | - S Jain
- Department of Radiation Oncology, RCC, Rohtak, Haryana, India
| | - Purvish M Parikh
- Department of Surgical Oncology, Ludhiana Medicity Hospital, Ludhinana, Punjab, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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Gupta S, Singh M, Vora A, Babu G, Walia M, Nautial V, Saha R, Smruti BK, Sharma JB, Koul R, Parikh PM, Aggarwal S. Practical consensus recommendations on duration of adjuvant hormonal therapy in breast cancer. South Asian J Cancer 2020; 7:142-145. [PMID: 29721482 PMCID: PMC5909293 DOI: 10.4103/sajc.sajc_122_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Optimization of adjuvant systemic therapy in women with early-stage hormone receptor-positive breast cancer includes the consideration of chemotherapy and duration of hormone therapy. Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). Expert oncologist discussed on the duration of adjuvant hormonal therapy for improvement of OS and quality of life of breast cancer patients by providing reduction in recurrence and mortality. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- S Gupta
- Department of Medical Oncology, Tata Memorial Center, Mumbai, Maharashtra, India
| | - M Singh
- Department of Medical Oncology, Mahaveer Cancer Sansthan, Patna, Bihar, India
| | - Amish Vora
- Department of Medical Oncology, Hope Clinic, New Delhi, India
| | - G Babu
- Department of Medical Oncology, KMIO, Bengaluru, Karnataka, India
| | - M Walia
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - V Nautial
- Department of Medical Oncology, Jolly Grant Himalayan Institute, Dehradoon, Uttarakhand, India
| | - R Saha
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - B K Smruti
- Department of Medical Oncology, Bombay Hospital, Mumbai, Maharashtra, India
| | - J B Sharma
- Department of Medical Oncology, Action Balajee Cancer Hospital, New Delhi, India
| | - R Koul
- Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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Aggarwal S, Calisti G. A case of respiratory co-infection with Aspergillus spp. and an uncommon non-tuberculosis mycobacterium, Mycobacterium szulgai. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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26
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Vincent V, Thakkar H, Shukla S, Aggarwal S, Singh A. Modulation of cholesterol efflux capacity (CEC) of high density lipoprotein (HDL) with bariatric surgery. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Mitra S, Jajodia A, Koyyala V, Mahawar V, Dewan A, Aggarwal S, Wahi IS, Barik S, Dobriyal K, Mukhee J, Khurana H, Tripathy R, Rao A, Chaturvedi A. PH-0718: Quantitative MRI in prognosticating clinical outcomes in carcinoma cervix treated with Radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00740-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Aggarwal S, Wang A, Topaloglu O, Diamond M. Quality of Life Outcomes in Treatments for Symptomatic Uterine Fibroids: A Systematic Literature Review. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mitra S, Dewan A, Aggarwal S, Singh Wahi I, Barik S, Dobriyal K, Mukhee J, Khurana H. PO-1146: Evaluation of Dose to pelvic lymphnodes in CTbased High DoseRate Brachytherapy in Carcinoma Cervix. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mitra S, Barik S, Suryavanshi M, Dewan A, Aggarwal S, Kaur I, Kumar D, Khurana H, Vishwakarna G, Dobriyal K, Sharief MI, Umesh P, Jwala M, Mishra M. To Study The Role Of Pre-treatment MicroRNA Expression As A Predictor Of Response To Chemoradiation In Locally Advanced Carcinoma Cervix. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mullen L, Shaw M, Meah M, Elamin A, Aggarwal S, Shahzad A, Khand A. Predictors of major bleeding following an acute coronary event: insights from a national study of 5,116 consecutive patients in clinical practice. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Major bleeding after acute coronary syndrome (ACS) predicts a poor outcome. Although predictors of major bleeding following ACS have been validated, these have been mostly in clinical trial populations and few contemporary analyses have been undertaken in clinical practise
Methods
Major bleeding was assessed in a national study of ACS and antiplatelet choice. A total of 5116 consecutive patients [Clopidogrel (n 2,491, 2011–13) and Ticagrelor (n 2,625, 2013–16)] were enrolled in 5 UK hospitals. Clinical outcomes were identified from a national coding database (n=59.5 million) with bleeding events tracked to 11 health care facilities. Bleed severity was independently adjudicated by 2 consultant cardiologists, blinded to antiplatelet, sequence and year. Bleeding events were categorised using BARC 3–5 and PLATO criteria. A logistic regression analysis was used to define independent predictors of bleeding.
Results
The median age was 68 (IQR57–78, 30.5%>75), 34% were female. 39% underwent PCI and 13% coronary artery bypass surgery. Clinical outcome data was 100% complete. 1-year mortality was 12.9%. Of 1193 icd10 codes for bleeding or anaemia 165 (3.2%) and 193 (3.8%) patients were adjudicated to have suffered a BARC 3–5 and PLATO major bleeding respectively. Independent predictors common between PLATO major and BARC 3–5 bleeding, in the year following ACS, were CRUSADE score >40 (OR 1.63, CI 1.1–2.4, p=0.008) moderate left ventricular systolic dysfunction (OR, 1.65, CI: 1.2–2.4, p=0.006), age (OR per year increase in age 1.03, CI 1.02–1.05, p<0.001) and subsequent coronary artery bypass surgery (OR 2.6, CI 1.8–3.8, p<0.001)
Conclusion
In a broad real-world population of ACS, CRUSADE score >40, incorporating simple clinical and laboratory criteria, remained an independent predictor of major bleeding using 2 internationally recognised bleed criteria
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Liverpool university hospitals; North-West Educational Cardiac Group
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Affiliation(s)
- L Mullen
- Aintree University Hospital, Liverpool, United Kingdom
| | - M Shaw
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - M Meah
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - A Elamin
- Aintree University Hospital, Liverpool, United Kingdom
| | - S Aggarwal
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - A Shahzad
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - A Khand
- University of Liverpool, Liverpool, United Kingdom
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32
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Bedi O, Aggarwal S, Trehanpati N, Ramakrishna G, Grewal AS, Krishan P. In vitro targeted screening and molecular docking of stilbene, quinones, and flavonoid on 3T3-L1 pre-adipocytes for anti-adipogenic actions. Naunyn Schmiedebergs Arch Pharmacol 2020; 393:2093-2106. [PMID: 32588069 DOI: 10.1007/s00210-020-01919-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 06/03/2020] [Indexed: 12/17/2022]
Abstract
In metabolic disorders like obesity, NAFLD and T2DM, adipocytes are dysfunctional. Hence, pharmacological interventions have importance in preventing differentiation of adipocytes and stimulating lipid uptake. We, therefore, investigated the effects of arbutin (ARB), purpurin (PUR), quercetin (QR), and pterostilbene (PTS) on adipocyte differentiation and lipid uptake using 3T3-L1 adipocytes. Further, in silico docking studies were achieved to investigate interactions of ARB, PUR, QR, and PTS with beta-ketoacyl reductase (KR) and thioesterase (TE) domains of fatty acid synthase (FAS) enzyme. Mature 3T3-L1 adipocytes were used to investigate the anti-adipogenic effect of selected pharmacological agents by Oil Red O staining and in vitro fatty acid uptake analysis. Molecular docking studies were performed to predict the binding interactions of selected compounds with KR and TE domains of FAS enzyme. All these agents significantly decrease the adipocyte differentiation and showed the stimulatory effect on fatty acid uptake in 3T3-L1 adipocytes. However, PTS and PUR proved to be anti-adipogenic, whereas ARB and QR showed significant effect on fatty acid uptake, compared to others. Similarly, all the compounds displayed significant binding interactions with KR and TE domains of FAS enzyme, supporting the results of in vitro studies. Graphical abstract.
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Affiliation(s)
- Onkar Bedi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India
| | - Savera Aggarwal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gayatri Ramakrishna
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ajmer Singh Grewal
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India
| | - Pawan Krishan
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India.
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Mitra S, Dewan A, Aggarwal S, Singh Wahi I, Barik S, Dobriyal K, Mukhee J, Dewan A. PO-1670: Dosimetric and Volumetric impact of Intensity Modulated Adaptive Radiotherapy in Head Neck Cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01688-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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34
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Mitra S, Aggarwal S, Dewan A, Kaur Wahi I, Barik S, Dobriyal K, Mukhee J, Jajodia A, Khurana H, Dewan A. PO-1088: Short Course Radiationtherapy chemotherapy and delayed surgery in locally advanced rectal carcinoma. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01105-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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35
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Aggarwal S, Whipple S, Hsu H, Tu H, Carrigan G, Wang X, Ngarmchamnanrith G, Chia V. 1339P Clinicopathological characteristics and treatment patterns observed in real-world care in patients with advanced non-small cell lung cancer (NSCLC) and KRAS G12C mutations in the Flatiron Health (FH)-Foundation Medicine (FMI) Clinico-Genomic Database (CGDB). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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36
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Aggarwal G, Aggarwal S, Robles J, Depasquale JR, Auseon A. Medical education focus in published articles related to COVID-19. Eur Rev Med Pharmacol Sci 2020; 24:7905-7907. [PMID: 32744719 DOI: 10.26355/eurrev_202007_22297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The ongoing pandemic of Coronavirus Disease 2019 (COVID-19) has affected >2 million patients with approximately 900,000 cases in the United States alone. Medical education has possibly suffered during this time, due to disease mitigation strategies and stress on both students and teachers. We aimed to quantify the publications describing the impact of COVID-19 on medical education in the early stage of the pandemic. MATERIALS AND METHODS Abstract and titles related to COVID-19 listed in PubMed were reviewed for an educational focus. Articles with an educational focus were further evaluated for characteristics of content. RESULTS Out of a total of 3641 articles related to COVID-19, only 26 (0.7%) articles had an educational theme. Thirteen articles were pertaining to residency and fellowship education and twelve articles were focused on medical student education. Only one article referred to nursing education. CONCLUSIONS Publications pertaining to medical education during the ongoing COVID-19 pandemic are few. There is an urgent need for scholarship to understand the best processes and develop innovative methods that can help improve the educational experience of students and trainees during this extraordinary time.
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Affiliation(s)
- G Aggarwal
- Department of Medicine, Jersey City Medical Center, Jersey City, NJ, USA.
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37
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Sahu P, Mohan KV, Aggarwal S, Arindkar S, Mahesh Kumar J, Kumar Upadhyay P, Ramakrishna G, Nagarajan P. Apoptosis-inducing factor deficient mice fail to develop hepatic steatosis under high fat high fructose diet or bile duct ligation. Cell Biochem Funct 2020; 39:296-307. [PMID: 32767404 DOI: 10.1002/cbf.3579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/22/2020] [Accepted: 07/05/2020] [Indexed: 11/08/2022]
Abstract
Apoptosis-inducing factor (AIF) is a mitochondrial flavoprotein involved in redox signalling and programmed cell death. The role of AIF has been well recognized in diabetes and obesity. However, the aspect of AIF deficiency in the development of hepatic steatosis and liver injury is unknown. Therefore, in the current study, Harlequin (Hq mutant) mouse with markedly reduced content of AIF was investigated to explore the role of AIF on the initiation of liver injury. The wild type (WT) developed physiological and pathological features of non-alcoholic fatty liver disease (NAFLD) that were not seen in the Hq mice with AIF deficiency, when fed on high fat high fructose (HFHF) diet. Following bile duct ligation (BDL), the liver associated pathological changes were less conspicuous in Hq mice as compared to WT mice. The expression of AIF protein and apoptosis was markedly lesser as compared to their respective control in Hq mice on HFHF diet. Furthermore, the genes involved in fatty acid metabolism were also altered in the group of treated Hq mice. In conclusion, Hq mice failed to develop diet induced hepatic steatosis, suggestive of a role of AIF mediated pathway in the initiation and progression of liver inflammation. Thus, partial loss of AIF appears to be hepatoprotective. SIGNIFICANCE OF THE STUDY: AIF deficiency has multiple roles in altered pathology processes and cellular metabolism, thereby compromising the cellular homeostasis. Considering the molecular functions of AIF in other organ pathology little is known about its role in diet induced liver injury. Hence, the aim of the current study was to investigate the role of AIF deficiency in liver injury and diseases with focus on NAFLD. The study will help to deliniate the mechanisms of NAFLD using Harliquin Mice.
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Affiliation(s)
- Parul Sahu
- National Institute of Immunology, New Delhi, India
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38
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Affiliation(s)
- Gayatri Ramakrishna
- Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - Pradeep Kumar
- Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - Savera Aggarwal
- Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - Mojahidul Islam
- Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - Ravinder Singh
- Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, Delhi, India
| | - Rakesh K. Jagdish
- Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India
| | - Nirupma Trehanpati
- Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, Delhi, India
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39
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Aggarwal S, Norris A. Professional attitudes to a ‘smart’ tracheal tube: report of a survey of Difficult Airway Society delegates in 2018. Br J Anaesth 2020. [DOI: 10.1016/j.bja.2020.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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40
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Robles J, Aggarwal G, Aggarwal S. Representation of specialties in Coronavirus Disease 2019 (COVID-19) research: analysis of published literature in the first 3 months. Eur Rev Med Pharmacol Sci 2020; 24:5810-5812. [PMID: 32495919 DOI: 10.26355/eurrev_202005_21375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) has infected more than 1.5 million patients worldwide and is associated with high morbidity and mortality. The volume of research published in a specialty, which may shed light on the perceived impact that a topic plays within that discipline, is unknown for the present pandemic. MATERIALS AND METHODS We analyzed all articles published in the first 3 months on COVID-19 and categorized them by journal type and article content. RESULTS There was a ~100-fold difference in articles published on COVID when categorized by journal type and ~65-fold difference when grouped by article content. CONCLUSIONS There is a wide variation in research published withing various specialties regarding COVID-19. Researchers across specialties need to urgently realize the impact of COVID-19 and publish articles that can help improve understanding of this ongoing pandemic.
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Affiliation(s)
- J Robles
- Department of Medicine, UnityPoint Clinic, Des Moines, IA, USA.
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41
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Dewan A, Mitra S, Varghese A, Aggarwal S, Kaur I, Khurana R, Raman K, Tamilarasu S, Bhushan M, Dutta S, Barik S, Sundari A, Dobriyal K. PO-158: Dosimetric comparison of 3D and 2D vaginal brachy in post-op patients with endometrial/cervical ca. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30500-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Chawla R, Makkar BM, Aggarwal S, Bajaj S, Das AK, Ghosh S, Gupta A, Gupta S, Jaggi S, Jana J, Keswadev J, Kalra S, Keswani P, Kumar V, Maheshwari A, Moses A, Nawal CL, Panda J, Panikar V, Ramchandani GD, Rao PV, Saboo B, Sahay R, Setty KR, Viswanathan V, Aravind SR, Banarjee S, Bhansali A, Chandalia HB, Das S, Gupta OP, Joshi S, Kumar A, Kumar KM, Madhu SV, Mittal A, Mohan V, Munichhoodappa C, Ramachandran A, Sahay BK, Sai J, Seshiah V, Zargar AH. RSSDI consensus recommendations on insulin therapy in the management of diabetes. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00783-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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43
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Gupta S, Rajappa S, Advani S, Agarwal A, Aggarwal S, Goswami C, Dattatreya Palanki S, Arya D, Patil S, Kodagali R. Prevalence of germline BRCA1 and BRCA2 mutations and variants among ovarian, primary peritoneal and fallopian tube cancer patients: A multicentre Indian study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz426.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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44
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Martomo S, Feng XJ, Lu D, Polonskaya Z, Luna X, Poyurovsky M, McCracken K, Miyara F, Li L, Aggarwal S, Patel J. Anti-PD-L1/IL-15 fusion protein generates robust adaptive immune gene signatures in tumours leading to tumour inhibition and memory responses. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Ketogenic diet (KD) is a high-fat, adequate-protein, and low-carbohydrate diet that leads to nutritional ketosis, long known for antiepileptic effects and has been used therapeutically to treat refractory epilepsy. This review attempts to summarize the evidence and clinical application of KD in diabetes, obesity, and other endocrine disorders. KD is usually animal protein based. An empiric vegetarian Indian variant of KD has been provided keeping in mind the Indian food habits. KD has beneficial effects on cardiac ischemic preconditioning, improves oxygenation in patients with respiratory failure, improves glycemic control in diabetics, is associated with significant weight loss, and has a beneficial impact on polycystic ovarian syndrome. Multivitamin supplementations are recommended with KD. Recently, ketones are being proposed as super-metabolic fuel; and KD is currently regarded as apt dietary therapy for "diabesity."
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Affiliation(s)
- L Gupta
- Department of Dietetics, Maharaja Agrasen Hospital, New Delhi, India
| | - D Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
| | - S Kalra
- Department of Endocrinology, Bharti Hospital and Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana, India
| | - P Gupta
- Department of Paediatrics, Maharaja Agrasen Hospital, New Delhi, India
| | - D Dutta
- Department of Endocrinology, Venkateshwar Hospitals, New Delhi, India
| | - S Aggarwal
- Department of Medicine, Division of Endocrinology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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46
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Bedi O, Aggarwal S, Trehanpati N, Ramakrishna G, Krishan P. Molecular and Pathological Events Involved in the Pathogenesis of Diabetes-Associated Nonalcoholic Fatty Liver Disease. J Clin Exp Hepatol 2019; 9:607-618. [PMID: 31695251 PMCID: PMC6823706 DOI: 10.1016/j.jceh.2018.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 10/30/2018] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is a rising epidemic in most part of the world and is often associated with multiple organ disorders such as kidney, liver, and cardiovascular diseases. Liver is a major metabolic hub, and the metabolic disorders associated with diabetes result in liver dysfunctions culminating in spectrum of liver diseases such as fatty liver disorders, cirrhosis, and hepatocellular carcinoma. The intervention strategies to prevent diabetes-associated liver injury require an overall understanding of the key factors and molecular pathways which can be strategically targeted. The present review focuses on some of the key aspects of fatty acid metabolism, fetuin-A regulation, inflammatory pathways, and genetic factors associated with insulin resistance, dyslipidemia, hyperglycemia, oxidative stress, and so on involved in the nexus between diabetes and liver injury. Further recent interventions, pharmacological target, and newer therapeutic agents are discussed briefly for the better clinical management of diabetes-associated hepatic disorders.
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Key Words
- AP-1, Activator protein 1
- DLI, diabetic liver injury
- DM, diabetes mellitus
- DMPs, Damage-associated molecular patterns
- FFA, free fatty acid
- FOXO1, Forkhead box protein O1
- FetA, fetuin-A
- G6Pase, Glucose-6-phosphatase
- HCC, hepatocellular carcinoma
- IKK, IκB kinase
- IL, interleukin
- IRS2, Insulin receptor substrate-2
- IκB, Inhibitor of Kb
- LPS, Lipopolysaccharide
- MD2, Myeloid differentiation protein-2
- MMP, matrix metalloproteinase
- MyD88, Myeloid differentiation factor 88
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- NFe κB, Nuclear factor-κB
- NIDDM, noninsulin dependent diabetes mellitus
- PC, Pyruvate carboxylase
- PEPCK, Phosphoenolpyruvate carboxykinase
- PIP3, Phosphatidyl inositol (3, 4, 5)-triphosphate
- T2DM, type 2 diabetes mellitus
- TLR4, Toll-like receptor
- TNF, tumor necrosis factor
- Th 17, T helper 17 cells
- VLDL, very low–density lipoprotein
- diabetes mellitus
- diabetic liver injury
- fetuin-A
- free fatty acid
- inflammatory mediators
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Affiliation(s)
- Onkar Bedi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Savera Aggarwal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gayatri Ramakrishna
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
| | - Pawan Krishan
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
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47
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Mitra S, Khurana R, Dewan A, Kaur I, Aggarwal S, Barik S, Dutta S, Varghese A, Mishra M. Clinical Outcomes and Patterns of Failure after D2 Gastrectomy and Adjuvant Chemoradiotherapy in Patients with Locally Advanced Carcinoma Stomach: A Retrospective Review From A Tertiary Care Cancer Research Institute. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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48
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Aggarwal S, Sharma R, Singh M, Aggarwal A. Abstract P3-16-02: Voice of cancer patient: Analysis of breast cancer patients' experience with PARP inhibitors. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-16-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Many breast and ovarian cancer patients have germline or somatic mutations in BRCA 1&2 genes. These proteins are important for repairing double-strand DNA breaks by homologous recombinational repair. In patients who have mutations in these genes, PARP is the major alternative for repairing single-strand DNA breaks. PARP inhibitors (PARPi) inhibit PARP, thereby causing cell death by accumulation of damaged DNA in cells. Many PARPi, including Olaparib, have been approved and used in treatment of metastatic ovarian cancer patients with BRCA 1&2 mutation.
Recently, Olaparib was also approved by the FDA for treatment of metastatic breast cancer patients with germline BRCA 1&2 mutation, and many other PARPi are in clinical trial. In this study we analyzed breast cancer patients' awareness, use and experience with PARPi s.
Many patients share their experiences on online forums which contain millions of freely shared messages. These can be used to analyze patient concerns and experiences. However, this data is unstructured and difficult to analyze. We used our automated system VoCP, that uses techniques from Big Data Science and Artificial Intelligence (deep learning, topic modeling, information retrieval, and natural language processing) to analyze these messages.
Methods:
We collected 15.13 million unique messages by 987,189 users from 37 unrestricted cancer forums that provide clinically relevant information. We built custom ontologies for breast cancer, various PARPi, chemotherapy and side effects, and then used our automated system VoCP to extract relevant information from these messages.
Results:
We found 1,536 breast cancer patients discussing PARPi. 459 patients mentioned use of PARPi whereas 706 patients shared the information about PARPi and 196 inquired about them. 176 patients mentioned that they were planning to use PARPi.
76 patients using PARPi mentioned having BRCA 1 or 2 mutation and 1 patient mentioned CHEK 2 mutation. 91 patients mentioned having triple negative cancer.
212 patients mentioned being treated on clinical trial and 10 mentioned being off trial. 162 patients mentioned use of chemotherapy with PARPi and 40 mentioned use of PARPi as single agent.
Specific PARPi: 47 mentioned Olaparib, 104 mentioned Valiparib, & Talazoparib, 6 rucaparib and 4 Niraparib. Most patient just mentioned “PARP inhibitor.” Some patients mentioned iniparib on clinical trial.
Side effects were reported by 60 patients. These include:
· Nausea: 14
· Fatigue: 15
· GI side effect: 7
· Thrombocytopenia: 5
· Anemia: 2
· Neutropenia: 2
· Neuropathy: 5
· Insomnia:2
99 patients mentioned PARPi were “effective,” 21 mentioned they were “somewhat effective” and 36 mentioned they were “ineffective.”
144 patient expressed positive sentiments, 30 patients expressed negative sentiments and 16 patients expressed neutral sentiment for PARPi.
Conclusion:
· There is increasing awareness and curiosity for PARPi in breast cancer patients as more patients are being tested for BRCA and other mutations.
· Among the users, PARPi are generally associated with low toxicity and positive sentiments.
· VoCP reliably provides meaningful insights from the patient's point of view; it also gives insight into unmet needs where more resources and research should be focused.
Citation Format: Aggarwal S, Sharma R, Singh M, Aggarwal A. Voice of cancer patient: Analysis of breast cancer patients' experience with PARP inhibitors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-16-02.
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Affiliation(s)
- S Aggarwal
- Santa Clara Valley Medical Center, San Jose, CA; Scry Analytics India PVT, Gurgaon, Harayana, India; Scry Analytics . INC, San Jose, CA
| | - R Sharma
- Santa Clara Valley Medical Center, San Jose, CA; Scry Analytics India PVT, Gurgaon, Harayana, India; Scry Analytics . INC, San Jose, CA
| | - M Singh
- Santa Clara Valley Medical Center, San Jose, CA; Scry Analytics India PVT, Gurgaon, Harayana, India; Scry Analytics . INC, San Jose, CA
| | - A Aggarwal
- Santa Clara Valley Medical Center, San Jose, CA; Scry Analytics India PVT, Gurgaon, Harayana, India; Scry Analytics . INC, San Jose, CA
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49
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Aggarwal S, Chu C, Ngumi M. Abstract P1-10-05: Analysis of genetic mutation in ethnically diverse population with Breast and ovarian cancer: Single institution experience. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-10-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Only 5-10% of all breast and ovarian cancers have been attributed to inherited mutation. In unselected breast cancer patients, prevalence of germline BRCA 1 & 2 is about 2%. In Ashkenazi Jewish population the prevalence is estimated to be 11.7%. The rate of mutations in other populations has not been well characterized. The purpose of this study is to identify and characterize the risk of genetic mutations in an ethnically diverse population referred for genetic testing according to NCCN guidelines.
Method:
In this single institution retrospective study, we analyzed 782 patients referred for genetic testing between 2009-2018. Information regarding reason for referral, ethnicity, cancer history and results of genetic mutation using multigene panels were collected.
Results:
Reasons for referral were:
· Family History of cancer (142; 18.6%),
· Breast cancer diagnosed at early age (207; 26.4%),
· Triple negative breast cancer (12 ;53%
· Ovarian cancer (61; 7.8%)
· Multiple cancer (32; 4.09%)
· Known BRCA 1 or 2 mutation (51;6.5%)
· Known other mutation (9;1.15%)
· Family h/o cancer but not diagnosed with cancer (268)
Ethnic distribution:
· 328 Hispanic (41.94%)
· 177 Caucasian (22.6%),
· 27 Chinese, (3.4%)
· 52 Vietnamese (6.6%)
· 86 other- Asian (11%)
· 32 Middle eastern (4.1%),
· 14 South Asian (1.8%)
· 35 African American (4.5%)
· 8 Ashkenazi Jewish (1%)
· 19 Mixed Hispanic (2.1%)
Genetic testing was done in 545 /782 patients.
Deleterious Mutation detected: 88 patients (16.5% of tested)
· BRCA 1: 32(5.8%)
· BRCA 2:28 (5.14%)
· MSH2:5(0.9%)
· p53:39 (0.5%)
· PLB2:3 (0.38%)
· MUTYH:3 (0.38%)
· CDH1 :2 (0.26%)
· PMS2: 2 ( 0.26%)
· ATM: 1(0.13%)
· CCKn2A: 1(0.13%)
· CHEK 2: 1(0.13)
· MET:1(0.13%)
· MSH6:1 (0.13%)
· RAD50 :1(0.13%)
· RET1;1(0.13%)
BRCA1/BRCA2 mutation: 60
Mutation in BRCA 1/ 2 distribution by ethnicity:
· Hispanic (28; 8.54 %),
· Chinese (4;14.8%)
· Vietnamese (4; 7.7%)
· other Asian (12;13.9%)
· African American (3, 8.5, %)
· South Asian (0 %)
· Caucasian (8; 4.5 %)
· All Asian (20/165: 12.1%)
Mutation in other gene by Ethnicity: total 26
Hispanic (16, 4.5%), Caucasian: (3, 1.7%) Asian other than Chinese and Vietnamese (4, 4.65%)
Mutation in Breast cancer: 333 Breast cancer patients tested, 39 patients (11.17%) were found to have mutations.
10/32 triple negative (31%) 4/49 her2neu positive patients (8.1%) and 15/252 (5.9%) ER+ patients found to have mutations.
17/39 breast cancer patients with mutation had prophylactic BSO.
Mutation in BRCA 1& 2 by reason for referral:
Known family h/o of BRCA1 or 2 mutations (18; 39.5%)
Early age of cancer (10, 7.4%)
Cancer with positive family history (17, 8.2%)
Triple negative (2, 16%).
Variant of Unknown significance (VUS): 140 patients (25 %)
VUS in BRCA 2 were most common. VUS were found in 17% of Hispanic and African American patients.
No significant difference in PFS and OS was found in patient with mutation and without mutation
Conclusion:
We found much higher rates (16.5%) than previously reported mutation detection in this very highly diverse patient population.
Rate of BRCA 1&2 mutation was 8.55% in Hispanic and 12.1% in Asian patients compared with 4.5% in Caucasian patient when selected for high risk factors.
We Also noted very high rate of VUS especially in Hispanic and African American patients.
Citation Format: Aggarwal S, Chu C, Ngumi M. Analysis of genetic mutation in ethnically diverse population with Breast and ovarian cancer: Single institution experience [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-10-05.
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Affiliation(s)
- S Aggarwal
- Santa Clara Valley Medical Center, San Jose, CA
| | - C Chu
- Santa Clara Valley Medical Center, San Jose, CA
| | - M Ngumi
- Santa Clara Valley Medical Center, San Jose, CA
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Aggarwal S, Sharma R, Bhoemick J, Singh M, Aggarwal A. Abstract P2-14-14: Voice of cancer patients (VoCP): Analysis of experiences of cancer patients undergoing breast cancer surgery. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-14-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Surgery is an important part of breast cancer treatment. Most patients either go for mastectomy or lumpectomy + radiation (i.e., breast conserving surgery, BCS). It is well known that mastectomy and BCS have equal long-term outcomes, and more patients are choosing to get breast reconstruction.
In this study, we analyzed experiences, concerns, complications and side effects in patients who have undergone breast cancer surgery and who shared their views on various online forums. Such forums have millions of freely shared messages and are rich sources of such information. However, this data is unstructured. We used our automated system, VoCP, that used techniques from Big Data science and artificial intelligence (e.g., deep learning, topic modeling, information retrieval, natural language processing) to analyze concerns and experiences of patients undergoing breast cancer surgeries.
Methods: We collected 5.5 million messages from 174556 distinct users in 21 unrestricted breast cancer forums. We built specific ontology for different surgeries, reconstruction, side effects and sentiments and used our system, VoCP, to extract relevant information from these messages.
Results: 52172 users shared 307966 messages regarding surgery and their views are summarized below.
Lumpectomy (BCS):
· 25850 users provided 98499 messages
· 15771 users had lumpectomy and shared 50390 messages
· 3760 users shared 6322 messages with complications
· 2760 users mentioned need for additional surgery
· 1447 users mentioned satisfaction with the outcome whereas 117 were dissatisfied
Mastectomy:
· 37544 users shared 198494 messages
· 22716 users had mastectomy and shared 94595 messages
· 5065 users shared 8983 messages regarding complications
· 2730 patients expressed satisfaction with outcome whereas 286 patients were dissatisfied
Reconstruction:
· 23164 users provided 113568 messages regarding reconstruction
· 9850 users had reconstruction and shared 32472 messages
· 1904 users shared 2734 messages with complication
· 1982 users had immediate reconstruction; 353 users mentioned delayed reconstruction
· 2686 users had autologous tissue reconstruction and 3105 repot implant reconstruction
· Type of Autologous Reconstruction reported : 759 TRAM flap, 296 Diep flap, 820 fat grafting, 108 Latissimus Dorsi flap, 89 SGAP Flap/hip Flap
· 418 users expressed satisfaction whereas 40 were dissatisfied with outcome
Complications reportedComplicationsReconstruction #Lumpectomy #Mastectomy#Overall#Scars1071,5051,4163,028Pain7101,4104052,525Infection2823106521,244Necrosis22951167447Numbness35145369549Lymphedema80136334550Lumps60115196371Seroma56222462740Swelling83290385758Frozen Shoulder3783151271Bleeding 445599Hematoma 178139317Itching/Rash 130253383Anxiety 82145227Blood Clot 6464Bruising 6060Drainage 5454
Conclusions:
· Despite reports of equal long term outcomes between BCS and mastectomy, more patient had mastectomy.
· Scar issues and pain is the most common complication from any surgery.
· Most patients have expressed satisfaction from their chosen surgery.
· VoCP reliably provides meaningful insights from the patient's point of view; it also gives insight into unmet needs where more resources and research should be focused.
Citation Format: Aggarwal S, Sharma R, Bhoemick J, Singh M, Aggarwal A. Voice of cancer patients (VoCP): Analysis of experiences of cancer patients undergoing breast cancer surgery [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-14.
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Affiliation(s)
- S Aggarwal
- Santa Clara Valley Medical Center, San Jose, CA; Scry Analytics India PVT, Gurgaon, Harayana, India; Scry Analytics . INC, San Jose, CA
| | - R Sharma
- Santa Clara Valley Medical Center, San Jose, CA; Scry Analytics India PVT, Gurgaon, Harayana, India; Scry Analytics . INC, San Jose, CA
| | - J Bhoemick
- Santa Clara Valley Medical Center, San Jose, CA; Scry Analytics India PVT, Gurgaon, Harayana, India; Scry Analytics . INC, San Jose, CA
| | - M Singh
- Santa Clara Valley Medical Center, San Jose, CA; Scry Analytics India PVT, Gurgaon, Harayana, India; Scry Analytics . INC, San Jose, CA
| | - A Aggarwal
- Santa Clara Valley Medical Center, San Jose, CA; Scry Analytics India PVT, Gurgaon, Harayana, India; Scry Analytics . INC, San Jose, CA
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