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Mann P, Joshi H, Nayyar V, Mishra D, Mehta DS. Birefringence mapping of biological tissues based on polarization sensitive non-interferometric quantitative phase imaging technique. Photodiagnosis Photodyn Ther 2024; 46:104094. [PMID: 38642728 DOI: 10.1016/j.pdpdt.2024.104094] [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: 02/26/2024] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE Oral cancer is a leading cause of mortality globally, particularly affecting developing regions where oral hygiene is often overlooked. The optical properties of tissues are vital for diagnostics, with polarization imaging emerging as a label-free, contrast-enhancing technique widely employed in medical and scientific research over past few decades. MATERIALS AND METHODS We present a novel polarization sensitive quantitative phase imaging of biological tissues by incorporating the conventional polarization microscope and transport of intensity equation-based phase retrieval algorithm. This integration provides access to the birefringence mapping of biological tissues. The inherent optical anisotropy in biological tissues induces the polarization dependent refractive index variations which can provide the detailed insights into the birefringence characteristics of their extracellular constituents. Experimental investigations were conducted on both normal and cancerous oral tissue samples by recording a set of three polarization intensity images for each case with a step size of 2 μm. RESULTS A noteworthy increment in birefringence quantification was observed in cancerous as compared to the normal tissues, attributed to the proliferation of abnormal cells during cancer progression. The mean birefringence values were calculated for both normal and cancerous tissues, revealing a significant increase in birefringence of cancerous tissues (2.1 ± 0.2) × 10-2 compared to normal tissues (0.8 ± 0.2) × 10-2. Data were collected from 8 patients in each group under identical experimental conditions. CONCLUSION This polarization sensitive non-interferometric optical approach demonstrated effective discrimination between cancerous and normal tissues, with various parameters indicating elevated values in cancerous tissues.
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Affiliation(s)
- Priyanka Mann
- Bio-Photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, Hauz-Khas, New Delhi 110016, India
| | - Himanshu Joshi
- Bio-Photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, Hauz-Khas, New Delhi 110016, India
| | - Vivek Nayyar
- Department of Oral Pathology and Microbiology, Centre for Dental Education & Research, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Centre for Dental Education & Research, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Dalip Singh Mehta
- Bio-Photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, Hauz-Khas, New Delhi 110016, India.
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Jot K, Nayyar V, Surya V, Kakkar A, Satapathy S, Roychoudhury A, Mishra D. Assessment of MUC5AC and MUC2 Immunoexpression in Glandular Odontogenic Cysts, Dentigerous Cysts, and Mucoepidermoid Carcinomas. Appl Immunohistochem Mol Morphol 2024; 32:183-188. [PMID: 38478391 DOI: 10.1097/pai.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/14/2024] [Indexed: 04/05/2024]
Abstract
Glandular odontogenic cysts (GOCs) and dentigerous cysts may show mucous metaplasia. Central mucoepidermoid carcinoma is very rare and mostly associated with dental cysts. It is hypothesized that odontogenic cysts showing mucus differentiation in their lining, have a propensity to transform into MEC. The present study is the first attempt to explore the relationship between odontogenic cysts [GOCs and dentigerous cysts with mucus metaplasia (DCMM)] and MEC by evaluating immunoexpression of MUC5AC and MUC2. Immunoexpression of MUC5AC and MUC2 was evaluated semiquantitatively in GOCs (20 cases), DCMMs (20 cases), and MECs (20 cases). The percentage of positive cells, intensity, and localization of immunoexpression were assessed for each marker in all cases. Of GOCs, DCMMs, and MECs cases, 85%, 70%, and 80%, respectively, were immunopositive for MUC5AC. Strong cytoplasmic immunoreactivity for MUC5AC was noted, particularly in mucous cells present diffusely within MECs. However, the immunoreactivity was limited to the epithelial lining of GOCs and DCMMs. Most of the MECs (60%) showed more than 25% positivity for MUC5AC, followed by GOCs, and the least in DMMCs. Mild cytoplasmic and nuclear positivity of MUC2 was noted only in epithelial lining cells of 70% GOCs and 45% DCMMs. Whereas, 55% of MECs displayed moderate to strong cytoplasmic and membranous immunopositivity for MUC2 exclusively within mucous cells. As MECs showed strong MUC5AC immunoreactivity in mucous cells, immunoexpression of MUC5AC in odontogenic cysts with mucus cells can possibly explain the pathogenesis of MEC from cysts. However, the variable expression of MUC2 did not give any strong evidence regarding its role as a marker.
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Affiliation(s)
- Kiran Jot
- Departments of Oral Pathology and Microbiology, Centre for Dental Education and Research
| | - Vivek Nayyar
- Departments of Oral Pathology and Microbiology, Centre for Dental Education and Research
| | - Varun Surya
- Departments of Oral Pathology and Microbiology, Centre for Dental Education and Research
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences
| | | | - Ajoy Roychoudhury
- Department of Oral and maxillofacial Surgery, Centre for Dental Education and Research, New Delhi, India
| | - Deepika Mishra
- Departments of Oral Pathology and Microbiology, Centre for Dental Education and Research
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Mann P, Thapa P, Nayyar V, Surya V, Mishra D, Mehta DS. Multispectral polarization microscopy of different stages of human oral tissue: A polarization study. J Biophotonics 2024; 17:e202300236. [PMID: 37789505 DOI: 10.1002/jbio.202300236] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023]
Abstract
Many optical techniques have been used in various diagnostics and biomedical applications since a decade and polarization imaging is one of the non-invasive and label free optical technique to investigate biological samples making it an important tool in diagnostics, biomedical applications. We report a multispectral polarization-based imaging of oral tissue by utilizing a polarization microscope system with a broadband-light source. Experiments were performed on oral tissue samples and multispectral Stokes mapping was done by recording a set of intensity images. Polarization-based parameters like degree of polarization, angle of fast axis, retardation and linear birefringence have been retrieved. The statistical moments of these polarization components have also been reported at multiples wavelengths. The polarimetric properties of oral tissue at different stages of cancer have been analyzed and significant changes from normal to pre-cancerous lesions to the cancerous are observed in linear birefringence quantification as (1.7 ± 0.1) × 10-3 , (2.5 ± 0.2) × 10-3 and (3.3 ± 0.2) × 10-3 respectively.
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Affiliation(s)
- Priyanka Mann
- Bio-photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, New Delhi, India
| | - Pramila Thapa
- Bio-photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, New Delhi, India
| | - Vivek Nayyar
- Department of Oral Pathology and Microbiology, Centre for Dental Education & Research, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Varun Surya
- Department of Oral Pathology and Microbiology, Centre for Dental Education & Research, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Centre for Dental Education & Research, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Dalip Singh Mehta
- Bio-photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, New Delhi, India
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Jot K, Nayyar V, Manchanda S, Bhutia O, Mishra D. Telangiectatic osteosarcoma of maxilla in a young child. Oral Oncol 2023; 147:106605. [PMID: 37890305 DOI: 10.1016/j.oraloncology.2023.106605] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
Telangiectatic osteosarcoma (TO) is an uncommon variant of osteosarcoma that primarily afflicts young adults. In this case report, we describe a unique instance of TO occurring in a young child's maxilla. Under microscopic examination, it reveals abundant blood-filled spaces, extensive hemorrhagic regions, alongside atypical pleomorphic tumor cells and osteoid. It is crucial to conduct a meticulous histopathological examination to distinguish TO from other lesions, such as aneurysmal bone cysts and Ewing sarcoma.
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Affiliation(s)
- Kiran Jot
- Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Nayyar
- Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India.
| | - Ongkila Bhutia
- Oral and Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepika Mishra
- Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
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Jot K, Nayyar V, Surya V, Mishra D, Sowmya SV, Augustine D, Indu M, Haragannavar VC. A multicentric case study of fibroblastic and myofibroblastic oral spindle cell lesions. J Oral Maxillofac Pathol 2023; 27:629-641. [PMID: 38304501 PMCID: PMC10829460 DOI: 10.4103/jomfp.jomfp_282_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024] Open
Abstract
Context Spindle cell lesions comprise a vast plethora of benign and malignant lesions with similar clinical and radiographic features. Their overlapping histopathologic features ensure a diagnostic dilemma. Aim The current multicentric study aims to delineate fibroblastic and myofibroblastic oral spindle cell lesions based on cytomorphology and comprehensive immunohistochemical analysis. Settings and Design The experimental study was conducted at MS Ramaiah University of Applied Sciences, Bangalore, and All India Institute of Applied Sciences, Delhi. Methods and Material A comprehensive histological scoring criteria and panel of immunohistochemical makers (STAT6, CD31, CD34, S100, SMA, vimentin, pan-CK, HHF-35, Ki67, ALK, desmin, HMB-45, SATB2, ERG, EMA and CD99) were employed concurrently for the first time for fibroblastic and myofibroblastic oral spindle cell lesions. The data obtained was tabulated and studied. Statistical Analysis Used NA. Results: Using cytological scoring criteria and panel of immunohistochemical makers, the cases analysed and characterized were desmoplastic fibroma, fibrosarcoma, leiomyosarcoma, nodular fasciitis, neurofibroma and epithelioid inflammatory myofibroblastic sarcoma (EIMS). Conclusions The diagnostic strategies need to be upgraded for the diagnosis of spindle cell lesions. Emphasis must be placed on cytomorphology, an immunohistochemistry (IHC) panel of markers is imperative for the accurate diagnosis of fibroblastic and myofibroblastic oral spindle cell lesions.
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Affiliation(s)
- Kiran Jot
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vivek Nayyar
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Varun Surya
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - SV Sowmya
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSR Nagar, Bengaluru, Karnataka, India
| | - Dominic Augustine
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSR Nagar, Bengaluru, Karnataka, India
| | - M Indu
- Department of Oral Pathology, Government Dental College, Kottayam, Kerala, India
| | - Vanishri C. Haragannavar
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSR Nagar, Bengaluru, Karnataka, India
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Thapa P, Singh V, Bhatt S, Maurya K, Kumar V, Nayyar V, Jot K, Mishra D, Shrivastava A, Mehta DS. Multimodal fluorescence imaging and spectroscopic techniques for oral cancer screening: a real-time approach. Methods Appl Fluoresc 2023; 11:045008. [PMID: 37666247 DOI: 10.1088/2050-6120/acf6ac] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/04/2023] [Indexed: 09/06/2023]
Abstract
The survival rate of oral squamous cell carcinoma (OSCC) patients is very poor, but it can be improved using highly sensitive, specific, and accurate techniques. Autofluorescence and fluorescence techniques are very sensitive and helpful in cancer screening; being directly linked with the molecular levels of human tissue, they can be used as a quantitative tool for cancer detection. Here, we report the development of multi-modal autofluorescence and fluorescence imaging and spectroscopic (MAF-IS) smartphone-based systems for fast and real-time oral cancer screening. MAF-IS system is indigenously developed and offers the advantages of being a low-cost, handy, non-contact, non-invasive, and easily operable device that can be employed in hospitals, including low-resource settings. In this study, we report the results of 43 individuals with 28 OSCC and 15 oral potentially malignant disorders (OPMDs), i.e., epithelial dysplasia and oral submucous fibrosis, using the developed devices. We observed a red shift in fluorescence emission spectrain vivo. We found red-shift of 7.72 ± 6 nm, 3 ± 4.36 nm, and 1.33 ± 0.47 nm in the case of OSCC, epithelial dysplasia, and oral submucous fibrosis, respectively, compared to normal. The results were compared with histopathology and found to be consistent. Further, the MAF-IS system provides results in real-time with higher accuracy and sensitivity compared to devices using a single modality. Our system can achieve an accuracy of 97% with sensitivity and specificity of 100% and 94.7%, respectively, even with a smaller number of patients (28 patients of OSCC). The proposed MAF-IS device has great potential for fast screening and diagnosis of oral cancer in the future.
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Affiliation(s)
- Pramila Thapa
- Bio-photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, Hauz-Khas, New Delhi 110016, India
| | - Veena Singh
- Bio-photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, Hauz-Khas, New Delhi 110016, India
| | - Sunil Bhatt
- Bio-photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, Hauz-Khas, New Delhi 110016, India
| | - Kiran Maurya
- Department of Oral Pathology and Microbiology, Center for Dental Education & Research, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India
| | - Virendra Kumar
- Bio-photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, Hauz-Khas, New Delhi 110016, India
| | - Vivek Nayyar
- Department of Oral Pathology and Microbiology, Center for Dental Education & Research, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India
| | - Kiran Jot
- Department of Oral Pathology and Microbiology, Center for Dental Education & Research, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Center for Dental Education & Research, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India
| | - Anurag Shrivastava
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India
| | - Dalip Singh Mehta
- Bio-photonics and Green-photonics Laboratory, Department of Physics, Indian Institute of Technology Delhi, Hauz-Khas, New Delhi 110016, India
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Nayyar V, Bhutia O, Kakkar A, Mishra D. Epithelioid inflammatory myofibroblastic sarcoma arising in the maxilla: first reported case in the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:e15-e19. [PMID: 37246059 DOI: 10.1016/j.oooo.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/11/2023] [Accepted: 03/06/2023] [Indexed: 05/30/2023]
Abstract
Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare variant of inflammatory myofibroblastic tumors located mostly in the intra-abdominal region. Herein, we present a case of a 32-year-old male with a lobulated growth in the right maxilla. Radiology revealed a solitary osteolytic lesion with an irregular margin, causing buccal and palatal cortex erosion. Histopathology revealed a tumor composed of spindle-shaped fascicles that blend into sheets of round to ovoid-shaped epithelioid cells, areas of myxoid changes, and necrosis. Tumor cells showed a moderate amount of eosinophilic cytoplasm, large vesicular nuclei with coarse chromatin, nuclear pleomorphism, and increased mitoses. Tumor cells were immunopositive for ALK-1, focal positivity for smooth muscle actin, panCK, epithelial membrane antigen, and immunonegativity for CD 30, desmin, CD34, and STAT6. P53 showed a wild-type staining pattern, and INI-1 expression was retained. The Ki-67 proliferative index was 22%. To the best of our knowledge, this is the first case of EIMS occurring in the maxilla.
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Affiliation(s)
- Vivek Nayyar
- Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
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Dekyi T, Kaur K, Bhutia O, Roychoudhury A, Mishra D, Nayyar V. Long term follow-up results of enucleation as the definitive treatment for melanocytic neuroectodermal tumour of infancy and a review on its treatment. J Oral Biol Craniofac Res 2023; 13:375-379. [PMID: 37025968 PMCID: PMC10070903 DOI: 10.1016/j.jobcr.2023.03.005] [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] [Received: 01/14/2022] [Revised: 12/27/2022] [Accepted: 03/06/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Melanotic Neuroectodermal tumour of Infancy (MNTI) is a rare entity of pigmented neoplasms of head and neck region. It predominantly occurs within the first year of life. The authors present enucleation as the definitive surgical treatment, with reference to the five departmental cases of MNTI with no recurrence at 5years and 1year of follow-up of other 4 cases. Case presentation Five cases of MNTI (age group of 2.5months-7 months) presented to our department as a large bluish-brown non tender swelling protruding into the oral cavity. Radiologic imaging revealed a well-circumscribed solid-cystic enhancing lesion causing elevation of orbit and nasal obliteration in maxillary region and causing buccolingual expansion in mandible. The tumor was enucleated without any bony margin. Histopathological and immunohistochemical evaluation (EMA, Pan Cytokeratin, HMB45, S100, p53, ki67) were done. Patients were followed up at regular intervals and had no recurrence at mean 3years follow-up. A detailed mention of surgical pearls, differential diagnosis and a brief literature review are also done. Conclusion MNTI is a pigmented neoplasm that occurs in infants and in head and neck region mostly involves the upper alveolus and maxilla, followed by skull and mandible. Incisional biopsy is needed to confirm the tumour and rule out other malignant round cell tumours. Enucleation of the lesion is necessary without the need for any extra bony margin removal. Close long term follow up is necessary. Conservative surgical approach is usually the best first choice for MNTI treatment.
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Affiliation(s)
- Tsering Dekyi
- Division of Oral and Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, India
| | - Kamalpreet Kaur
- Division of Oral and Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, India
| | - Ongkila Bhutia
- Division of Oral and Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, India
| | - Ajoy Roychoudhury
- Division of Oral and Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, India
| | - Deepika Mishra
- Division of Oral and Maxillofacial Pathology, CDER, All India Institute of Medical Sciences, India
| | - Vivek Nayyar
- Division of Oral and Maxillofacial Pathology, CDER, All India Institute of Medical Sciences, India
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Nayyar V, Bhatt K, Kakkar A, Mishra D. Unfamiliar case of metastatic myxoid leiomyosarcoma of mandible. Oral Oncol 2023; 138:106313. [PMID: 36706627 DOI: 10.1016/j.oraloncology.2023.106313] [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] [Received: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 01/27/2023]
Affiliation(s)
- Vivek Nayyar
- Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
| | - Krushna Bhatt
- Department of Oral and Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Dawar A, Kamra P, Anand D, Nayyar V, Mishra D, Pandey S. Oral mesotherapy technique for the treatment of physiologic gingival melanin hyperpigmentation using locally injectable vitamin C: a clinical and histologic cases series. Quintessence Int 2022; 53:580-588. [PMID: 35674171 DOI: 10.3290/j.qi.b3044857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Vitamin C (ascorbic acid) is widely used in dermatology for skin depigmentation. However, there are very few clinical studies on the efficacy of vitamin C in gingival depigmentation. This preliminary case series aims to present the clinical effectiveness, histologic changes, and patient-reported outcomes of intra-epidermal vitamin C injections (oral mesotherapy) for managing patients with gingival melanin hyperpigmentation. METHOD AND MATERIALS Five patients were administered locally injectable vitamin C (once per week for 4 to 5 visits) in maxillary or mandibular anterior pigmented gingiva. The depigmentation effect was evaluated using the Dummett Oral Pigmentation Index (DOPI) and Gingival Pigmentation Index (GPI). Digital photographs were used to assess gingival luminescence (L*) and pigmented surface area (PSA). Parameters were recorded at baseline and at 1 and 3 months. Melanocyte histopathologic count was determined at baseline and at 3 months. Pain, gingival color change, and patient satisfaction scores were also assessed. RESULTS Median GPI, DOPI, and PSA were significantly reduced (P ≤ .05) from baseline to 1 month. There was no statistically significant change from 1 month to 3 months. L* value significantly increased from baseline to 3 months. A median pain score of 3 (scale of 0 to 10) was observed on the day of the procedure. A score of 3 (scale of 0 to 4) was reported for the gingival color and scores 3 and 4 (scale of 0 to 4) for the overall patient satisfaction. CONCLUSION Oral mesotherapy using locally injectable vitamin C is a nonsurgical, minimally invasive, and efficient technique for gingival depigmentation. Indian patients were satisfied with the gingival color obtained and the overall treatment experience. CLINICAL IMPORTANCE As all the branches of medicine, specifically dentistry, direct to minimally invasive approaches, mesotherapy shows great importance to reduce the surgical interventions, especially when esthetic outcomes are needed. Oral mesotherapy using locally injectable vitamin C can be a useful nonsurgical technique for achieving gingival depigmentation in the esthetic zone.
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Nayyar V, Bhutia O, Kakkar A, Mishra D. Primary intraosseous oncocytic mucoepidermoid carcinoma of the jaw: First case report. Oral Oncol 2022; 126:105732. [DOI: 10.1016/j.oraloncology.2022.105732] [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] [Received: 01/11/2022] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
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Nayyar V, Roychoudhury A, Bhalla AS, Mishra D. Metastatic oncocytic adrenocortical carcinoma of mandible: an extraordinarily rare occurrence. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:e277-e280. [DOI: 10.1016/j.oooo.2022.01.022] [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] [Received: 08/06/2021] [Revised: 11/23/2021] [Accepted: 01/30/2022] [Indexed: 11/29/2022]
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Puri PD, Krishna A, Gosavi S, Nayyar V. Hemangiomatous Ameloblastoma with Spindle Cell Proliferation: A Rare Case Report and Review of Literature. J Oral Maxillofac Pathol 2022; 26:132-133. [PMID: 35571309 PMCID: PMC9106244 DOI: 10.4103/jomfp.jomfp_394_21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/30/2021] [Accepted: 01/21/2022] [Indexed: 12/02/2022] Open
Abstract
Ameloblastoma is a locally aggressive neoplasm with varied histological patterns. The histomorphologic variants of ameloblastoma bear no prognostic or biologic behavioral significance with possible exceptions of desmoplastic and hemangioameloblastoma. The present paper aims at reporting a case of 38-year-old male with a huge lesion present in the mandibular symphysial region crossing the midline, histopathologically showing hemangiomatous component in follicular and plexiform ameloblastoma along with spindle cell differentiation in the ameloblastic follicles. Spindle cell differentiation in ameloblastoma is rarely reported and the prognostic significance is yet not clear. The present paper also reviews the literature since the diagnosis of this lesion is must as it may lead to surgical complications.
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Affiliation(s)
- Pavan D Puri
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Abhinandh Krishna
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Suchitra Gosavi
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Vivek Nayyar
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Nagpur, Maharashtra, India
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Sood A, Nayyar V, Mishra D, Kakkar A, Priya H. Post-COVID mucormycosis: Ascertainment of the pathological diagnostic approach. J Oral Maxillofac Pathol 2021; 25:219-222. [PMID: 34703112 PMCID: PMC8491344 DOI: 10.4103/0973-029x.325117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Anubhuti Sood
- Division of Oral Pathology and Microbiology, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Nayyar
- Division of Oral Pathology and Microbiology, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Deepika Mishra
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Division of Public Health Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Priya
- Division of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India E-mail:
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Ramakrishnan N, Baronia AK, Divatia JV, Bhagwati A, Chawla R, Iyer S, Jani CK, Joad S, Kamat V, Kapadia F, Mehta Y, Myatra SN, Nagarkar S, Nayyar V, Padhy S, Rajagopalan R, Ray B, Sahu S, Sampath S, Todi S. Critical care delivery in intensive care units in India: Defining the functions, roles and responsibilities of a consultant intensivist. Indian J Crit Care Med 2020. [DOI: 10.5005/ijccm-17-s1-15] [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: 11/23/2022] Open
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16
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Affiliation(s)
- K. Shetty
- Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - V. Nayyar
- Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - E. Stachowski
- Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - K. Byth
- Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
- University of Sydney, Sydney
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Ash A, Whitehead C, Hughes B, Williams D, Nayyar V. Impact of a transport checklist on adverse events during intra-hospital transport of critically ill patients. Aust Crit Care 2015. [DOI: 10.1016/j.aucc.2014.10.033] [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: 11/26/2022] Open
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18
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Ramakrishnan N, Baronia AK, Divatia JV, Bhagwati A, Chawla R, Iyer S, Jani CK, Joad S, Kamat V, Kapadia F, Mehta Y, Myatra SN, Nagarkar S, Nayyar V, Padhy S, Rajagopalan R, Ray B, Sahu S, Sampath S, Todi S. Critical care delivery in intensive care units in India: Defining the functions, roles and responsibilities of a consultant intensivist. Indian J Crit Care Med 2013. [DOI: 10.5005/ijccm-17-5-15] [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: 11/23/2022] Open
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19
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Nayyar V, Jarvis J, Lawrence I, Kong MF, Gregory R, Hiles S, Jackson S, McNally P, Davies MJ. Long-term follow up of patients on U-500 insulin: a case series. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/pdi.1480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Mariappa V, Stachowski E, Balik M, Clark P, Nayyar V. Cricothyroidotomy: Comparison of three Different Techniques on a Porcine Airway. Anaesth Intensive Care 2009; 37:961-7. [DOI: 10.1177/0310057x0903700602] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared three different cricothyroidotomy techniques on a cadaveric porcine airway model to determine the most rapid, successful and safe method in emergency situations. In this observational comparative bench-test, surgical or scalpel cricothyroidotomy (ST), Cook Melker Cricothyrotomy Kit (CM) and Portex Cricothyroidotomy Kit (PCK) were evaluated. After a familiarisation program, four operators performed five procedures using each of the techniques. A dissected pig airway was housed in an airway training manikin. Time to successful completion of the procedure, complications and anatomical variations in the pig larynx were recorded. A patent airway was established in 20 of 20 (100%) attempts with CM technique, 11 of 20 (55%) with ST and six of 20 (30%) with PCK technique. The CM technique was associated with a higher success rate (P <0.001). There was no significant difference (P=0.4) in the median time (interquartile range) taken to achieve a patent airway; CM 50 seconds (40 to 57), ST 47 seconds (41 to 55) and PCK 63 seconds (41 to 150). There was a higher rate of posterior tracheal wall injury with the PCK technique (n=11) and ST technique (n=5). No complications were observed with CM technique. There were no significant anatomical variations in the pig larynxes. We conclude that the CM technique is safe, rapid and has a significantly higher success rate in achieving an artificial airway in this airway model. Overall, all the participants in our study preferred to use this kit in an emergency situation.
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Affiliation(s)
- V. Mariappa
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
- Staff Specialist. Intensive Care Unit, Toowoomba Hospital, Toowoomba, Queensland
| | - E. Stachowski
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
- Director, Intensive Care Unit
| | - M. Balik
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
- Head of Intensive Care, General Teaching Hospital, Prague, Czech Republic
| | - P. Clark
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - V. Nayyar
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
- Senior Staff Specialist, Intensive Care Unit
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21
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Sikka R, Nayyar V, Sidhu SS. Monitoring of Cd pollution in soils and plants irrigated with untreated sewage water in some industrialized cities of Punjab, India. Environ Monit Assess 2009; 154:53-64. [PMID: 18612834 DOI: 10.1007/s10661-008-0377-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 05/05/2008] [Indexed: 05/08/2023]
Abstract
The disposal of industrial and sewage water is a problem of increasing importance throughout the world. In India, and most of the developing countries untreated sewage and industrial wastes are discharged on land or into the running water streams which is used for irrigating crops. These wastes often contain high amount of trace elements which may accumulate in soils in excessive quantities on long term use and enter the food chain through absorption by the plants. Among the trace metals, Cd has received the greater attention because of its easy absorption and accumulation in plants and animals to levels toxic for their health. The objective of this study conducted in three industrially different cities viz., Ludhiana, Jalandhar and Malerkotla was to monitor the extent of Cd accumulation in soils and plants receiving untreated sewage water. Plant and soil samples were collected from sewage and tubewell irrigated areas. Soil samples were analysed for texture, pH, EC, organic carbon (OC), CaCO(3), bioavailable DTPA-Cd and plant samples were analysed for total Cd. In sewage irrigated soils, the mean values of pH were lower but organic carbon and electrical conductivity were generally higher both in surface and sub-surface layers of all the three cities as compared to tubewell irrigated soils. The mean DTPA- extractable Cd in sewage irrigated soil was 6.3- and 4.36-fold in Ludhiana, 3.38- and 1.71-fold in Jalandhar and 3.35- and 6.67-fold in Malerkotla in 0-15 and 15-30 cm soil depth, respectively, compared with the values in tubewell irrigated soils. The accumulation of DTPA-Cd in sewage irrigated soils was restricted to 30 cm depth after which the values were generally close to values in tubewell irrigated soils. Soil pH, OC, CaCO(3), clay and silt collectively accounted for 37.1%, 65.1% and 53.9% DTPA-extractable bioavailable Cd in soils of Ludhiana, Jalandhar and Malerkotla, respectively. Lower R(2) values in Ludhiana suggest that factors other than the ones mentioned may be affecting Cd availability. At all sites plants receiving sewage irrigation had elevated levels of Cd as compared to the plants receiving tubewell irrigation. The mean Cd content of sewage irrigated plants irrespective of the city was 5.96 microg g(-1) dry matter as compared to 0.98 microg g(-1) dry matter in tubewell irrigated plants. The results suggest that the intake of Cd obtained from consumption of crops grown on sewage irrigated soils would be much higher than the tolerable limits set by WHO and may, therefore, prove potentially toxic leading to various health ailments to humans and animals.
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Affiliation(s)
- R Sikka
- Department of Agronomy, Punjab Agricultural University, Ludhiana, India.
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Crasto W, Jarvis J, Hackett E, Nayyar V, McNally PG, Davies MJ, Lawrence IG. Insulin U-500 in severe insulin resistance in type 2 diabetes mellitus. Postgrad Med J 2009; 85:219-22. [PMID: 19417173 DOI: 10.1136/pgmj.2008.073379] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Some patients with type 2 diabetes mellitus (T2DM) are profoundly insulin resistant and require large insulin doses to achieve optimal glycaemic control. However, large volumes of subcutaneous conventional U-100 insulin can cause discomfort at the injection site, resulting in poor concordance with insulin therapy. One therapeutic option is the use of U-500 insulin, thus reducing the insulin volume by 80%. This review will address the practical issues associated with the use of U-500, clinical efficacy and safety aspects of this concentrated insulin, which has an important role in a subgroup of patients with T2DM.
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Affiliation(s)
- W Crasto
- Department of Diabetes and Endocrinology, University Hospitals of Leicester NHS Trust, UK
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Arora S, Lang I, Nayyar V, Stachowski E, Ross DL. Atrial fibrillation in a tertiary care multidisciplinary intensive care unit--incidence and risk factors. Anaesth Intensive Care 2007; 35:707-13. [PMID: 17933156 DOI: 10.1177/0310057x0703500508] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Atrial fibrillation is a common arrhythmia in an intensive care unit. We performed a prospective observational study over a period of three months, to study the incidence, risk factors and outcome of patients who develop atrial fibrillation in a multidisciplinary intensive care unit. All patients above the age of 50 years were eligible. Exclusion criteria were: cardiac or oesophageal surgery during current hospitalisation, atrial fibrillation at admission, implanted pacemaker and expected intensive care unit stay of less than 24 hours. Sixty-one patients were included in the study. Eighteen patients (29.5%, confidence interval 18-40) developed atrial fibrillation. Incidence of atrial fibrillation was 4.02 episodes per 100 patient days. Patients who developed atrial fibrillation had higher age (71.3 years vs. 63.2 years, P=0.001), severity of illness (APACHE II 25.4 vs. 20.0, P=0.005) and sepsis at admission (9/18 vs. 9/43, P=0.01). They also had higher in-hospital mortality (Risk ratio 2.7, 95% confidence interval 1.3-5.4). Standardised mortality ratio was higher in patients who developed atrial fibrillation (1.08 vs. 0.63). Patients who developed atrial fibrillation required a longer period of mechanical ventilation and inotropic support. Multivariate logistic regression analysis showed age >75 years, APACHE II score >20 and sepsis at admission were independent predictors for development of atrial fibrillation in critically ill patients. Although atrial fibrillation by itself is unlikely to be the cause of higher mortality, it is likely to be a marker for increased mortality and resource utilisation in the intensive care unit.
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Affiliation(s)
- S Arora
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
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24
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Ramakrishnan N, Baronia AK, Divatia JV, Bhagwati A, Chawla R, Iyer S, Jani CK, Joad S, Kamat V, Kapadia F, Mehta Y, Myatra SN, Nagarkar S, Nayyar V, Padhy S, Rajagopalan R, Ray B, Sahu S, Sampath S, Todi S. Critical care delivery in intensive care units in India: Defining the functions, roles and responsibilities of a consultant intensivist. Indian J Crit Care Med 2006. [DOI: 10.5005/ijccm-10-1-53] [Citation(s) in RCA: 6] [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: 11/23/2022] Open
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25
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Karanth S, Nayyar V. What influences outcome of patients with suicidal hanging. J Assoc Physicians India 2005; 53:853-6. [PMID: 16459527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
AIM Suicidal hanging is an uncommon medical emergency with significant neurological morbidity. The aim of the study was to identify factors that have a bearing on the final outcome. MATERIALS AND METHODS Retrospective analysis of 37 consecutive cases of suicidal hanging admitted to our ICU from July 1996 - December 2002 was performed. Outcome at discharge was defined as good (complete neurological recovery) or poor (death or incomplete neurological recovery). Three clinical variables (at presentation) namely Glasgow Coma Scale (GCS) at presentation, time lapse (in hours) from the incident to arrival at our hospital and the presence of Hypotension (defined as a systolic blood pressure < or = 90 mm Hg) at admission were recorded and tested individually for an association with the outcome. Statistical analysis was done using the Odds ratio (OR +/- 95% Confidence Intervals) and Chi-square test of significance for categorical data. RESULTS Patients with suicidal hanging constituted < 1% of ICU admissions (mean age 27 years). 34/37 survived giving a survival rate of 92%. Of those who survived, 31 patients (91%) had complete neurological recovery at the time of discharge from hospital. Among those who presented <4 hours of the incident (25 patients), 2 had an adverse outcome as compared to 4/10 patients who presented 4 hours or more after the incident (OR 7.6,95% CI 1.12-52.3). A low GCS (GCS <7) at presentation was also statistically associated with a poor outcome (OR 10.4, 95% CI 1.08-102.1). Hypotension was present in approximately 33% of patients (12/37) at presentation. Of these 12 patients, 3 had an adverse outcome as opposed to 3 patients among the remaining 25 (OR 1.6, 95% CI 0.41 - 14.47, NS). CONCLUSIONS Suicidal hanging is an unusual medical emergency that is common among young individuals in developing countries. Our study indicates that a delayed presentation to a medical facility and a low GCS at presentation predict a poor outcome.
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Affiliation(s)
- S Karanth
- Critical Care and Emergency Services, Manipal Hospital, Bangalore 560017
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Karanth S, Nayyar V. Rodenticide-induced hepatotoxicity. J Assoc Physicians India 2003; 51:816-7. [PMID: 14651148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Hepatotoxicity following acute poisoning with rodenticides has been infrequently reported in literature. To emphasize the fact that this form of clinical presentation is not unusual we are reporting two cases of rodenticide poisoning masquerading as severe hepatic dysfunction.
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Affiliation(s)
- S Karanth
- Department of Critical Care Medicine, Airport Road, Bangalore 560 017
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27
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Van der Touw T, Mudaliar Y, Nayyar V. Cardiorespiratory effects of manually compressing the rib cage during tidal expiration in mechanically ventilated patients recovering from acute severe asthma. Crit Care Med 1998; 26:1361-7. [PMID: 9710095 DOI: 10.1097/00003246-199808000-00021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the cardiorespiratory effects of manual expiratory rib cage compression in mechanically ventilated patients recovering from acute severe asthma; and to extrapolate these findings to emergency asthma management where ventilation cannot be achieved by positive-pressure ventilation. DESIGN A prospective, clinical study. SETTING Intensive care unit. PATIENTS Four intubated, mechanically ventilated (volume-controlled), adult patients recovering from acute severe asthma. INTERVENTIONS Patients were studied before, during, and after a 2- to 3-min period of manual compressions applied bilaterally over the lower rib cage (ribs 8 to 10) during consecutive tidal expirations. MEASUREMENTS AND MAIN RESULTS Air flow (pneumotachograph), airway pressure, radial or brachial arterial pressure, and the hand pressure applied to the patient's rib cage were monitored and recorded on magnetic tape. Playback of the recorded data enabled measurement of changes in lung volume (air flow integration). Changes during rib cage compression consisted chiefly of small decreases in lung volume and peak inspiratory airway pressure that were only observed in the least obstructed patient and were fully reversed after the cessation of compressions. Air flow-time and air flow-volume plots demonstrated expiratory air flow limitation during essentially the entire tidal expiration in each patient, except the least obstructed patient. CONCLUSION The results suggest that manual compression of the rib cage during consecutive tidal expirations would be ineffective in reducing pulmonary hyperinflation during the emergency management of asthma when air flow obstruction is so severe that ventilation cannot be achieved by positive-pressure ventilation.
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Affiliation(s)
- T Van der Touw
- Intensive Care Unit, Westmead Hospital, New South Wales, Australia
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Alexander R, Mathai E, Nayyar V, Mathew M, Jasper P. Low prevalence of chlamydial endocervical infection in antenatal south Indian women. Genitourin Med 1993; 69:240-1. [PMID: 8335319 PMCID: PMC1195069 DOI: 10.1136/sti.69.3.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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John L, Nayyar V, Shyla PM, Kanagasabapathy AS. Comparison of cardiovascular risk factors in type II (non-insulin dependent) diabetics with and without coronary heart disease. J Assoc Physicians India 1993; 41:84-7. [PMID: 8335614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cardiovascular risk factors in NIDDM were studied by comparing 175 subjects with coronary heart disease (CHD) to 173 subjects without CHD; both groups were matched with regard to male to female ratio, age at diagnosis of diabetes and body mass index. The risk factors included were hypertension, poor metabolic control, smoking and lipid abnormalities. Since the mean known duration of diabetes in subjects with CHD was longer compared to those without CHD (12.93 +/- 7.23 and 6.25 +/- 5.66) and sub sample of subjects from both groups with duration of diabetes with 15 years or less were also analysed for comparison. Even after adjustment of duration the clustering of vascular complication in the subjects with CHD was striking. Presence of low HDL cholesterol was significant in both men and women diabetics with CHD (p < 0.01); while hypertension and poor metabolic control showed a strong positive correlation to CHD in women (p < 0.01 & p < 0.05). Multiple logistic analysis carried out separately in men and women showed that both low HDL cholesterol and elevated serum triglycerides showed strong association to CHD in both sexes; while in women in addition hypertension and insulin therapy also had a positive correlation to CHD (p < 0.01). Furthermore the influence of known duration of diabetes was not observed to be a significant contributor to the cardiovascular risk factors, since the above mentioned risk factors remained statistically significant in the subsample of patients with duration of diabetes less than 15 years.
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Affiliation(s)
- L John
- Department of Medicine and Clinical Biochemistry, Christian Medical College & Hospital Vellore, S. India
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Abstract
A case of a 17-year-old Indian male with disseminated tuberculosis is reported. While on chemotherapy, he was detected to have splenic abscesses. The patient remained unresponsive to antituberculous drugs until a splenectomy was performed.
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Affiliation(s)
- V Nayyar
- Department of Medicine, Christian Medical College and Hospital, Vellore, India
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Chandy ST, Peter JV, John L, Nayyar V, Mathai D, Dayal AK, Thomas K, Sheshadri MS, Cherian AM. Betamethasone in tetanus patients: an evaluation of its effect on the mortality and morbidity. J Assoc Physicians India 1992; 40:373-6. [PMID: 1452560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effect of betamethasone on the outcome in moderate to severe tetanus was studied in a randomised, double blind, placebo controlled study in 22 patients. The mortality rate was reduced by 36.1% with the addition of corticosteroids to the regime of treatment. Betamethasone did not alter the duration of intensive care in those requiring it, but reduced the need for tracheostomy and ventilation. The mean daily dose of diazepam required was not significantly different between the two groups and there was no increase in the incidence of infections in the betamethasone group.
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Affiliation(s)
- S T Chandy
- Department of Medicine, Christian Medical College & Hospital, Vellore
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Nayyar V. Pleural aspiration and biopsy. Natl Med J India 1992; 5:76-80. [PMID: 1304272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- V Nayyar
- Department of Medicine, Christian Medical College, Vellore, Tamilnadu, India
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