Publications by authors named "Kanika Singh"

39 Publications

Effects of biochar, compost, and biochar-compost on soil total nitrogen and available phosphorus concentrations in a corn field in Papua New Guinea.

Environ Sci Pollut Res Int 2021 Jan 28. Epub 2021 Jan 28.

Genecology Research Centre, School of Science, Technology and Engineering, University of the Sunshine Coast, ML 40, Locked Bag 4, Maroochydore DC, QLD, 4558, Australia.

Replenishing soil nutrient particularly total nitrogen (TN) and available phosphorus (P) is important to sustain soil health for food production. Organic amendments such as compost and biochar are commonly applied to improve soil nutrient retention especially N and P. In farms, biochar is usually applied once followed by applying other organic amendment applied in their full rates. Both form and rate of organic amendments can affect soil nutrient concentrations particularly in short term. This study aimed to examine the effects of compost and mixture of compost with biochar (both at full rates) on soil nutrient concentrations in short term. A randomised complete block filed experiment with eight replicates was used for this study. The effects of biochar (5 t/ha) only, compost (at the rates of 10 t/ha, 25 t/ha and 35 t/ha) and biochar mixed with compost (5 t/ha and 10 t/ha, respectively) on soil nutrient concentrations compared with control were explored in a corn field. Compost treatment at the rate of 35 t/ha had significantly higher TN, available P, calcium (Ca) and iron (Fe) compared with other treatments and control. Soil potassium (K) levels remained unchanged among all treatments. Biochar only treatment had significantly higher available P and Ca concentrations compared with biochar mixed with compost treatment. Compost application at higher rate (35 t/ha) proved best practice to significantly increase TN and available P concentrations in short term. Significantly higher available P concentration in biochar only treatment compared with the biochar mixed with compost treatment could have been associated with stimulation of P immobilisation when biochar was mixed with compost. Our results indicated that the form and rate of organic amendments in short term cropping systems are important to be considered while applying to a volcanic soil to ensure N and P availability for plants are not compromised.
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http://dx.doi.org/10.1007/s11356-021-12477-wDOI Listing
January 2021

NGS-based expanded carrier screening for genetic disorders in North Indian population reveals unexpected results - a pilot study.

BMC Med Genet 2020 11 2;21(1):216. Epub 2020 Nov 2.

Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India.

Background: To determine the carrier frequency and pathogenic variants of common genetic disorders in the north Indian population by using next generation sequencing (NGS).

Methods: After pre-test counselling, 200 unrelated individuals (including 88 couples) were screened for pathogenic variants in 88 genes by NGS technology. The variants were classified as per American College of Medical Genetics criteria. Pathogenic and likely pathogenic variants were subjected to thorough literature-based curation in addition to the regular filters. Variants of unknown significance were not reported. Individuals were counselled explaining the implications of the results, and cascade screening was advised when necessary.

Results: Of the 200 participants, 52 (26%) were found to be carrier of one or more disorders. Twelve individuals were identified to be carriers for congenital deafness, giving a carrier frequency of one in 17 for one of the four genes tested (SLC26A4, GJB2, TMPRSS3 and TMC1 in decreasing order). Nine individuals were observed to be carriers for cystic fibrosis, with a frequency of one in 22. Three individuals were detected to be carriers for Pompe disease (frequency one in 67). None of the 88 couples screened were found to be carriers for the same disorder. The pathogenic variants observed in many disorders (such as deafness, cystic fibrosis, Pompe disease, Canavan disease, primary hyperoxaluria, junctional epidermolysis bullosa, galactosemia, medium chain acyl CoA deficiency etc.) were different from those commonly observed in the West.

Conclusion: A higher carrier frequency for genetic deafness, cystic fibrosis and Pompe disease was unexpected, and contrary to the generally held view about their prevalence in Asian Indians. In spite of the small sample size, this study would suggest that population-based carrier screening panels for India would differ from those in the West, and need to be selected with due care. Testing should comprise the study of all the coding exons with its boundaries in the genes through NGS, as all the variants are not well characterized. Only study of entire coding regions in the genes will detect carriers with adequate efficiency, in order to reduce the burden of genetic disorders in India and other resource poor countries.
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http://dx.doi.org/10.1186/s12881-020-01153-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607710PMC
November 2020

The effect and correlation of smoking with platelet indices, neutrophil lymphocyte ratio and platelet lymphocyte ratio.

Hematol Transfus Cell Ther 2020 Sep 13. Epub 2020 Sep 13.

IBS Ashwani Hospital, Faridabad, Haryana, India.

Introduction: Smoking is associated with the occurrence and progression of cardiovascular diseases, inflammatory disorders and malignancies.

Objective: To study the platelet indices, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in smokers and their correlation with smoking pack-years.

Method: A total of 110 smokers and 110 non-smokers were included. The smokers were grouped into three groups: mild (<5 pack-years), moderate (5-10 pack-years) and heavy (>10 pack-years). The platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) were noted. The NLR and PLR were calculated and the statistical analysis was made using the Student's T-test, Analysis of Variance (ANOVA) and Spearman's correlation coefficient.

Results: The platelet count, PCT and PDW were significantly higher with mean values: 218.56 ± 121.31 vs 203.23 ± 80.35 (p-value = 0.038), 0.27 ± 0.10 vs 0.26 ± 0.10 (p-value = 0.041) and 12.54 ± 1.45 vs 11.99 ± 1.70 (p-value = 0.001) in smokers and non-smokers, respectively. The PLR differed significantly with mean values: 119.40 ± 84.81 in smokers and 181.99 ± 313.09 in non-smokers, with a p-value of 0.045. A significant positive correlation was found between pack-years of smoking and platelet count and PLR with the Pearson correlation coefficient of 0.250 and 0.198 and p-values, 0.008 and 0.037, respectively. The Platelet Count, PCT, MPV and PDW varied significantly between mild, moderate and heavy smoker groups, with p-values of 0.045, 0.010, 0.015 and 0.017, respectively.

Conclusion: The platelet indices and inflammatory markers NLR and PLR are derived from routine blood investigations, which are easily available and inexpensive. The monitoring of platelet indices, along with the PLR, can be used as early predictors of morbidity in smokers.
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http://dx.doi.org/10.1016/j.htct.2020.07.006DOI Listing
September 2020

Cannabinoids and Prostate Cancer: A Systematic Review of Animal Studies.

Int J Mol Sci 2020 Aug 29;21(17). Epub 2020 Aug 29.

The Pangenomics Lab, School of Science, RMIT University, Bundoora, Victoria 3083, Australia.

Prostate cancer is a major cause of death among men worldwide. Recent preclinical evidence implicates cannabinoids as powerful regulators of cell growth and differentiation, as well as potential anti-cancer agents. The aim of this review was to evaluate the effect of cannabinoids on in vivo prostate cancer models. The databases searched included PubMed, Embase, Scopus, and Web of Science from inception to August 2020. Articles reporting on the effect of cannabinoids on prostate cancer were deemed eligible. We identified six studies that were all found to be based on in vivo/xenograft animal models. Results: In PC3 and DU145 xenografts, WIN55,212-2 reduced cell proliferation in a dose-dependent manner. Furthermore, in LNCaP xenografts, WIN55,212-2 reduced cell proliferation by 66-69%. PM49, which is a synthetic cannabinoid quinone, was also found to result in a significant inhibition of tumor growth of up to 90% in xenograft models of LNCaP and 40% in xenograft models of PC3 cells, respectively. All studies have reported that the treatment of prostate cancers in in vivo/xenograft models with various cannabinoids decreased the size of the tumor, the outcomes of which depended on the dose and length of treatment. Within the limitation of these identified studies, cannabinoids were shown to reduce the size of prostate cancer tumors in animal models. However, further well-designed and controlled animal studies are warranted to confirm these findings.
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http://dx.doi.org/10.3390/ijms21176265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503992PMC
August 2020

Xanthogranulomatous change in a pleomorphic adenoma: An extremely rare variant/degenerative change. Is it fine needle aspiration induced?

Diagn Cytopathol 2021 Feb 21;49(2):E71-E74. Epub 2020 Aug 21.

Department of Pathology, ESIC Medical College & Hospital, Faridabad, Haryana, India.

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor characterized by morphological diversity, metaplastic changes, degeneration, cystic change, altered differentiation, and rarely malignant transformation, thereby may create a diagnostic dilemma on cytology. Xanthogranulomatous (XG) inflammation within a PA could be due to XG sialadenitis coexistent with PA or preoperative fine-needle aspiration cytology (FNAC) induced histologic alteration. The argument in favor of this hypothesis is that the changes seen in the histopathology would not be present in the cytology, implying that the alterations were most likely due to the traumatic injury of needling rather than spontaneous change of the lesions themselves. These FNAC induced changes are focal in most of the cases, so the underlying lesion is readily identifiable, but on rare occasions they are so extensive that it can masquerade as a malignancy. We report a case of XG change in a PA in a 39-year-old male of 8 years standing. Through this case we wish to emphasize that knowledge of a previous FNAC and its potential effects on histology of the subsequent surgical specimen is necessary to avoid potential misdiagnosis.
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http://dx.doi.org/10.1002/dc.24585DOI Listing
February 2021

Author Correction: Arginyltransferase knockdown attenuates cardiac hypertrophy and fibrosis through TAK1-JNK1/2 pathway.

Sci Rep 2020 Jun 25;10(1):10662. Epub 2020 Jun 25.

Drug Discovery Research Centre, Translational Health Science and Technology Institute, Faridabad, Haryana, India.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41598-020-67556-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314792PMC
June 2020

Granular Cell Tumor Breast Masquerading as a Malignancy Cytologically: a Rare Case Presenting a Diagnostic Dilemma.

Indian J Surg Oncol 2020 Jun 26;11(2):321-324. Epub 2020 Mar 26.

Department of Surgery, ESIC Medical College, Faridabad, Haryana India.

Granular cell tumor (GCT) also known as Abrikossoff's tumor is an uncommon soft tissue tumor of neurogenic origin. GCT of the breast accounts for < 0.1% of breast tumors and 6% of all reported cases of granular cell tumor. Although GCT is a benign tumor, malignant GCT can be seen in 1% v of the cases. GCT of the breast is diagnostically challenging as it can imitate carcinoma clinically and radiologically but need to be differentiated from breast malignancy since they have totally different approach in treatment and prognosis. GCT has a great ability to mimic a variety of lesions from benign histiocytic to malignant epithelial/mesenchymal lesions, thereby presenting a diagnostic challenge to the practicing cytopathologist. We report a case of GCT of breast cytologically masquerading as a malignancy in a 45-year-old female. Although, fine needle aspiration (FNA) is a first-line diagnostic tool, the present case reemphasizes the role of histopathology as the gold standard for a definite diagnosis clubbed with ancillary techniques like immunohistochemistry and special stains.
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http://dx.doi.org/10.1007/s13193-020-01055-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260310PMC
June 2020

Evaluation of Tumor infiltrating lymphocytes in breast carcinoma and their correlation with molecular subtypes, tumor grade and stage.

Breast Dis 2020 ;39(2):61-69

Department of Community Medicine, ESIC Medical College, Faridabad, Haryana, India.

Background: Tumour infiltrating lymphocytes (TILs) exhibit the local immune response directed against tumor growth and metastasis. TILs have emerged as a tool to assess immune-reactivity in various malignancies including colon, ovary, lung, bladder, breast etc as well as independent marker of favourable prognosis in many tumors. TILs in breast cancer (BC) play a role in tumor response to therapy in the adjuvant and neoadjuvant settings, especially in triple-negative cancers.

Material & Methods: This cross sectional study comprised of 101cases of invasive breast carcinoma. For each case, a representative 5 μm H&E stained section was selected and the clinicopathological details were recorded. To establish the molecular subtype of breast cancer, immunohistochemistry for ER, PR and Her2neu was done. Both stromal (sTIL) and intratumoral (iTIL) TILs were assessed based on the recommendations of the International TIL Working Group (ITILWG).

Results: A statistically significant difference was observed in the mean sTIL as well as iTIL scores and tumor grade, size, molecular type and lymph node metastasis. A signification correlation was observed between stromal TIL and tumor grade, lymph node metastasis, molecular subtype and mitosis. Intratumoral TIL showed a significant correlation with tumor size, mitosis, tumor grade, distant metastasis, stage and lymph node metastasis. Moreover, stromal and intratumoral TIL showed a highly significant correlation with each other.

Conclusion: The ITILWG recommendations are reproducible and reliable for the evaluation of sTILs and iTILs. TILs, as evaluated on Hematoxylin and eosin (H&E) slides, has been shown in numerous studies now to be a reliable, reproducible, inexpensive and readily available marker of pre-existing antitumor immunity in breast cancer. We suggest that TILs should be evaluated for each case of breast carcinoma and should be part of histopathology report.
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http://dx.doi.org/10.3233/BD-200442DOI Listing
January 2020

Arginyltransferase knockdown attenuates cardiac hypertrophy and fibrosis through TAK1-JNK1/2 pathway.

Sci Rep 2020 01 17;10(1):598. Epub 2020 Jan 17.

Drug Discovery Research Centre, Translational Health Science and Technology Institute, Faridabad, Haryana, India.

Myocardial hypertrophy, an inflammatory condition of cardiac muscles is a maladaptive response of the heart to biomechanical stress, hemodynamic or neurohormonal stimuli. Previous studies indicated that knockout of Arginyltransferase (ATE1) gene in mice and embryos leads to contractile dysfunction, defective cardiovascular development, and impaired angiogenesis. Here we found that in adult rat model, downregulation of ATE1 mitigates cardiac hypertrophic, cardiac fibrosis as well as apoptosis responses in the presence of cardiac stress i.e. renal artery ligation. On contrary, in wild type cells responding to renal artery ligation, there is an increase of cellular ATE1 protein level. Further, we have shown the cardioprotective role of ATE1 silencing is mediated by the interruption of TAK1 activity-dependent JNK1/2 signaling pathway. We propose that ATE1 knockdown in presence of cardiac stress performs a cardioprotective action and the inhibition of its activity may provide a novel approach for the treatment of cardiac hypertrophy.
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http://dx.doi.org/10.1038/s41598-019-57379-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969214PMC
January 2020

Prenatal presentation of a rare genetic disorder: a clinical, autopsy and molecular correlation.

Autops Case Rep 2019 Oct-Dec;9(4):e2019124. Epub 2019 Sep 30.

Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital. New Delhi, India.

Walker Warburg syndrome (WWS) lies at the severe end of the spectrum of the congenital muscular dystrophies. WWS is a congenital disorder of the O-glycosylation that disrupts in the post-translation modification of dystroglycan proteins. WWS is characterized by the involvement of the central nervous system and rarely by multisystem involvement. Next-generation sequencing discovered that multiple genes are associated with this disorder. is the rarest cause of WWS. We describe a clinical-autopsy report of a molecularly- confirmed WWS case presenting with ventriculomegaly, agenesis of the corpus callosum with a novel phenotype of Dandy-Walker malformation and unilateral multi-cystic kidney. The whole-exome sequencing confirmed a homozygous variant (c.411C>A) in the gene with a premature termination codon. This case emphasizes the importance of detailed postnatal phenotyping through an autopsy in any pregnancy with antenatally identified malformations. Obstetricians, pediatricians as well as fetal medicine experts need to counsel the parents and focus on preserving the appropriate sample for genetic testing. WWS, though rare deserves testing especially in the presence of positive family history. Dandy-Walker malformation is a novel feature and expands the phenotypic spectrum.
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http://dx.doi.org/10.4322/acr.2019.124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771443PMC
September 2019

A Clinicopathological Correlation of International Federation of Gynecology and Obstetrics's PALM-COEIN Classification of Abnormal Uterine Bleeding: Indian Scenario.

J Midlife Health 2019 Jul-Sep;10(3):147-152

Department of Community Medicine, ESIC Medical College, Faridabad, Haryana, India.

Background: Abnormal uterine bleeding (AUB) is a common problem affecting the women of reproductive age group and may also have a significant impact on their physical, social, and emotional aspects directly affecting their quality of life. The International Federation of Gynecology and Obstetrics (FIGO) devised a universally acceptable system of nomenclature and classification, namely PALM-COEIN classification of AUB in the year 2011. The objective of the present study was to analyze the structural (PALM) and functional (COEIN) component of FIGO system in the Indian scenario.

Materials And Methods: Three hundred patients with complaints of AUB were taken. A clinical diagnosis according to PALM-COEIN system was made after thorough history and clinical examination. Additional investigations if required were done, and endometrial sampling or hysterectomy was done whichever indicated. A histological diagnosis was made, and each case was allocated a category according to PALM-COEIN classification. A clinicopathological correlation was done in the hysterectomy cases for structural causes (PALM).

Results: Leiomyoma (30%) was the most common cause of AUB closely followed by adenomyosis (29.66%) overall. The clinicopathological correlation in hysterectomy cases was good with concordance rate of 85.03%. The concordance between clinical and pathological diagnoses for AUB-L, AUB-A, AUB-M, and AUB-A, L was statistically significant with < 05 in positive cases. However, additional finding of adenomyosis was diagnosed in 48.2% of the cases apart from primary clinical diagnosis.

Conclusion: A good clinicopathological correlation was seen in the cases when classified according to PALM-COEIN classification. The system also provides for consideration of multiple etiologies contributing toward AUB both clinically and histopathologically. However, histopathology remains the cornerstone in establishing the accurate diagnosis as the cases without specific symptoms can be missed clinically.
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http://dx.doi.org/10.4103/jmh.JMH_128_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767954PMC
October 2019

IAC standardized reporting of breast fine-needle aspiration cytology, Yokohama 2016: A critical appraisal over a 2 year period.

Breast Dis 2019 ;38(3-4):109-115

Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India.

Background: Breast cytology is a significant component of the "Triple approach" for pre-operative diagnosis of breast lumps, the other two being clinical assessment and radiological imaging. The role of Fine needle aspiration cytology (FNAC) as a first line investigation in diagnosing breast lesions is well documented, however histopathology is the gold standard. Cyto-histopathological correlation is of great relevance and also increases precision.AIMS \& OBJECTIVES:The present study was conducted with the aim to categorize breast lesions according to the latest standardized reporting system proposed by International academy of cytologists (IAC) in 2016. Evaluation of diagnostic accuracy, sensitivity and specificity of FNAC in diagnosing breast lesions and cyto-histopathological correlation was planned.

Materials And Methods: All FNAs of breast lesions over a period of 2 years were included in the study. The cases were grouped into five standardized categories proposed by the International academy of cytology: Category I (Insufficient material), Category II (Benign), Category III (Atypical, probably benign), Category IV (Suspicious, probably in situ or invasive) & Category V (Malignant) respectively. Specificity, sensitivity, diagnostic accuracy, negative and positive predictive value of FNAC were calculated and cyto-histopathological correlation assessed wherever possible.

Results: Out of 468 breast lesions reported on FNAC, the category wise distribution was - Category I, II, III, IV & V accounting for 23(4.9%), 342(73.07%), 7(1.5%), 11(2.35%) and 85(18.16%) respectively. Histopathology was performed in 331/468 cases with cyto histological concordance of 98.4% and a type agreement rate of 90.9%. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy was 98.90%, 99.16%, 97.82%, 99.58% and 99.09% respectively.

Conclusion: FNAC is a simple, reliable, cost effective, first line diagnostic procedure for all breast lumps. In collaboration with physical examination and imaging studies (triple approach), FNAC is a highly sensitive diagnostic tool. Adopting a universally acceptable standardized reporting system for breast cytology can enhance the diagnostic accuracy of FNAC.
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http://dx.doi.org/10.3233/BD-190393DOI Listing
March 2020

A correlation between platelet indices and preeclampsia.

Hematol Transfus Cell Ther 2019 Apr - Jun;41(2):129-133. Epub 2018 Dec 31.

Employees State Insurance Corporation Medical College, Faridabad, Haryana, India.

Background: Preeclampsia is one of the major health problems causing maternal morbidity and mortality, complicating 3-8% of pregnancies. It has been suggested that the alterations in the coagulation and fibrinolysis play a role in the pathogenesis of preeclampsia. The markers of platelet activation include platelet count, platelet distribution width, mean platelet volume and plateletcrit.

Study Design: It was a case-controlled study which included a total of 60 patients (30 cases and 30 controls). Blood samples were collected and the platelet indices - platelet count, plateletcrit, mean platelet volume and platelet distribution width - were evaluated using the Sysmex XN1000 and compared between the two groups.

Results: The MPV and PDW also showed a significant difference (p>0.05) between the two groups, with a significant positive correlation with increasing blood pressure (MPV - r=+0.6126, p<0.05 and PDW - r=+0.6441, p<0.05). The PC and PCT had lower values in the preeclampsia patients, however the difference between the two groups was not statistically significant.

Conclusion: The MPV and PDW showed a significant difference between the two groups and increasing values with increasing BP. However, the PC and PCT in our study did not show a significant correlation with preeclampsia. Thus, the platelet indices, mainly the MPV and PDW, which are economical and easily available, can be reliable in the prediction and early diagnosis of preeclampsia, as well as a marker for the severity of preeclampsia.
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http://dx.doi.org/10.1016/j.htct.2018.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517612PMC
December 2018

Association of coagulation profile with microvascular complications and glycemic control in type 2 diabetes mellitus - a study at a tertiary care center in Delhi.

Hematol Transfus Cell Ther 2019 Jan-Mar;41(1):31-36. Epub 2018 Jun 11.

Department of Community medicine, Employees State Insurance Corporation (ESIC) Medical College, Faridabad, Haryana, India.

Introduction: Type 2 diabetes mellitus, characterized by insulin resistance, corresponds to approximately 90% of cases of diabetes worldwide. Hyperglycemia in diabetes contributes to hyperfibrinogenemia and activates the coagulation cascade thereby producing atherothrombotic events.

Objectives: This study was designed to evaluate the coagulation profile (activated partial thromboplastin time, prothrombin time and fibrinogen) in Type 2 diabetes and to analyze correlations between body mass index, fasting blood glucose, glycated hemoglobin and duration of diabetes with coagulation parameters.

Methods: This study included 60 type 2 diabetics and 30 controls. Diabetic patients were grouped in two sets based on the presence or absence of microvascular complications. The demographic profile and clinical details were recorded. Fasting blood glucose, glycated hemoglobin, coagulation parameters such as prothrombin time, activated partial thromboplastin time and fibrinogen along with other biochemical parameters were investigated.

Results: There were statistically significant differences in the coagulation parameters between the two groups of diabetics (with and without complications). The present study also found significant correlations between age and the duration of diabetes with and without complications and coagulation parameters such as the activated partial thromboplastin time, which was found to be significantly lower, and fibrinogen, which was found to be significantly higher in subjects with complications compared to subjects without complications.

Conclusion: Clinical tests for prothrombin time, activated partial thromboplastin time and fibrinogen are relatively inexpensive and readily available. The present study shows that shortened prothrombin time, activated partial thromboplastin time and increased fibrinogen levels might be useful hemostatic markers in diabetic patients, especially in those at high-risk for thrombotic complications.
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http://dx.doi.org/10.1016/j.htct.2018.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371197PMC
June 2018

Masood's and Modified Masood's Scoring Index: An Evaluation of Fine Needle Aspiration Cytology of Breast Lesions with Histopathological Correlation.

Acta Cytol 2019 13;63(3):233-239. Epub 2019 Feb 13.

Department of Pathology, ESIC Medical College, Faridabad, India.

Objective: As fine needle aspiration cytology (FNAC) is the primary tool for evaluation of breast lesions, it is essential to segregate lesions with low and high risk of malignancy. To address this, Masood proposed a cytological scoring system for categorization, Masood's Scoring Index (MSI), which was modified later (Modified Masood's Scoring Index [MMSI]). This study analyses the effectiveness of MMSI over MSI and assesses the concordance between cytological scoring and histopathology.

Study Design: All breast FNACs over a period of 2 years were categorized based on MSI and MMSI by 2 reviewers independently. The agreement rate along with specificity, sensitivity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. Correlation and concordance analyses between cytological and histopathological categories were conducted.

Results And Discussion: Out of 415 cases of breast FNACs, histopathology was available for 310 for which MSI and MMSI were evaluated. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 95, 100, 100, 97.6 and 98.3%, respectively. The difference between the concordance rate of MSI and of MMSI for various cytological categories was found to be statistically significant.

Conclusion: MMSI has a better concordance with histopathological diagnosis than MSI. MMSI can serve as a uniform standardized scoring system for breast cytology for better categorization of proliferative breast diseases.
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http://dx.doi.org/10.1159/000496139DOI Listing
June 2019

Are all Granulomatous Mastitis Cases Tuberculous?: A Study on the Role of Cytology in Evaluation of Granulomatous Mastitis.

Turk Patoloji Derg 2019 ;35(2):128-133

Department of Pathology, ESIC Medical College and Hospital, NIT 3, FARIDABAD, INDIA.

Objective: Granulomatous mastitis is a rare inflammatory condition of the breast clinically mimicking breast carcinoma and pyogenic abscess, thereby creating a diagnostic dilemma. Tuberculous mastitis is a rare clinical entity accounting for approximately 3% of all mammary lesions. All cases of granulomatous mastitis diagnosed cytologically over a period of 3 years were evaluated to ascertain the cases with tuberculous etiology.

Material And Method: Fine needle aspiration cytology of the breast lump was performed and all the cytological parameters were evaluated. Wherever histopathology was available, the diagnosis was confirmed on Hematoxylin & Eosin stained sections and the Ziehl Neelsen (ZN) stain was applied.

Results: A total of 10 cases of granulomatous mastitis were diagnosed on cytology during the 3-year period. On cytological smears, four cases showed presence of ill-formed granulomas and one case had scattered epithelioid histiocytes; however, the rest of the cases had well-formed granulomas. Finally, four out of ten cases were labeled as tuberculous mastitis based on the ZN stain/Tuberculosis-Polymerase chain reaction (TB-PCR) and the other six cases were granulomatous mastitis.

Conclusion: Cytology plays a significant role in the diagnosis of granulomatous mastitis. This study re-emphasizes the role of the cytopathologist in the accurate and early diagnosis of these lesions so that unnecessary surgery can be avoided, and also highlights the fact that all granulomatous mastitis cases are not tuberculous.
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http://dx.doi.org/10.5146/tjpath.2018.01442DOI Listing
September 2019

A critical appraisal of the Milan system for reporting salivary gland cytology (MSRSGC) with histological correlation over a 3-year period: Indian scenario.

Diagn Cytopathol 2019 May 12;47(5):382-388. Epub 2018 Nov 12.

Department of Pathology, ESIC Medical College, Faridabad, Haryana, India.

Background: Fine needle aspiration cytology (FNAC) is the first line investigation for pre-operative diagnosis of salivary gland lesions, but due to its inherent limitations remains a challenge for the cytopathologists. The recently proposed international risk stratification scheme, the Milan System for Reporting Salivary Gland Cytology (MSRSGC) aims to promote and standardise the communication between cytopathologist and clinician thereby improving patient care.

Methods: A retrospective study of all salivary gland cytology cases was performed over a 3-year period, reviewed by pathologists and categorised into 1 of the 6 diagnostic categories according to MSRSGC, namely, non-diagnostic, non-neoplastic, atypia of undetermined significance (AUS), benign neoplasm, and salivary gland neoplasm of undetermined significance (SUMP), suspicious for malignancy (SFM), and malignant neoplasm. Cyto- histological correlation was done wherever possible. Risk of malignancy (ROM) was calculated for each diagnostic category.

Results: Out of a total of 150 salivary FNAC cases, histopathology was available for 64 cases. The sensitivity of FNAC was 81.8%, specificity was 100% while the diagnostic accuracy was 96.9%. The positive and negative predictive values were 100% and 96.4% respectively. The ROM for non-diagnostic, non-neoplastic, AUS, benign neoplasm, SUMP, SFM, and malignant categories were 0%, 10%, 50%, 2.5%, 50%, 100%, and 100% respectively.

Conclusion: MSRSGC fulfils the critical need for a uniform, internationally acceptable reporting system with ROM specified for each category. However, large scale multi centre studies need to be conducted before its reliability and validity is proven.
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http://dx.doi.org/10.1002/dc.24109DOI Listing
May 2019

Impacted mandibular third molar: Comparison of coronectomy with odontectomy.

Indian J Dent Res 2018 Sep-Oct;29(5):605-610

Department of Oral and Maxillofacial Surgery, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India.

Aim: Damage to the inferior alveolar nerve (IAN) while extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth. The aim of this study was to compare the sequelae of coronectomy with odontectomy in impacted mandibular third molars.

Patients And Methods: This study included thirty patients which were divided into two groups, Group-I (test group) including 15 patients undergoing coronectomy and Group-2 (control group) of 15 patients undergoing odontectomy. Investigations included digital orthopantomogram. The parameters for this study included pain, swelling, nerve paresthesia, trismus, postoperative infection, postoperative wound dehiscence, postoperative pocket depth, and migration.

Results: In Group-1 (coronectomy group), the patients underwent follow-up for 6 months to evaluate migration of the retained mandibular third molar root which was in proximity with the IAN. There was a mean increase in migration when the distance from the inferior border of IAN until the apex of the retained mandibular third molar root was measured which was by 3.43 mm after 6 months of follow up.

Conclusion: On statistical analysis, the result in this study showed no statistical difference in both the groups in all the parameters that were taken.
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http://dx.doi.org/10.4103/ijdr.IJDR_549_16DOI Listing
March 2019

Encapsulated Follicular Variant of Papillary Thyroid Carcinoma Arising in a Follicular Adenoma: a Diagnostic Dilemma.

Indian J Surg Oncol 2018 Sep 13;9(3):414-417. Epub 2018 Aug 13.

2Department of ENT, ESIC Medical College, Faridabad, Haryana India.

Papillary thyroid carcinoma (PTC) arising within follicular adenoma is a rare histological subset of papillary carcinoma. A 24-year-old female (euthyroid and asymptomatic) presented with a solitary mass in the right lobe of thyroid for 2 years. Fine-needle aspiration cytology (FNAC) suggested features of hyperplasia of thyroid. Hemithyroidectomy was performed. Histopathological examination revealed two distinct areas and was reported as encapsulated variant of papillary carcinoma along with follicular adenoma. Papillary carcinoma was confirmed by positive immunohistochemistry for HBME-1. CT head and neck region ruled out metastasis and the patient was kept on follow-up. There have been reports of medullary and papillary carcinomas occurring together; however, there is a paucity of literature on co-existing follicular neoplasm and papillary carcinoma. We hereby report a rare case of follicular variant of papillary carcinoma arising within follicular adenoma of the thyroid.
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http://dx.doi.org/10.1007/s13193-018-0801-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6154354PMC
September 2018

IV Levetiracetam versus IV Phenytoin in Childhood Seizures: A Randomized Controlled Trial.

J Pediatr Neurosci 2018 Apr-Jun;13(2):158-164

Department of Neuropsychopharmacology, Institute of Human Behaviour and Allied Sciences Delhi - 110095 India.

Objectives: To compare the efficacy of IV phenytoin and IV levetiracetam in acute seizures.

Design: Randomized controlled trial.

Setting: Tertiary care hospital, November 2012 to April 2014.

Patients: 100 children aged 3-12 yrs of age presenting with acute seizures.

Intervention: Participants randomly received either IV phenytoin 20 mg/kg ( = 50) or IV levetiracetam 30 mg/kg ( = 50). Patients who were had seizures at presentation received IV diazepam prior to these drugs.

Outcome Measures: Absence of seizure activity within next 24 hrs. Stopping of clinical seizure activity within 20 mins of first intervention, change in cardiorespiratory parameters, and achievement of therapeutic drug levels.

Results: Two groups were comparable in patient characteristics and seizure type ( > 0.05). Of the 100 children, 3 in levetiracetam and 2 in phenytoin group had a repeat seizure in 24 hrs, efficacy was comparable (94% vs 96%, > 0.05). Of these, 18 (36%) in phenytoin and 12 (24%) in levetiracetam group received diazepam. Sedation time was 178.80 ±97.534 mins in phenytoin and 145.50 ±105.208 mins in levetiracetam group ( = 0.346). Changes in cardiorespiratory parameters were similar in both groups except a lower diastolic blood pressure with phenytoin ( = 0.023). Therapeutic drug levels were achieved in 38 (76%) children both at 4 and 24 hrs with phenytoin, compared to 50 (100%) and 48 (98%) at 1 and 24 hrs with levetiracetam ( < 0.05).

Conclusion: Intravenous levetiracetam and phenytoin have similar efficacy in preventing seizure recurrences for 24 hrs in children 3-12 years presenting with acute seizures.
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http://dx.doi.org/10.4103/jpn.JPN_126_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057176PMC
August 2018

Clinical heterogeneity and molecular profile of triple A syndrome: a study of seven cases.

J Pediatr Endocrinol Metab 2018 Jul;31(7):799-807

Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India.

Background Triple A syndrome is characterized by achalasia, alacrima and adrenal insufficiency with neurological manifestations occurring later in the course of the disease. It occurs due to biallelic mutations in the AAAS gene which codes for the nuclear pore protein ALADIN. A number of other features have been reported over time in this heterogeneous and multisystemic disorder. Unlike other autosomal recessive disorders, triple A syndrome patients show a wide phenotypic variability both among different patients and family members harboring the same mutation(s). A gene-environment interaction has been thought to be a plausible cause. Methods A retrospective analysis of six families and seven patients presenting with triple A syndrome was carried out. The clinical, biochemical and molecular testing data were collected and correlated. The results of treatment and follow-up and genetic counseling of the families were obtained wherever feasible. Results Our cohort consisted mostly of children and displayed a wide phenotypic variability in the presenting symptoms ranging from hypoglycemic seizures at the severe end of the spectrum to insidious hyperpigmentation and delayed development. Neurological and autonomic features were present in a few patients, suggesting requirement of prolonged follow-up for these patients. A significant gap between the onset of symptoms and confirmatory diagnosis was noted, suggesting that a high index of suspicion is required for diagnosing this disorder. Sudden unexplained death was observed in siblings, and early diagnosis and treatment could help in preventing early mortality and improving the quality of life for these patients. Conclusion High index of suspicion for a potentially treatable disorder allows early appropriate intervention.
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http://dx.doi.org/10.1515/jpem-2018-0023DOI Listing
July 2018

Ubiquitin Proteasome pathway proteins as potential drug targets in parasite Trypanosoma cruzi.

Sci Rep 2018 05 30;8(1):8399. Epub 2018 May 30.

Drug Discovery Research Centre, Translational Health Science and Technology Institute, Faridabad, 121001, India.

Trypanosomiasis infects more than 21 million people and claims approximately 2 million lives annually. Due to the development of resistance against currently available anti-trypanosomal drugs, there is a growing need for specific inhibitors and novel drug targets. Of late, the proteins from the Ubiquitin Proteasome Pathway (UPP): ubiquitin ligases and deubiquitinase have received attention as potential drug targets in other parasites from the apicomplexan family. The completion of Trypanosoma cruzi (Tc) genome sequencing in 2005 and subsequent availability of database resources like TriTrypDB has provided a platform for the systematic study of the proteome of this parasite. Here, we present the first comprehensive survey of the UPP enzymes, their homologs and other associated proteins in trypanosomes and the UPPs from T. cruzi were explored in detail. After extensive computational analyses using various bioinformatics tools, we have identified 269 putative UPP proteins in the T. cruzi proteome along with their homologs in other Trypanosoma species. Characterization of T. cruzi proteome was done based on their predicted subcellular localization, domain architecture and overall expression profiles. Specifically, unique domain architectures of the enzymes and the UPP players expressed exclusively in the amastigote stage provide a rationale for designing inhibitors against parasite UPP proteins.
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http://dx.doi.org/10.1038/s41598-018-26532-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976635PMC
May 2018

Small-Cell Neuroendocrine Carcinoma of the Cervix Masquerading as a Cervical Fibroid: Report of a rare entity.

Sultan Qaboos Univ Med J 2018 Feb 4;18(1):e100-e103. Epub 2018 Apr 4.

Department of Obstetrics & Gynaecology, Employees State Insurance Corporation Medical College & Hospital, Faridabad, Haryana, India.

Primary neuroendocrine tumours of the cervix are extremely rare, with an incidence of only 0.5-1%; as such, these entities can present a clinical and diagnostic challenge. Small-cell neuroendocrine carcinomas of the cervix are highly aggressive tumours that have a tendency to metastasise. We report a 44-year-old woman who presented to the Gynaecology Clinic of the Employees State Insurance Corporation Medical College & Hospital, Faridabad, India, in 2016 with . Based on a clinical examination, she was provisionally diagnosed with a cervical fibroid. However, a biopsy revealed features of a small-cell neuroendocrine carcinoma of the cervix which was subsequently confirmed via immunohistochemistry. An accurate diagnosis of a neuroendocrine carcinoma is vital as it forms the basis for treatment decisions as well as informing predictions for long-term survival.
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http://dx.doi.org/10.18295/squmj.2018.18.01.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892798PMC
February 2018

Solitary nodular lesion on forehead in a 56-year-old woman.

Indian J Dermatol Venereol Leprol 2019 Sep-Oct;85(5):555-558

Department of Pathology, ESIC Medical College, Faridabad, Haryana, India.

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http://dx.doi.org/10.4103/ijdvl.IJDVL_1141_16DOI Listing
February 2020

Delineating Crosstalk Mechanisms of the Ubiquitin Proteasome System That Regulate Apoptosis.

Front Cell Dev Biol 2018 9;6:11. Epub 2018 Feb 9.

Drug Discovery Research Centre, Translational Health Science and Technology Institute, Faridabad, India.

Regulatory functions of the ubiquitin-proteasome system (UPS) are exercised mainly by the ubiquitin ligases and deubiquitinating enzymes. Degradation of apoptotic proteins by UPS is central to the maintenance of cell health, and deregulation of this process is associated with several diseases including tumors, neurodegenerative disorders, diabetes, and inflammation. Therefore, it is the view that interrogating protein turnover in cells can offer a strategy for delineating disease-causing mechanistic perturbations and facilitate identification of drug targets. In this review, we are summarizing an overview to elucidate the updated knowledge on the molecular interplay between the apoptosis and UPS pathways. We have condensed around 100 enzymes of UPS machinery from the literature that ubiquitinates or deubiquitinates the apoptotic proteins and regulates the cell fate. We have also provided a detailed insight into how the UPS proteins are able to fine-tune the intrinsic, extrinsic, and p53-mediated apoptotic pathways to regulate cell survival or cell death. This review provides a comprehensive overview of the potential of UPS players as a drug target for cancer and other human disorders.
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http://dx.doi.org/10.3389/fcell.2018.00011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5811474PMC
February 2018

Scar Endometriosis with Rudimentary Horn: An Unusual and Elucidative Report of a Case Diagnosed on Histopathology and Immunohistochemistry.

J Midlife Health 2017 Oct-Dec;8(4):196-199

Department of Obstetrics and Gynecology, ESIC Medical College and Hospital, Faridabad, Haryana, India.

Endometriosis is defined as the presence of functioning endometrial tissue outside the endometrial cavity. Scar endometriosis, also known as spontaneous abdominal wall endometriosis, is an unusual clinical presentation which often goes unnoticed. It usually develops after pelvic operations. The incidence has been estimated to be only 0.03%-0.15% of all cases of endometriosis. It can be either asymptomatic or present as abdominal wall pain at the site of surgical incision. It is most commonly diagnosed clinically or on ultrasonography. The treatment of choice predominantly remains surgical excision. We present a case of a 24-year-old female (known case of bicornuate uterus) who presented with chief complaints of abdominal pain for 1 month and 6 months after metroplasty. The patient was clinically diagnosed as a case of scar endometriosis with rudimentary horn and fistulous tract and taken up for surgery. Both the scar tissue and fistulous tract were removed and histopathology revealed only endometrial glands without stroma or hemosiderin-laden macrophages. Diagnosis of scar endometriosis was established on positive immunohistochemistry for estrogen and progesterone receptor in endometrial glands. Timely diagnosis and surgical excision of scar endometriosis along with close follow-up are necessary to prevent complications and recurrence.
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http://dx.doi.org/10.4103/jmh.JMH_69_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753504PMC
January 2018

Treatment of Maxillary Impacted Canine using Ballista Spring and Orthodontic Wire Traction.

Int J Clin Pediatr Dent 2017 Jul-Sep;10(3):313-317. Epub 2017 Feb 27.

Reader, Department of Orthodontics, Subharti Dental College, Meerut Uttar Pradesh, India.

In orthodontic practice, impaction of maxillary permanent canines is a frequently encountered clinical problem. After the third molar, the canine is the most frequently impacted tooth. For functional occlusion, bringing the impacted canine into occlusion is important to achieve final esthetic in orthodontic practice. This article illustrates a distinct case in which the three permanent canines maintained their unerupted status till the age of 18 years. The three impacted canines were surgically exposed, attachment bonded, traction given with ballista spring for vertical and labial movement, and ideally positioned with fixed orthodontic mechanotherapy.

How To Cite This Article: Raghav P, Singh K, Reddy CM, Joshi D, Jain S. Treatment of Maxillary Impacted Canine using Ballista Spring and Orthodontic Wire Traction. Int J Clin Pediatr Dent 2017;10(3):313-317.
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http://dx.doi.org/10.5005/jp-journals-10005-1457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661050PMC
February 2017

Genetic Testing in Pediatric Ophthalmology.

Indian J Pediatr 2018 03 2;85(3):228-236. Epub 2017 Oct 2.

Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, 110060, India.

The authors review the utility of genetic testing in ophthalmic disorders - precise diagnosis, accurate prognosis, genetic counseling, prenatal diagnosis, and entry into gene-specific therapeutic trials. The prerequisites for a successful outcome of a genetic test are an accurate clinical diagnosis, a careful family history that guides which genes to study, and genetic counseling (both pre-test and post-test). The common eye disorders for which genetic testing is commonly requested are briefly discussed - anophthalmia, microphthalmia, coloboma, anterior segment dysgenesis, corneal dystrophies, cataracts, optic atrophy, congenital glaucoma, congenital amaurosis, retinitis pigmentosa, color blindness, juvenile retinoshisis, retinoblastoma etc. A protocol for genetic testing is presented. If specific mutations in a gene are common, they should form the first tier test, as the mutations in Leber hereditary optic neuropathy. If mutations in one gene are likely, sequencing of that gene should be carried out, e.g. GALT gene in galactosemia, RS1 gene in retinoshisis. Disorders with genetic heterogeneity require multi-gene panel tests, and if these show no abnormality, then deletion / duplication or microarray studies are recommended, followed in sequence by clinical exome (5000 to 6000 genes), full exome (about 20,000 genes or whole genome studies (includes all introns). It is fortunate that most genetic tests in ophthalmology are available in India, including gene panel and whole exome/genome sequencing tests.
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http://dx.doi.org/10.1007/s12098-017-2453-7DOI Listing
March 2018

Pleuro-pulmonary Cryptococcosis without Pleural Effusion.

J Assoc Physicians India 2017 Jul;65(7):94

RMO cum Clinical Tutor, Dept. of Cardiology.

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July 2017

Piezosurgery versus Rotatory Osteotomy in Mandibular Impacted Third Molar Extraction.

Ann Maxillofac Surg 2017 Jan-Jun;7(1):5-10

Department of Oral and Maxillofacial Surgery, I.T.S Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India.

Aim: The aim of this study is to compare piezoelectric surgery versus rotatory osteotomy technique in removal of mandibular impacted third molar.

Materials And Methods: Sample size of 30 patients 18 males, 12 females with a mean age of 27.43 ± 5.27. Bilateral extractions were required in all patients. All the patients were randomly allocated to two groups in one group, namely control group, surgical extraction of mandibular third molar was done using conventional rotatory osteotomy and in the other group, namely test group, extraction of lower third molar was done using Piezotome.

Results: Parameters assessed in this study were - mouth opening (interincisal opening), pain (visual analog scale VAS score), swelling, incidence of dry socket, paresthesia and duration of surgery in both groups at baseline, 1, 3, and 7 postoperative day. Comparing both groups pain scores with ( < 0.05) a statistically significant difference was found between two groups. Mean surgical time was longer for piezosurgery group (51.40 ± 17.9) minutes compared to the conventional rotatory group with a mean of (37.33 ± 15.5) minutes showing a statistically significant difference ( = 0.002).

Conclusion: The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient, and protection of tooth structures. Therefore, the piezoelectric device was efficient in decreasing the short-term outcomes of pain and swelling although taking longer duration than conventional rotatory technique it significantly reduces the associated postoperative sequelae of third molar surgery.
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http://dx.doi.org/10.4103/ams.ams_38_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5502515PMC
July 2017