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Adlakha P, Maheshwari G, Dhanawat A, Sinwer R, Singhal M, Jakhar SL, Sharma N, Kumar HS. Comparison of two schedules of hypo-fractionated radiotherapy in locally advanced head-and-neck cancers. J Cancer Res Ther 2022; 18:S151-S156. [PMID: 36510956 DOI: 10.4103/jcrt.jcrt_1793_20] [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] [Indexed: 12/15/2022]
Abstract
Aim In India, more than 70% patients present as locally advanced head-and-neck cancers (LAHNC), with poor performance status and are suitable candidates for palliative radiotherapy (RT) aimed at symptom relief. This prospective study aims to compare two different short course hypo-fractionated RT regimens in patients of LAHNC at a regional cancer centre of north-west India. Materials and Methods A total of 70 patients of LAHNC were randomized to receive palliative RT in two groups of 35 each. Group A received 30 Gy/10# over 2 weeks and Group B received 20 Gy/5# over 1 week. Baseline symptoms of pain, dysphagia, insomnia, dysphonia, bleeding, fungation, and dyspnea were assessed before the start of study. The first assessment for toxicities, subjective and objective response was done at the conclusion of RT and then after 4-6 weeks. Results Out of total 70 patients, 71% were males and 29% were females with a median age of 54 years. The most common sites were oropharynx (39%) followed by larynx (24%), oral cavity (20%), and hypopharynx (17%). Nearly 60% of the patients in both groups presented in stage IV and 40% in stage III. At conclusion of RT and at 4-6 weeks follow-up, both groups showed similar results in terms of symptom palliation, objective response, and acute toxicities. Group B showed higher incidence of Grade III and above mucositis (P = 0.027). Median overall survival was found to be 5.9 months (range 1-15 months) in group A and 6.1 months (range 1-18 months) in Group B. Conclusion Hypo-fractionated RT promises to effectively relieve symptoms in LAHNC and reduces the need of analgesics and hospital visits. Furthermore, a shorter overall treatment time is beneficial at high volume centers and is also welcomed by patients with shorter life expectancy.
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Affiliation(s)
- Pramila Adlakha
- Department of Radiation Oncology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Guncha Maheshwari
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Aditya Dhanawat
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajesh Sinwer
- Department of Radiation Oncology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Mukesh Singhal
- Department of Radiation Oncology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Shankar Lal Jakhar
- Department of Radiation Oncology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Neeti Sharma
- Department of Radiation Oncology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Harvindra Singh Kumar
- Department of Radiation Oncology, Sardar Patel Medical College, Bikaner, Rajasthan, India
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Goel A, Malik A, Bandyopadhyay D, Gupta R, Hajra A, Krishnan AM, Singhal M, Ahmad H. Trends in outcomes, complications and readmission rates in patients undergoing transcatheter aortic valve implantation: a nationwide analysis from 2012 to 2019. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2096] [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
Transcatheter aortic valve implantation (TAVI) has evolved over the years from a procedure requiring surgical vascular access and general anesthesia, to one that can be completed entirely percutaneously with conscious sedation. Advancement in procedural techniques and operator experience has resulted in better outcomes for patients undergoing TAVI.
Purpose
The purpose of our study was to analyze the trends over the years in outcomes, complications and unplanned readmission rate in patients undergoing TAVI.
Methods
The United States Nationwide Readmission Database for the years 2012 to 2019 was queried to identify all adult patients who underwent elective TAVI. The primary outcome of the study was inpatient mortality during TAVI hospitalization. Secondary outcomes included periprocedural complications (like acute kidney injury, bleeding requiring transfusion, need for permanent pacemaker implantation, stroke), length of stay, hospitalization cost, and unplanned 30-day readmission rate. Appropriate International Classification of Diseases (ICD-9 and ICD-10) codes were used to identify comorbidities and complications.
Results
A total of 283,409 patients who underwent TAVI were included in the study. The baseline characteristics of these patients are shown in picture 1. The inpatient mortality during TAVI admission declined steadily and significantly from 5.3% in the year 2012 to 0.0% in the year 2019 (p value for trend <0.001). There was a significant reduction in peri-TAVI occurrence of acute kidney injury (from 18.1% in 2012 to 8.7% in 2019), bleeding requiring transfusion (from 28.0% in 2012 to 4.3% in 2019), and stroke (from 1.8% in 2012 to 0.1% in 2019) (p value for trend <0.001 for all). Periprocedural conduction abnormalities requiring permanent pacemaker implantation increased from 7.4% in 2012 to 12.1% in 2015, before coming down to 8.9% in 2019 (p value for trend <0.001). The mean length of hospital stay and inflation-adjusted costs during admission for TAVI decreased from 9.6 days and $64,695 in the year 2012, to 3.6 days and $49,710 in the year 2019, respectively (p value for both <0.001). The unplanned 30-day all-cause readmission rate after TAVI also reduced steadily and significantly from 18.2% in 2012 to 11.5% in 2019 (p value <0.001).
Conclusion
Over the years, there has been a significant reduction in inpatient mortality, periprocedural complications (such as acute kidney injury, need for blood transfusion, stroke), length of hospital stay, and inflation-adjusted hospital costs in patients undergoing transcatheter aortic valve implantation. Furthermore, there has been a significant decline in the 30-day unplanned readmission rate after transcatheter aortic valve implantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Goel
- Westchester Medical Center , Valhalla , United States of America
| | - A Malik
- Westchester Medical Center , Valhalla , United States of America
| | - D Bandyopadhyay
- Westchester Medical Center , Valhalla , United States of America
| | - R Gupta
- Lehigh Valley Hospital , Allentown , United States of America
| | - A Hajra
- Jacobi Medical Center/Albert Einstein College of Medicine , New York , United States of America
| | - A M Krishnan
- The University of Vermont Medical Center , Burlington , United States of America
| | - M Singhal
- Cape Fear Valley Medical Center , Fayetteville , United States of America
| | - H Ahmad
- Westchester Medical Center , Valhalla , United States of America
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Arora N, Behera A, Naganur SH, Chhabra M, Singhal M, Dhibar DP. Hydatid disease and the heart. QJM 2021; 114:342. [PMID: 33459794 DOI: 10.1093/qjmed/hcab003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Behera
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S H Naganur
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - M Singhal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D P Dhibar
- Department of Internal medicine , Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Cisneros R, Gharibi H, Entwistle MR, Tavallali P, Singhal M, Schweizer D. Nitrogen dioxide and asthma emergency department visits in California, USA during cold season (November to February) of 2005 to 2015: A time-stratified case-crossover analysis. Sci Total Environ 2021; 754:142089. [PMID: 33254941 DOI: 10.1016/j.scitotenv.2020.142089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/03/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 06/12/2023]
Abstract
Nitrogen dioxide (NO2) is responsible for aggravating respiratory diseases, particularly asthma. The aim of this study is to investigate the association between NO2 exposure and asthma emergency department (ED) visits during the cold season (November-February) in five populated locations (Sacramento, San Francisco, Fresno, Los Angeles, and San Diego) of California from 2005 to 2015 (1320 Days). Conditional logistic regression models were used to obtain the odds ratio (OR) and 95% confidence interval (CI) associated with a 5 ppb increase in NO2 concentration for the 19,735 ED visits identified. An increase in NO2 exposure increased the odds of having asthma ED visits for the studied population. The potential effect modification by sex (female and male), race (White, Black, Hispanic, and Asian), and age (2-5, 6-18, 19-40, 41-64, and ≥65) was explored. A 5 ppb increase in the concentration of NO2 during lag 0-30 was associated with a 56% increase in the odds of having an asthma ED visit (OR = 1.560, CI: 1.428-1.703). Sex was not found to be a modifier. Asthma ED visits among all the races/ethnicities (except Asians) were associated with NO2 exposure. Whites had the highest OR 75% (OR = 1.750, CI: 1.417-2.160) at lag 0-30 in response to NO2 exposure. The association between NO2 exposure and asthma ED visits was positive among all age groups except for 19 to 40 years old; the OR was higher among 2 to 18 year old (at lag 0-30: age group 2-5 (OR = 1.699, CI: 1.399-2.062), and age group 6-18 (OR = 1.568, CI 1.348-1.825)). For stratification by location, San Diego and Fresno were found to have the highest OR, compared to the other studied locations.
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Affiliation(s)
- Ricardo Cisneros
- Health Sciences Research Institute, University of California, Merced, USA.
| | - Hamed Gharibi
- Health Sciences Research Institute, University of California, Merced, USA.
| | | | - Pooya Tavallali
- Electrical Engineering and Computer Science, University of California, Merced, USA.
| | - Mukesh Singhal
- Electrical Engineering and Computer Science, University of California, Merced, USA.
| | - Donald Schweizer
- Health Sciences Research Institute, University of California, Merced, USA; USDA Forest Service, Pacific Southwest Region, 1600 Tollhouse Road, Clovis, CA 93611, USA.
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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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6
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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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Chandra GS, Singhal M, Valame S, Sharma A. 51P Shortcomings of immuno oncology (IO) agents application into real-world practise due to financial constraints in a resource constrained setting. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.538] [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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Abstract
BACKGROUND The purpose of this study was to compare the outcomes of infants with giant omphalocele (GO) born in two different epochs over two decades at a single institution. Specifically, it examined whether the utilization of selective pulmonary vasodilators and extracorporeal membrane oxygenator (ECMO) in the management of pulmonary hypertension in the second epoch were associated with improved outcomes. METHODS The medical records of all patients diagnosed with GO at a large children's hospital from January 1, 1996 to December 31, 2016 were reviewed and divided into two epochs. Patients were classified as having an isolated GO or GO with minor or major associated anomalies. GO was defined as a defect more than or equal to 5 cm in size and/or liver in the sac. RESULTS During the study period, 59 infants with GO were identified. The duration of invasive mechanical ventilation was significantly shorter among the survivors from the second epoch (p = 0.03), with none greater than seven days. There were no significant differences in the outcomes of survival to NICU discharge and length of stay (LOS) between infants in the two epochs. CONCLUSIONS Infants with GO who required invasive mechanical ventilation for more than seven days did not survive in the second epoch. Survival did not improve with uses of selective pulmonary vasodilators and ECMO. This information could be shared with families during prenatal and postnatal counselling to facilitate informed decision making regarding goals of care.
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Affiliation(s)
- R E Witt
- Department of Pediatrics, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - M Singhal
- Department of Pediatrics, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - A J Vachharajani
- Department of Pediatrics, Washington University in Saint Louis, Saint Louis, Missouri, USA
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Dar PMUD, Gupta P, Kaul RP, Kumar A, Gamangatti S, Kumar S, Gupta A, Singhal M, Sagar S. Haemorrhage control beyond Advanced Trauma Life Support (ATLS) protocol in life threatening maxillofacial trauma - experience from a level Ⅰ trauma centre. Br J Oral Maxillofac Surg 2020; 59:700-704. [PMID: 34092410 DOI: 10.1016/j.bjoms.2020.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 11/16/2022]
Abstract
Maxillofacial injuries are usually not life-threatening and do not get priority over other associated injuries. However, some maxillofacial injuries with active oral or nasal bleeding need immediate management due to threatened airway and blood loss. In the case of major active vascular bleeding, measures such as local pressure, anterior nasal packing, posterior nasal packing, and balloon tamponade are ineffective. In these cases, angiography and transcatheter arterial embolisation (TAE) are used to treat life-threatening haemorrhage caused by maxillofacial trauma. We analysed the medical records of 39 patients with severe maxillofacial trauma and life-threatening haemorrhage that was a result of intractable oral or nasal bleeding. These patients were considered for TAE from January 2010 to December 2019. A total of 1668 patients was admitted, out of which 39 (2.3%) had severe maxillofacial injuries with life-threatening oral or nasal bleeding and underwent TAE. Out of a total of 39 patients, 38 were male and one female. Ages ranged from 16 to 65 years. Road traffic injury was the most common cause of injury (79.5%), Lefort I and II were the most common facial fractures, and traumatic brain injury was the most common associated injury. Embolisation and bleeding control were done successfully in all 39 patients with no procedure-related complications. A total of 17 deaths during the study period were due to severe traumatic brain injuries or haemorrhagic shock.
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Affiliation(s)
- P M U D Dar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - P Gupta
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - R P Kaul
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - A Kumar
- Department of Radio Diagnosis, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - S Gamangatti
- Department of Radio Diagnosis, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - S Kumar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - A Gupta
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - M Singhal
- Department of Plastic and Reconstructive Surgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - S Sagar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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Chattopadhyay A, Singhal M, Debi U, Sharma A, Jain S. THU0299 MYOCARDIAL INVOLVEMENT IN TAKAYASU ARTERITIS PATIENTS ASSESSED BY MAGNETIC RESONANCE IMAGING AND ITS RELATION WITH DISEASE ACTIVITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Cardiac involvement in Takayasu arteritis(TA) is the major cause of morbidity and mortality. [1] Cardiovascular magnetic resonance (CMR) is an excellent modality for the assessment of myocardial involvement. Studies have shown subclinical myocardial scarring in 25-27% of patients.[2,3] There is no such study from India.Objectives:To evaluate the prevalence of myocardial involvement in TA, as detected by CMR and its correlation with disease activity score (ITAS 2010 and ITAS-A).Methods:Patients classified as Takayasu arteritis according to Sharma et al. criteria [4] were included after an informed consent. Demographic, clinical, laboratory data were documented in the predesigned proforma. CMR was done on a dedicated CMR machine. Disease activity was recorded by ITAS2010 and ITAS-A.[5] Ethical clearance has been obtained from the ethics committee of the institute (INT/IEC/2018/001538).Results:In the present study, 37 TA patients were included. Mean(±SD) age was 29 ±11 years. Female to male ratio was 3:1. The most frequent presenting symptom was upper limb claudication (49%), and vessel involved was left subclavian and descending thoracic aorta(75% each). Of the total cohort, 65% had hypertension, 35% had dyslipidemia and 19% had valvular involvement. Five patients (14%) had myocardial involvement as detected by CMR. Three (8%) patients had late gadolinium enhancement(LGE) on CMR suggestive of myocardial fibrosis. In the current study, both the CMR and echocardiography performed equally in detecting various valvular heart disease, whereas only CMR had detected subclinical myocardial fibrosis in two patients. Details of different risk factors and relation with disease activity provided in table 1.Conclusion:To the best of our knowledge, this is the largest cohort on CMR in TA. Prevalence of subclinical myocardial involvement in Indian patients was much less(8% vs 25-27%) compared to the previous studies. The higher percentage of LGE detected by the earlier studies may be a reflection of cumulative damage with increasing age, prolonged hypertension, and disease duration. Myocardial involvement trend towards early age of onset, less disease duration, lack of classical risk factors, and more with disease activity. Judicious use of CMR may help in detecting subclinical myocardial involvement.Table 1.Relation of different risk factors with myocardial heart disease.ParametersMHD - (n=32)MHD + (n=5)pDisease duration>5 yr13(41)2(40)0.98Age at onset<18 yr7(22)3(60)0.07BMI>23kg/m219(59)1(20)0.1Hb<12gm/dl16(50)2(40)0.68Platelets>450x 109/L4(13)0(0)0.40ESR>20 mm in 1sthour28(88)4(80)0.65CRP>10 mg/dl16(50)4(80)0.21Cholesterol>200 mg/dl10(31)1(20)0.61LDL>130 mg/dl9(28)0(0)0.17BNP>125 pg/ml11(34)3(60)0.27ITAS2010-Active17(53)3(60)0.77ITAS-A-Active11(34)3(60)0.27[MHD: myocardial heart disease]References:[1]Cong XL, Dai SM, Feng X et al. Takayasu’s arteritis: clinical features and out- comes of 125 patients in China. Clin Rheumatol 2010;29:973–81.[2]Keenan NG, Mason JC, Maceira A et al. Integrated cardiac and vascular assessment in Takayasu arteritis by cardiovascular magnetic resonance. Arthritis Rheum. 2009;60:3501-9.[3]Comarmond C, Cluzel P, Toledano D et. al. Findings of cardiac magnetic resonance imaging in asymptomatic myocardial ischemic disease in Takayasu arteritis. Am J Cardiol. 2014;113:881-7.[4]Sharma BK, Jain S, Suri S et al. Diagnostic criteria for Takayasu Arteritis. Int J Cardiol 1996;54: S141-7.[5]Misra R, Danda D, Rajappa SM, et al. Development and initial validation of the Indian Takayasu Clinical Activity Score (ITAS2010). Rheumatology 2013;52:1795-801.Disclosure of Interests:None declared
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Gabella P, Singhal M, Szabo T, Vas S, Oreopoulos D. Therapy with Gastric Acid Inhibitors is not Related to Enteric Peritonitis in Peritoneal Dialysis. ARCH ESP UROL 2020. [DOI: 10.1177/089686089801800619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P. Gabella
- The Toronto General Hospital Western Division 399 Bathurst St. Toronto, Ontario M5T 2S8 Canada
| | - M. Singhal
- The Toronto General Hospital Western Division 399 Bathurst St. Toronto, Ontario M5T 2S8 Canada
| | - T. Szabo
- The Toronto General Hospital Western Division 399 Bathurst St. Toronto, Ontario M5T 2S8 Canada
| | - S. Vas
- The Toronto General Hospital Western Division 399 Bathurst St. Toronto, Ontario M5T 2S8 Canada
| | - D.G. Oreopoulos
- The Toronto General Hospital Western Division 399 Bathurst St. Toronto, Ontario M5T 2S8 Canada
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Sandal R, Jandial A, Mishra K, Singhal M, Malhotra P. Pulmonary arteriovenous malformations. QJM 2019; 112:141-142. [PMID: 30215798 DOI: 10.1093/qjmed/hcy207] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Sandal
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Jandial
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Mishra
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M Singhal
- Department of Radio-diagnosis, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Malhotra
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
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Tewari KS, Agarwal A, Pathak A, Ramesh A, Parikh B, Singhal M, Saini G, Sushma PV, Huilgol N, Gundeti S, Gupta S, Nangia S, Rawat S, Alurkar S, Goswami V, Swarup B, Ugile B, Jain S, Kukreja A. Meeting report, “First Indian national conference on cervical cancer management - expert recommendations and identification of barriers to implementation”. gynaecol oncol res pract 2018. [PMCID: PMC6063013 DOI: 10.1186/s40661-018-0061-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objective In India, cervical cancer accounts for almost 14% of all female cancer cases. Although poverty continues to cast a wide net over the Indian subcontinent, the preceding three decades have borne witness to improvements in nutrition and sanitation for many citizens. However, due to an absence of a national immunization program to cover human papillomavirus (HPV) vaccination and lack of accessible cervical cancer screening, the disease is characterized by late detection, lack of access to affordable and quality health care, and high mortality rates. Treatment of cervical cancer is stage-specific and depends on the patient’s age, desire to preserve fertility, overall health, the clinician’s expertise, and accessibility to resources. There is a paucity of uniform treatment protocols for various stages of cervical cancer in India. Considering all these parameters, a need to optimize treatment paradigms for the Indian population emerged. Methods/materials Three expert panel meetings were held in different regions of India from 2016 to 2017. They were comprised of 15 experts from across the country, and included surgical oncologists, radiation oncologists, and medical oncologists. The panel members reviewed the literature from both national and global sources, discussed their clinical experience and local practices and evaluated current therapeutic options and management gaps for women diagnosed with cervical cancer. Results This article summarizes the expert opinion from these meetings. It discusses the available resources and highlights the current therapeutic options available for different cervical cancer stages: early stage disease, locally advanced tumors, recurrent/persistent/metastatic cancer. An Indian consensus governing treatment options emerged, including guidelines for use of the only approved targeted therapy in this disease, the anti-angiogenesis drug, bevacizumab. Conclusions The panel concluded that given the availability of state-of-the-art imaging modalities, surgical devices, radiotherapeutics, and novel agents in several population-dense urban centers, a uniform, multi-disciplinary treatment approach across patient care centers is ideal but not realistic due to cost and a paucity of third party payors for most Indian citizens. Preventative strategies including visual inspection with acetic acid to screen for precursor lesions (i.e., cervical intraepithelial neoplasia) with immediate referral for cervical cryotherapy and possible large-scale roll-out of the HPV vaccine in the near future can be expected to reduce mortality rates significantly in this country.
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Dharabuoriya A, Singhal M, Srivastava A, Dhar A, Kumar C, Kataria K, Ranjan P. Lateral mammary crease incision – an aesthetic incision for Skin and Nipple sparing mastectomy. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30436-2] [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: 10/17/2022]
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Satheesh C, Bhatt A, Singhal M, Aarthi R, Shubham K, Madhura G, Maka V, Naik R, Iyer S, Shafi G. 53P Lung cancer: Beyond EGFR and ALK dichotomy. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30330-7] [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: 10/17/2022]
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LaGrandeur RG, Singhal M, Bany-Mohammed F, Uy C, Koeppel R, Zaldivar F, Haddad F, Nalbandian A, Donovan P, Cooper DM, Aslam M. Pilot feasibility study to detect mesenchymal stem cell biomarkers of bronchopulmonary dysplasia in the tracheal aspirate fluid of preterm infants. J Neonatal Perinatal Med 2018; 11:1-10. [PMID: 29689740 DOI: 10.3233/npm-181722] [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] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study aimed to detect novel mesenchymal stem cell peptides/biomarkers of bronchopulmonary dysplasia (BPD) in the tracheal aspirate fluid (TAF) of preterm infants. STUDY DESIGN Participants included infants less than 32 weeks' gestational age or birth weight under 1500 grams who required endotracheal intubation and mechanical ventilation within first 24 hours of life. TAF sample collection was performed at the time of the first clinically indicated routine suctioning. Standardization curves for human levels of osteopontin (Opn), macrophage colony stimulating factor 1 (Csf1), transforming growth factor beta 1 (TGF-β1), and secretory immunoglobulin A (sIgA) were generated for 15 enrolled participants. RESULTS We demonstrated that stem cell biomarkers are secreted into the TAF of preterm infants and their concentrations can be easily measured during the first week of life. CONCLUSIONS Further studies are warranted to determine a causal relationship between these biomarkers and BPD development and severity.
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Affiliation(s)
- R G LaGrandeur
- Department of Pediatrics, Division of Neonatology, University of California Irvine, Irvine, CA, USA
| | - M Singhal
- Department of Pediatrics, Division of Neonatology, University of California Irvine, Irvine, CA, USA
| | - F Bany-Mohammed
- Department of Pediatrics, Division of Neonatology, University of California Irvine, Irvine, CA, USA
| | - C Uy
- Department of Pediatrics, Division of Neonatology, University of California Irvine, Irvine, CA, USA
| | - R Koeppel
- Department of Pediatrics, Division of Neonatology, University of California Irvine, Irvine, CA, USA
| | - F Zaldivar
- Institute for Clinical and Translational Science, University of California Irvine, Irvine, CA, USA
| | - F Haddad
- Institute for Clinical and Translational Science, University of California Irvine, Irvine, CA, USA
| | - A Nalbandian
- Department of Pediatrics, Division of Neonatology, University of California Irvine, Irvine, CA, USA
| | - P Donovan
- Department of Developmental and Cellular Biology and of Biological Chemistry, University of California Irvine, Irvine, CA, USA
| | - D M Cooper
- Department of Pediatrics, Division of Pulmonology, University of California Irvine, Irvine, CA, USA
| | - M Aslam
- Department of Pediatrics, Division of Neonatology, University of California Irvine, Irvine, CA, USA
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Dixit A, Yadav S, Kumar N, Khan T, Hajela S, Singhal M. Validation of computer code ‘ATMIKA’ against RD-14M Small Break LOCA experiments. Nuclear Engineering and Design 2017. [DOI: 10.1016/j.nucengdes.2017.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chandrasekhar S, Ibrahim A, Singhal M. A novel access control protocol using proxy signatures for cloud-based health information exchange. Comput Secur 2017. [DOI: 10.1016/j.cose.2017.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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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Chaudhary R, Chauhan A, Singhal M, Bagga S. Risk factor profiling and study of atherosclerotic coronary plaque burden and morphology with coronary computed tomography angiography in coronary artery disease among young Indians. Int J Cardiol 2017; 240:452-457. [PMID: 28477962 DOI: 10.1016/j.ijcard.2017.04.090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Received: 12/22/2016] [Revised: 04/21/2017] [Accepted: 04/26/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND With a decade earlier manifestation of coronary artery disease (CAD) and paucity of data characterizing coronary plaque with coronary computed tomography angiography (CTA) among CAD patients in India, the study aimed to analyze patient characteristics and coronary plaque burden and morphology in young Indian patients with CAD. METHODS Serial coronary CTA was performed in 96 CAD patients. Among 60 patients ≤40years, risk factor and coronary plaque analysis done using a 256- slice CT in 33 patients with acute coronary syndrome (ACS) was compared with 27 patients with chronic stable angina (CSA). Univariate and multivariate analysis was performed, for factors predicting ACS as an outcome among young CAD patients. In addition, quantitative and morphologic plaque characteristics were compared among those ≤40years and >40years. RESULTS Among 60 subjects ≤40years of age, 77% had dyslipidemia, 70% high lipoprotein(a), 53.33% elevated hs-CRP and 73.33% raised homocysteine. hs-CRP (9.33 vs. 3.33, p value=0.01) and serum triglycerides (178.67 vs. 141.42, p value=0.03) were markedly raised in patients with ACS. Statistically significant number of patients in the ACS group had positive remodelling (ACS, 69.7% vs. CSA, 14.8%; p value<0.001), low attenuation plaque (ACS, 63.6% vs. CSA, 11.1%; p value<0.001), spotty calcification (ACS, 36.4% vs. CSA, 3.7%; p=0.002) and non-calcified plaque (ACS, 69.7% vs. CSA, 11.1%; p<0.001). On multivariate analysis, only lipoprotein (a) >30mg/dL and composite vulnerability score maintained a predictive value for ACS in patients ≤40years. Statistically significant number of patients in the younger age group had higher mean total plaque volume (66.17±41.31mm3 vs. 44.94±49.07mm3; p=0.03), remodelling index (1.5±0.27 vs. 1.08±0.38; p=0.0001). Comparing culprit lesion characteristics of ACS patients in the two age groups, positive remodelling (95.8% vs. 70.5%, p=0.02), spotty calcification (50% vs. 11.7%, p=0.01) and non-calcified plaque (95.8% vs. 70.5%, p=0.02) were significantly more frequent in patients ≤40years. CONCLUSION ACS in young Indians is characterized by a higher prevalence of both conventional and newer risk factors. In addition, culprit lesions in young ACS patients are more frequently characterized by coronary plaques with high risk morphological features. This may have implications in terms of preventive strategies to identify this high-risk group.
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Affiliation(s)
- R Chaudhary
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Chauhan
- Department of Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M Singhal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Bagga
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Marchetti A, Singhal M, Faulwasser T, Bonvin D. Modifier adaptation with guaranteed feasibility in the presence of gradient uncertainty. Comput Chem Eng 2017. [DOI: 10.1016/j.compchemeng.2016.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Parikh PM, Ranade AA, Govind B, Ghadyalpatil N, Singh R, Bharath R, Bhattacharyya GS, Koyande S, Singhal M, Vora A, Verma A, Hingmire S. Lung cancer in India: Current status and promising strategies. South Asian J Cancer 2016; 5:93-5. [PMID: 27606289 PMCID: PMC4991145 DOI: 10.4103/2278-330x.187563] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- P M Parikh
- Asian Cancer Institute, KJ Somaiya Ayurvihar, Mumbai, Maharashtra, India
| | - A A Ranade
- Avinash Cancer Clinic, Pune, Maharashtra, India
| | - Babu Govind
- Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - R Singh
- HCG Cancer Center, New Delhi, India
| | - R Bharath
- Kovai Hospital, Coimbatore, Tamil Nadu, India
| | | | - S Koyande
- Indian Cancer Society, Mumbai, Maharashtra, India
| | - M Singhal
- Indraprastha Apollo Hospital, New Delhi, India
| | - A Vora
- Max Hospital, New Delhi, India
| | - A Verma
- Max Hospital, New Delhi, India
| | - S Hingmire
- Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
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Kapoor A, Charan I, Singhal M, Kumar H. Borderline phyllodes tumor of breast in a premenarchal girl: A relatively common tumor at an uncommon age. Int J Cancer Ther Oncol 2016. [DOI: 10.14319/ijcto.42.13] [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: 11/05/2022] Open
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Kumari P, Beniwal S, Khatri P, Singhal M, Saugat S. P-112 Weekly gemcitabine for the treatment of biliary tract and gallbladder cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kumar A, Gupta A, Singhal M, Gupta A, Nada R, Minz R, Suri D, Singh S. SAT0264 A Single Centre Experience of Childhood Polyarteritis Nodosa from North India. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Saugat S, Kumar H, Sharma N, Singhal M, Beniwal S, Kumari P, Narayan S, Kapoor A, Jakhar S, Maharia S, Nirban R. RM-024 Survival analysis of post-operatively treated cancer gall bladder patients with Adjuvant Chemo-radiotherapy: an institutional study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw201.23] [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: 11/12/2022] Open
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Kumari P, Narayan S, Singhal M, Saugat S. RM-010 Irinotecan and oxaliplatin-based regimens in metastatic colorectal cancer and optimization of sequence: a regional cancer center study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw201.10] [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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Kumari P, Khatri P, Singhal M. RM-025 Chemoradiation for unresectable gall bladder cancer: regional cancer centre study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw201.24] [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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Jagadeeshan S, Subramanian A, Tentu S, Beesetti S, Singhal M, Raghavan S, Surabhi RP, Mavuluri J, Bhoopalan H, Biswal J, Pitani RS, Chidambaram S, Sundaram S, Malathi R, Jeyaraman J, Nair AS, Venkatraman G, Rayala SK. P21-activated kinase 1 (Pak1) signaling influences therapeutic outcome in pancreatic cancer. Ann Oncol 2016; 27:1546-56. [PMID: 27117533 DOI: 10.1093/annonc/mdw184] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 11/26/2015] [Accepted: 04/21/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Therapeutic resistance to gemcitabine in pancreatic ductal adenocarcinoma (PDAC) is attributed to various cellular mechanisms and signaling molecules that influence as a single factor or in combination. DESIGN In this study, utilizing in vitro p21-activated kinase 1 (Pak1) overexpression and knockdown cell line models along with in vivo athymic mouse tumor xenograft models and clinical samples, we demonstrate that Pak1 is a crucial signaling kinase in gemcitabine resistance. RESULTS Pak1 kindles resistance via modulation of epithelial-mesenchymal transition and activation of pancreatic stellate cells. Our results from gemcitabine-resistant and -sensitive cell line models showed that elevated Pak1 kinase activity is required to confer gemcitabine resistance. This was substantiated by elevated levels of phosphorylated Pak1 and ribonucleotide reductase M1 levels in the majority of human PDAC tumors when compared with normal. Delineation of the signaling pathway revealed that Pak1 confers resistance to gemcitabine by preventing DNA damage, inhibiting apoptosis and regulating survival signals via NF-κB. Furthermore, we found that Pak1 is an upstream interacting substrate of transforming growth factor β-activated kinase 1-a molecule implicated in gemcitabine resistance. Molecular mechanistic studies revealed that gemcitabine docks with the active site of Pak1; furthermore, gemcitabine treatment induces Pak1 kinase activity both in vivo and in cell-free system. Finally, results from athymic mouse tumor models illustrated that Pak1 inhibition by IPA-3 enhances the cytotoxicity of gemcitabine and brings about pancreatic tumor regression. CONCLUSION To our knowledge, this is the first study illustrating the mechanistic role of Pak1 in causing gemcitabine resistance via multiple signaling crosstalks, and hence Pak1-specific inhibitors will prove to be a better adjuvant with existing chemotherapy modality for PDAC.
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Affiliation(s)
- S Jagadeeshan
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai Department of Genetics, University of Madras, Chennai
| | - A Subramanian
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - S Tentu
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - S Beesetti
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - M Singhal
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | - S Raghavan
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | | | - J Mavuluri
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
| | | | - J Biswal
- Department of Bioinformatics, Alagappa University, Karaikudi
| | | | | | - S Sundaram
- Department of Pathology, Sri Ramachandra University, Porur, Chennai
| | - R Malathi
- Department of Genetics, University of Madras, Chennai
| | - J Jeyaraman
- Department of Bioinformatics, Alagappa University, Karaikudi
| | - A S Nair
- Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, Kerala, India
| | | | - S K Rayala
- Department of Biotechnology, Indian Institute of Technology Madras (IITM), Chennai
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Singhal M, Gupta P, Sharma A, Lal A, Rathi M, Khandelwal N. Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa. Clin Radiol 2016; 71:222-7. [DOI: 10.1016/j.crad.2015.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 09/16/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
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Singhal M, Jarava D, Manzella C, Kumar A, Malhotra P, Saksena S, Alrefai W, Dudeja P, Gill R. Expression and Regulation of Intestine Specific Serotonin Transporter (iSERT) Variant. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.855.3] [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: 11/11/2022]
Affiliation(s)
- M Singhal
- MedicineUniv of IL at ChicagoChicagoILUnited States
| | - D Jarava
- MedicineUniv of IL at ChicagoChicagoILUnited States
| | - C Manzella
- MedicineUniv of IL at ChicagoChicagoILUnited States
| | - A Kumar
- MedicineUniv of IL at ChicagoChicagoILUnited States
| | - P Malhotra
- MedicineUniv of IL at ChicagoChicagoILUnited States
| | - S Saksena
- MedicineUniv of IL at ChicagoChicagoILUnited States
| | - W Alrefai
- MedicineUniv of IL at ChicagoChicagoILUnited States
- Research JBVAMCChicagoILUnited States
| | - P Dudeja
- MedicineUniv of IL at ChicagoChicagoILUnited States
- Research JBVAMCChicagoILUnited States
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Kapoor A, Singhal M, Kumar N, Lal S, Narayan S, Bagri P, Singh D, Nirban R, Maharia S, Singh G, Jakhar S, Beniwal S, Sharma N, Kumar H, Kumari P, Sharma A, Bardia M. Analysis of Sociodemographic Parameters of Esophageal Cancer and its Association with ABO Blood Group. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu164.15] [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: 11/14/2022] Open
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Lal A, Singhal M, Ramachandran R, Rathi M, Jha V, Khandelwal N. Percutaneous injection of acrylic glue into renal allograft pseudoaneurysm for control of intractable post-biopsy hematuria. Indian J Nephrol 2014; 24:124-6. [PMID: 24701048 PMCID: PMC3968602 DOI: 10.4103/0971-4065.127909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report a 44-year-old male, renal allograft recipient of 1-year duration who had two episodes of steroid responsive acute rejection. He presented with graft dysfunction for which a graft biopsy was performed and was suggestive of mixed rejection. At 2 weeks post-biopsy, patient developed severe pain over the graft site with anuria and graft hydronephrosis (HDN). The HDN and anuria intermittently settled with the passage of blood clots per-urethra. Contrast enhanced computerized tomography was suggestive of pseudoaneurysm in the graft kidney. The case was successfully managed with ultrasound guided percutaneous cyanoacrylate glue injection into the pseudoaneurysm.
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Affiliation(s)
- A Lal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M Singhal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M Rathi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - V Jha
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N Khandelwal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bhalla A, Singhal M, Suri V, Singh V, Varma S. Liver injury in patients of dengue fever: Is alcohlism predictor of severity? Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1089] [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: 10/25/2022] Open
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Bhalla A, Singhal M, Suri V, Malhotra S, Shafiq N, Varma S. Methylprednisolone in dengue patients with alarm signs: The MIDWAS study. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1087] [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: 10/25/2022] Open
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Jain V, Gupta A, Gulia A, Singhal M, Gulati S, Tiwari SC, Kumar A. Gelatin-thrombin hemostatic matrix injection to salvage refractory post-renal graft biopsy bleed. Indian J Nephrol 2013; 23:149-52. [PMID: 23716926 PMCID: PMC3658297 DOI: 10.4103/0971-4065.109447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Post-renal biopsy bleeding refractory to angioembolization usually requires graft nephrectomy as a life-saving measure. Gelatin-thrombin hemostatic matrix injection in the needle tract is a novel attempt to control bleeding in such cases and to salvage the allograft. We hereby describe two cases of post-graft biopsy bleed. Both these patients continued to bleed even after angioembolization. They were shifted to the operating room upon developing hypotension, having received multiple blood transfusions with the intention of performing graft nephrectomy to save their lives. However, bleeding was successfully controlled by using Gelatin-thrombin hemostatic matrix injection in the biopsy needle tract. Patients improved hemodynamically after the procedure. Graft function returned to normal in both the cases. At an average follow-up of 10.4 months, both the patients have shown stable graft functions.
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Affiliation(s)
- V Jain
- Department of Urology, Robotics and Renal Transplant, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India
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Saini NK, Singhal M. Evaluation of antihyperglycemic activity of methanolic Tecomaria capensis Thunb. (Bignoniaceae) leaves extract in alloxan induced hyperglycemic rats. ASIAN PAC J TROP MED 2012. [DOI: 10.1016/s1995-7645(12)60179-5] [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: 10/27/2022] Open
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Singhal M, Singhal R. A CAD-CAM prosthodontic option and gingival zenith position for a rotated maxillary right central incisor: An evaluation. Indian J Dent Res 2012; 23:112-5. [PMID: 22842262 DOI: 10.4103/0970-9290.99053] [Citation(s) in RCA: 2] [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: 11/04/2022] Open
Abstract
OBJECTIVE Even with beautifully done restorations, an unattractive gingival zenith position, can negatively affect the smile of a person. In this short communication we describe the treatment of a rotated maxillary right central incisor using a digital photographic approach instead of the conventional approach. BACKGROUND The conjecture literature on prosthodontic considerations and gingival zenith position in cases of rotated maxillary central incisors is sparse. The gingival zenith level (GZL) in an apical-coronal direction of lateral incisors, relative to the gingival tangential zenith line joining the adjacent central incisor and canine, is approximately 1 mm under healthy conditions. MATERIALS AND METHODS For our patient, the treatment plan was decided by CAD-CAM technique as Zirconia, jacket crown. Clinical procedures included enameloplasty on the left central and right lateral maxillary incisors. Reduction of the rotated and crooked incisor was performed in the normal manner; periodontal plastic surgery was also done. RESULTS The patient expressed satisfaction with the intermediary (preliminary) two-dimensional photographs that were provided by the CAD-CAM system. The technique distinguished among the different treatment modalities for aesthetics and to relieve the emotional problems which were faced by female patient. The gingival zenith level of the rotated incisor was also improved. CONCLUSION Digital imaging provides an immediate treatment option for the patients. Software also provides an interim aid, for the clinician as well as technician, in the form of two-dimensional photographs. CAD-CAM is entirely a helping instrument against the conservative prosthetic options and gingival zenith position for a rotated central incisor. It helps in patient education and in motivation.
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Affiliation(s)
- Mukesh Singhal
- Department of Prosthodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
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Singhal M, Prasad S, Kumar S, Negi S, Gupta P, Gupta S, Rawat D, Chauhan L, Rai A. A novel 146bp region of Ag 85B mRNA as target in Taqman Real-time PCR for efficient detection of active genital tuberculosis. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.974] [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] Open
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Bansal SB, Saxena V, Pokhariyal S, Gupta P, Kher V, Ahlawat R, Singhal M, Gulati S. Comparison of azathioprine with mycophenolate mofetil in a living donor kidney transplant programme. Indian J Nephrol 2011; 21:258-63. [PMID: 22022086 PMCID: PMC3193669 DOI: 10.4103/0971-4065.85483] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
There are conflicting data regarding the comparative efficacy of mycophenolate mofetil (MMF) versus azathioprine (AZA) as maintenance immunosuppressive agent in kidney transplantation. The data are even less in combination with tacrolimus (TAC) in living donor kidney transplantation. A total of 205 living donor kidney transplants, on TAC-based triple drug immunosuppression were included in the study. A total of 113 patients received AZA and rest 92 were on MMF based protocol. TAC levels were monitored and graft biopsy was done whenever rejection was suspected. The outcomes were evaluated in terms acute rejection (AR) episodes at 1 year, infections, renal function, graft loss, and death between two groups. The study group comprised 163 males (79.5%) and 42 (20.5%) females. The mean age of patients was 42.4±11.8 years in the AZA group and 39.4 ±13.4 in the MMF group (P=0.09). The mean duration of follow-up was 491.7±240.7 and 478.8±334.4 days respectively in the AZA and MMF groups (P=0.75). Thirty-seven of 92 (40.2%) patients in the MMF group and 70/113 (61.9%) patients in the AZA group received IL-2 RAb induction (P=0.002). 32 patients (15.6 %) developed AR within a year. The incidence of AR was similar in patients who received MMF (12/92, 13%) and those who received AZA (20/113, 17.5%), (P=0.36). There was no difference in the incidence of AR in the subgroup of patients who received IL-2 RAb compared to those who did not receive induction in the two groups (5/37 vs. 7/55 in the MMF group and 10/70 vs. 10/43 in the AZA group, P=0.72). The incidence of infections was similar in the two groups (19/92, 20.6% vs. 25/113, 22.1%, P=0.79). Three patients developed CMV disease, of which two were in the MMF group. Graft loss occurred in 7/205 (3.4%) and death in 8/205 (3.9%) patients. Six of eight patients who died had functioning grafts. The rate of graft loss (3/92 vs. 4/113, P=0.97) and death (5/92 vs. 3/113, P=0.27) was similar in two groups. The overall patient survival was 94.5% and death censored graft survival was 97.4%. Cost comparison suggests AZA to be 6-10 times cheaper than MMF. This study suggests that, in tacrolimus-based immunosuppression, azathioprine may be as good as MMF as maintenance immunosuppressive drug in living donor kidney transplantation. It is also a more cost-effective immunosuppression.
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Affiliation(s)
- S B Bansal
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta- The Medicity, Gurgaon, Haryana, India
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Sagar S, Kumar N, Singhal M, Kumar S, Kumar A. A rare case of life-threatening penetrating oropharyngeal trauma caused by toothbrush in a child. J Indian Soc Pedod Prev Dent 2010; 28:134-6. [PMID: 20660984 DOI: 10.4103/0970-4388.66758] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 11/04/2022] Open
Abstract
We present a case of 10 year-old boy with oropharyngeal injury caused by a toothbrush which penetrated the parapharyngeal space. Initial examination revealed broken end of the toothbrush in oral cavity with the head of the toothbrush having bristles, beyond the soft palate. Tongue and palate were lacerated and there were blood and oral secretions in the oral cavity. Patient was having bradycardia. Computed tomography (CT) scan showed the toothbrush head near the carotid artery, the carotid being laterally displaced. The foreign body was surgically removed without any intraoperative or postoperative complications.
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Affiliation(s)
- S Sagar
- Department of Surgery, Trauma Centre, AIIMS, New Delhi, India.
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Singhal M, Bansal SB, Saxena V, Pokhariyal S, Gulati S, Ahlalwat R, Kher V. 017 Successful Treatment of Recurrent FSGS post Kidney Transplant with Plasmapheresis and Rituximab – A report of 2 cases. Indian Journal of Transplantation 2010. [DOI: 10.1016/s2212-0017(11)60060-9] [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] Open
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Gulati S, Saxena V, Pokhariyal S, Singhal M, Bansal SB, Sharma R, Ahlalwat R, Kher V. 023 Steroid Free Immunosuppression in Kidney Transplantation : a useful alternative. Indian Journal of Transplantation 2010. [DOI: 10.1016/s2212-0017(11)60066-x] [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] Open
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Bansal SB, Singhal M, Ahlawat R, Kher V. Reply to 'kidney transplantation in a patient with HIV disease'. Indian J Nephrol 2009; 19:175. [PMID: 20535260 PMCID: PMC2875714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- S. B. Bansal
- Department of Nephrology and Kidney Transplantation, Fortis Hospital, Noida, India,Address for correspondence: Dr. Shyam B Bansal, B-22, Sector 62, Noida, UP-201 301, India. E-mail:
| | - M. Singhal
- Department of Nephrology and Kidney Transplantation, Fortis Hospital, Noida, India
| | - R. Ahlawat
- Department of Nephrology and Kidney Transplantation, Fortis Hospital, Noida, India
| | - V. Kher
- Department of Nephrology and Kidney Transplantation, Fortis Hospital, Noida, India
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Lal A, Singhal M, Kumar S, Bag S, Singh SK, Khandelwal N. Bilateral renal and jejunal metastasis of choriocarcinoma presenting as spontaneous renal hemorrhage. Cancer Imaging 2009; 9:56-8. [PMID: 19770094 PMCID: PMC2760937 DOI: 10.1102/1470-7330.2009.0010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Spontaneous renal hemorrhage (SRH) is a difficult diagnostic problem with various causes. We report a case of SRH and episodic gross hematuria in a patient with metastatic choriocarcinoma involving both kidneys for which successful angioembolization was carried out for control of hemorrhage. There was no evidence of primary uterine tumor and pulmonary or liver involvement. The patient developed gastrointestinal bleeding due to jejunal metastasis while on chemotherapy and surgical resection of the involved segment was carried. However, the patient acquired nosocomial pneumonia and succumbed to sepsis in the postoperative period.
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Affiliation(s)
- A Lal
- Department of Radio-diagnosis, Post Graduate Institute of Medical Education and Research, Sector 12, 160012 Chandigarh, India.
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