1.Tumour morphology after neoadjuvant chemotherapy as a predictor of survival in serous ovarian cancer: an experience from a tertiary care centre in India
Binny Khandakar ; Lalit Kumar ; Sunesh Kumar ; Siddharth Datta Gupta ; Kalaivani M ; Venkateswaran K Iyer ; Sandeep R Mathur
The Malaysian Journal of Pathology 2015;37(2):115-121
Serous ovarian cancer is the most common malignant ovarian tumour. Traditional management consists
of surgical resection with postoperative chemotherapy. Currently neoadjuvant chemotherapy is offered
to patients with advanced stage disease. The present study aims to analyse the histomorphological
alterations in serous ovarian cancer following neoadjuvant chemotherapy. Correlation of these
morphological alterations with survival is also presented here. Serous ovarian cancers from 100
advanced stage cases were included; 50 were treated with pre-surgery chemotherapy. Semi-quantitative
scoring was used to grade the alterations in tumour morphology. Survival data was correlated with
the final morphological score. Tumour morphology was significantly different in cases treated with
neoadjuvant chemotherapy (CT group) as compared to cases with upfront surgery. The CT group
cases showed more fibrosis, calcification, and infiltration by lymphocytes, plasma cells, foamy
and hemosiderin-laden macrophages. The residual tumour cells had degenerative cytoplasmic
changes with nuclear atypia. Patients with significant morphological response had a longer median
survival, although it did not attain statistical significance in the current study. With the increasing
use of neoadjuvant chemotherapy in management, the pathologist needs to be aware of the altered
morphological appearance of tumour. Further studies are required to establish a grading system to
assess the tissue response which can be helpful in predicting the overall therapeutic outcome and
the prognosis of patients.
2.A determination of occlusal plane comparing different levels of the tragus to form ala-tragal line or Camper's line: A photographic study.
Sandeep KUMAR ; Sandeep GARG ; Seema GUPTA
The Journal of Advanced Prosthodontics 2013;5(1):9-15
PURPOSE: The purpose of this study was to determine accurately the part of the tragus to be used to form the Ala-Tragal line or Camper's line in orthognathic profile patients. MATERIALS AND METHODS: 150 dentate subjects with age of 18-40 years with orthognathic profile were sampled. Life-size lateral digital photographs of the face with fox plane were taken in natural head position. Different angles between Eye-Ear plane and occlusal plane (OT1-OP), Eye-Ear plane and ala-superior border of tragus (OT1-AT1), Eye-Ear plane and ala-middle border of tragus (OT1-AT2) and Eye-Ear plane and ala-inferior border of tragus (OT1-AT3) were calculated using computer software package, AutoCAD 2004. From the three angles formed by the Eye-ear plane (OT1 or FH plane) and the ala-tragal lines, the one closest to the angle formed between Eye-Ear plane (OT1) and occlusal plane (OP) was used to determine the occlusal plane of orientation. The obtained results were subjected to ANOVA F test, Tukey's Honestly significant difference test, followed by Karl Pearson coefficient of correlation test. P values of less than 0.05 were taken as statistically significant. RESULTS: The mean of base line angle i.e. OT1-OP angle (11.96 +/- 4.36) was found to be close to OT1-AT2 angle (13.67 +/- 1.93) and OT1-AT3 angle (10.31 +/- 2.03), but OT1-OP angle was found to be more closer to OT1-AT3 angle. Comparison of mean angles showed that OT1-OP angle in both males (11.68) and females (12.51) is close to OT1-AT3 angle (males- 11.01, females- 11.95). CONCLUSION: The line joining from ala to the lower border of the tragus was parallel to the occlusal plane in 53.3% of the subjects. There was no influence of the sex on the level of occlusal plane.
Dental Occlusion
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Female
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Head
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Humans
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Male
;
Orientation
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Software
3.The effect of Valsalva maneuver in attenuating skin puncture pain during spinal anesthesia: a randomized controlled trial.
Sanjay KUMAR ; Sujeet Kumar Singh GAUTAM ; Devendra GUPTA ; Anil AGARWAL ; Sanjay DHIRRAJ ; Sandeep KHUBA
Korean Journal of Anesthesiology 2016;69(1):27-31
BACKGROUND: Valsalva maneuver reduces pain by activating sinoaortic baroreceptor reflex arc. We planned this study to evaluate the role of valsalva in attenuating spinal needle-puncture pain. METHODS: Ninety American Society of Anesthesiologists (ASA) grade I and II enrolled patients undergoing elective surgery were randomized into 3 groups of 30 each. Group I (Control): didn't blow; group II (Distraction): patients blew into rubber tube; Group III (Valsalva): blew into sphygmomanometer tube and raise mercury column up to 30 mmHg for at least 20 seconds. During above procedures, spinal puncture was performed with 25-gauge spinal needle. RESULTS: Eighty-two patient data were analyzed. Incidence of spinal puncture pain was reduced to 10% (3 of 27) in Valsalva group as compared to 100% (28 of 28 in control group and 27 of 27 in Distraction group) observed in other two groups (P < 0.05). Severity of lumbar puncture pain as assessed by visual analog scale (0-10; where 0 is no pain and 10 is the worst imaginable pain) presented as Median (Interquartile range) were significantly reduced in the Valsalva group (0.0 [0.0] as compared to other 2 groups 2.0 [0.0] in the Distraction group and 3.0 [0.8] in Control group) (P < 0.05). Regarding time taken by CSF to fill spinal needle hub, there was no difference among the three groups (P > 0.05). None patient of all groups had post dural puncture headache (P > 0.05). CONCLUSIONS: Valsalva can be performed routinely in ASA I and II patients undergoing spinal anesthesia as it is safe, painless and non-pharmacological method of pain attenuation.
Anesthesia, Spinal*
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Baroreflex
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Humans
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Incidence
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Needles
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Post-Dural Puncture Headache
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Punctures*
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Rubber
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Skin*
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Sphygmomanometers
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Spinal Puncture
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Valsalva Maneuver*
;
Visual Analog Scale
4.A Multicentre, Multinational, Open-Label, 52-Week Extension Study of Gemigliptin (LC15-0444) Monotherapy in Patients with Type 2 Diabetes Mellitus
Sae Jeong YANG ; Kyung Wan MIN ; Sandeep Kumar GUPTA ; Joong Yeol PARK ; Vyankatesh K.SHIVANE ; Pankaj Kumar AGARWAL ; Doo Man KIM ; Yong Esong KIM ; Sei Hyun BAIK
Diabetes & Metabolism Journal 2021;45(4):606-612
The purpose of this extension study was to assess the long-term efficacy and safety of gemigliptin 50 mg in patients with type 2 diabetes mellitus (T2DM). Patients with T2DM who had completed the initial 24-week study comparing gemigliptin monotherapy with placebo were eligible to enrol. In the open-label, 28-week extension study, all enrolled patients received gemigliptin, regardless of the treatment received during the initial 24-week study period. The mean reduction±standard deviation (SD) in glycosylated hemoglobin (HbA1c) observed after 24 weeks of treatment (–0.6%±1.1%) was further decreased for the gemi-gemi group and the mean change in HbA1c at week 52 from baseline was –0.9%±1.2% (P<0.0001). For the pbo-gemi group, HbA1c decreased after they were switched to gemigliptin, and the mean change in HbA1c at week 52 from baseline was –0.7%±1.2% (P<0.0001). Furthermore, the overall incidence of adverse events demonstrated that gemigliptin was safe and well tolerated up to 52 weeks.
5.A Multicentre, Multinational, Open-Label, 52-Week Extension Study of Gemigliptin (LC15-0444) Monotherapy in Patients with Type 2 Diabetes Mellitus
Sae Jeong YANG ; Kyung Wan MIN ; Sandeep Kumar GUPTA ; Joong Yeol PARK ; Vyankatesh K.SHIVANE ; Pankaj Kumar AGARWAL ; Doo Man KIM ; Yong Esong KIM ; Sei Hyun BAIK
Diabetes & Metabolism Journal 2021;45(4):606-612
The purpose of this extension study was to assess the long-term efficacy and safety of gemigliptin 50 mg in patients with type 2 diabetes mellitus (T2DM). Patients with T2DM who had completed the initial 24-week study comparing gemigliptin monotherapy with placebo were eligible to enrol. In the open-label, 28-week extension study, all enrolled patients received gemigliptin, regardless of the treatment received during the initial 24-week study period. The mean reduction±standard deviation (SD) in glycosylated hemoglobin (HbA1c) observed after 24 weeks of treatment (–0.6%±1.1%) was further decreased for the gemi-gemi group and the mean change in HbA1c at week 52 from baseline was –0.9%±1.2% (P<0.0001). For the pbo-gemi group, HbA1c decreased after they were switched to gemigliptin, and the mean change in HbA1c at week 52 from baseline was –0.7%±1.2% (P<0.0001). Furthermore, the overall incidence of adverse events demonstrated that gemigliptin was safe and well tolerated up to 52 weeks.
6.Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease
Sanchit SHARMA ; Arti GUPTA ; Saurabh KEDIA ; Samagra AGARWAL ; Namrata SINGH ; Sandeep GOYAL ; Saransh JAIN ; Vipin GUPTA ; Pabitra SAHU ; Sudheer Kumar VUYYURU ; Bhaskar KANTE ; Raju SHARMA ; Rajesh PANWAR ; Peush SAHNI ; Govind MAKHARIA ; Vineet AHUJA
Intestinal Research 2021;19(3):291-300
Background/Aims:
Exclusive enteral nutrition (EEN), an established modality for pediatric Crohn’s disease (CD) is seldomly utilized in adults. The present study reports the outcome of EEN in adult CD patients at a tertiary care hospital in India.
Methods:
This was a retrospective analysis of CD patients who received EEN as a sole modality/adjunct to other treatment. The primary and secondary outcomes changed in Crohn’s Disease Activity Index (CDAI), and clinical response (decline in CDAI > 70), respectively, at 4 and 8 weeks. Subgroup analysis evaluated response across different phenotypes, EEN formulations and prior treatment. Linear mixed effect model was created to assess the predictors of EEN response.
Results:
Thirty-one CD patients received EEN over median duration of 4 weeks (range, 2–6 weeks). CDAI showed a significant improvement post EEN at 4 (baseline 290 [260–320] vs. 240 [180–280], P= 0.001) and 8 weeks (baseline 290 [260–320] vs. 186 [160–240], P= 0.001), respectively. The cumulative clinical response rates at 4 and 8 weeks were 37.3% and 80.4% respectively. The clinical response rates at 8 weeks across B1 (n = 4), B2 (n = 18) and B3 (n = 9) phenotypes were 50%, 78.8% and 100% respectively (log-rank test, P= 0.093). The response rates at 8 weeks with polymeric (n = 8) and semi-elemental diet (n = 23) were 75% and 82.6%% respectively (log-rank test, P= 0.49). Baseline CDAI (odds ratio, 1.008; 95% confidence interval, 1.002–1.017; P= 0.046) predicted response to EEN.
Conclusions
EEN was effective in inducing clinical response across different phenotypes of CD. Baseline disease activity remained the most important predictor of clinical response to EEN.
7.Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease
Sanchit SHARMA ; Arti GUPTA ; Saurabh KEDIA ; Samagra AGARWAL ; Namrata SINGH ; Sandeep GOYAL ; Saransh JAIN ; Vipin GUPTA ; Pabitra SAHU ; Sudheer Kumar VUYYURU ; Bhaskar KANTE ; Raju SHARMA ; Rajesh PANWAR ; Peush SAHNI ; Govind MAKHARIA ; Vineet AHUJA
Intestinal Research 2021;19(3):291-300
Background/Aims:
Exclusive enteral nutrition (EEN), an established modality for pediatric Crohn’s disease (CD) is seldomly utilized in adults. The present study reports the outcome of EEN in adult CD patients at a tertiary care hospital in India.
Methods:
This was a retrospective analysis of CD patients who received EEN as a sole modality/adjunct to other treatment. The primary and secondary outcomes changed in Crohn’s Disease Activity Index (CDAI), and clinical response (decline in CDAI > 70), respectively, at 4 and 8 weeks. Subgroup analysis evaluated response across different phenotypes, EEN formulations and prior treatment. Linear mixed effect model was created to assess the predictors of EEN response.
Results:
Thirty-one CD patients received EEN over median duration of 4 weeks (range, 2–6 weeks). CDAI showed a significant improvement post EEN at 4 (baseline 290 [260–320] vs. 240 [180–280], P= 0.001) and 8 weeks (baseline 290 [260–320] vs. 186 [160–240], P= 0.001), respectively. The cumulative clinical response rates at 4 and 8 weeks were 37.3% and 80.4% respectively. The clinical response rates at 8 weeks across B1 (n = 4), B2 (n = 18) and B3 (n = 9) phenotypes were 50%, 78.8% and 100% respectively (log-rank test, P= 0.093). The response rates at 8 weeks with polymeric (n = 8) and semi-elemental diet (n = 23) were 75% and 82.6%% respectively (log-rank test, P= 0.49). Baseline CDAI (odds ratio, 1.008; 95% confidence interval, 1.002–1.017; P= 0.046) predicted response to EEN.
Conclusions
EEN was effective in inducing clinical response across different phenotypes of CD. Baseline disease activity remained the most important predictor of clinical response to EEN.