Publications by authors named "Sunil Choudhary"

45 Publications

An assessment of serum oxidative stress and antioxidant parameters in patients undergoing treatment for cervical cancer.

Free Radic Biol Med 2021 May 9;167:29-35. Epub 2021 Mar 9.

Radiotherapy and Radiation Medicine, Banaras Hindu University, Institute of Medical Sciences, Varanasi, 221005, Uttar Pradesh, India. Electronic address:

Objectives: Oxidative stress and antioxidants are involved in all aspects of cervical cancer. The present study evaluated serum levels of oxidative stress and antioxidant biomarkers in cervical cancer patients and healthy controls. Moreover, the effect of Concurrent chemoradiotherapy (CCRT) on these biomarkers and their association with treatment outcome was investigated.

Design: This study included ninety-seven cervical cancer patients and thirty controls. Three oxidative stress parameters (8-hydroxy-2-deoxyguanosine, Protein Carbonyl, and Malondialdehyde) and four antioxidant parameters (Superoxide Dismutase, Catalase, Glutathione Peroxidase, and Total Antioxidant Status) were measured. The analysis was conducted using repeated measures ANOVA for comparing among the phases (before, during, and follow-up) of treatment. The control group was compared using the Dunnet test. Logistic regression analysis was also conducted between oxidative stress and antioxidant parameters to study their association.

Results: Significant rises in oxidative damage markers were observed in cervical cancer patients of all stages, compared to controls. There was a further increase in oxidative stress markers during CCRT among complete responders. However, among non-responders, the oxidative stress biomarkers like Protein Carbonyl and Malondialdehyde were unaltered during CCRT. Simultaneously, there was a significant decrease in antioxidant parameters in cervical cancer patients of all stages compared to controls. During CCRT, antioxidant levels continuously depleted among complete responders. Nevertheless, in non-responders, antioxidant parameters like Superoxide Dismutase and Total Antioxidant Status were consistent. The oxidative stress markers and antioxidant parameters normalized among complete responders at six months follow up. While in non-responders, the normalization of these parameters was not observed.

Conclusion: Our results indicate that increased oxidative stress and diminished antioxidants among patients were associated with carcinoma cervix. Induced oxidative stress and decreased antioxidant parameters during CCRT among the complete responders show the treatment's efficacy. Oxidant-antioxidant profile merits investigation as markers of diagnosis, treatment response, survival, and recurrence in extensive prospective studies.
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http://dx.doi.org/10.1016/j.freeradbiomed.2021.02.037DOI Listing
May 2021

Diagnostic and prognostic application of Raman spectroscopy in carcinoma cervix: A biomolecular approach.

Spectrochim Acta A Mol Biomol Spectrosc 2021 Apr 22;250:119356. Epub 2020 Dec 22.

Department of Physics, Banaras Hindu University, Institute of Science, Varanasi 221005, Uttar Pradesh, India. Electronic address:

Blood serum samples from 63 cervical cancer patients and 30 controls were collected at three different phases of the treatment (i.e. before, during, and at follow up). The spectra of serum samples from control as well as patients were classified into different groups using principal component analysis (PCA) and linear discriminant analysis (LDA) based on different phases of treatment using R software. The spectra of blood serum samples have shown the distinct changes and differences compared with each other in the profile of various biochemical parameters. The sensitivity (92.5%) and specificity (85%) were observed maximum between control and cervical cancer patients (before treatment). Between different phases of treatment, the sensitivity and specificity were less but, all accuracies of detection and classification reached above 50%. This method can be considered as a screening method for detection and treatment monitoring.
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http://dx.doi.org/10.1016/j.saa.2020.119356DOI Listing
April 2021

Comparison of two hypofractionated radiotherapy schedules in locally advanced postmastectomy breast cancer patients.

J Cancer Res Ther 2020 Oct-Dec;16(6):1331-1335

Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Introduction: The role of hypofractionated radiotherapy (HFRT) in postmastectomy breast cancer patients is not well established. This study was done to establish the role of two different HFRT schedules in the treatment of chest wall and regional lymph nodes after mastectomy.

Materials And Methods: Between 2012 and 2016, consecutively registered patients of locally advanced breast cancer patients having undergone mastectomy and adjuvant radiotherapy (RT) at a tertiary cancer center were analyzed. Locoregional recurrence (LRR) was the primary endpoint, whereas overall survival (OS), disease-free survival (DFS), and both acute and late adverse events were secondary endpoints.

Results: A total of 34 patients who were treated with 39 Gy in 13 fractions over 2½ weeks and 35 patients who were treated with 40 Gy in 15 fractions over 3 weeks were identified. The median follow-up period was 47 months and 63.5 months in the 39 Gy and 40 Gy arms, respectively. LRR was seen in 11.8% and 8.6% of patients in the 39 Gy and 40 Gy arms, respectively. OS at 4 years was 66% and 71.5% in the 39 Gy and 40 Gy arms, respectively. The mean DFS for 39 Gy and 40 Gy arms was 43.6 months and 66.4 months, respectively (P = 0.822). Acute skin toxicity was similar in the two groups. Arm edema was significantly more in the 40 Gy arm.

Conclusion: The two HFRT schedules are equivalent to each other in terms of survival outcomes. Arm edema is higher with 40 Gy arm as compared to 39 Gy arm.
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http://dx.doi.org/10.4103/jcrt.JCRT_722_19DOI Listing
February 2021

Commentary on Letter to the Editor on "Suprazygomatic Aponeurotic McLaughlin Myoplasty for Facial Reanimation".

Ann Plast Surg 2020 Nov 24. Epub 2020 Nov 24.

Max Institute of Reconstructive Aesthetic Cleft and Craniofacial Surgery (MIRACLES), Max Super Specialty Hospital, New Delhi, India

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http://dx.doi.org/10.1097/SAP.0000000000002596DOI Listing
November 2020

Letter to the editor on the research article "Total reference air kerma can accurately predict isodose surface volumes in cervix cancer brachytherapy. A multicenter study".

Brachytherapy 2021 Jan-Feb;20(1):290. Epub 2020 Sep 17.

Department of Radiotherapy and Radiation Medicine Institute of Medical Sciences, Banaras Hindu University Varansi, Uttar Pradesh, India.

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http://dx.doi.org/10.1016/j.brachy.2020.08.016DOI Listing
September 2020

Plastic Surgery in Times of the Pandemic: Go Back to the Roots!

Ann Plast Surg 2020 11;85(5):459-460

From the Max Institute of Reconstructive Aesthetic Cleft and Craniofacial Surgery (MIRACLES) Max Super Specialty Hospital Saket, New Delhi, India.

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http://dx.doi.org/10.1097/SAP.0000000000002546DOI Listing
November 2020

A comparison between revised Manchester Point A and ICRU-89-recommended Point A definition absorbed-dose reporting using CT images in intracavitary brachytherapy for patients with cervical carcinoma.

Brachytherapy 2021 Jan-Feb;20(1):118-127. Epub 2020 Aug 16.

Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. Electronic address:

Purpose: This study is a comparison between revised Manchester Point A and International Commission on Radiation Units and measurements (ICRU) 89 report-recommended Point A absorbed-dose reporting in intracavitary brachytherapy for patients with cervical carcinoma.

Methods And Materials: The retrospective dosimetric study is based on the data of 32 patients with cervical carcinoma treated with high-dose-rate brachytherapy. Patients received 21 Gy in three fractions (7.0 Gy X three fractions) to Point A (A, revised Manchester definition). All the patients were replanned with a new Point A (A) defined on CT images as per the American Brachytherapy Society/ICRU-89. The data collected were compared with the data obtained from Point A (A).

Results: When using the A plan normalization method, the mean dose of 0.1 cc, 1 cc, and 2 cc bladder volumes was 820.79 ± 207.47 cGy, 654.66 ± 152.69 cGy, and 588.91 ± 136.35 cGy, respectively. Likewise, when using the ICRU-89 Point A normalization method, the mean dose of 0.1 cc, 1 cc, and 2 cc bladder volumes was 869.30 ± 224.67 cGy, 693.24 ± 166.20 cGy, and 616.61 ± 150.32 cGy, respectively. For the rectum, Point A normalization plans, the mean dose of 0.1 cc, 1 cc, and 2 cc volumes was 589.37 ± 163.26 cGy, 487.51 ± 126.03 cGy, and 442.70 ± 111.43 cGy, respectively. Likewise, using the A plan, the mean 0.1 cc, 1 cc, and 2 cc rectum volume was 625.07 ± 171.31 cGy, 517.50 ± 131.05 cGy, 464.94 ± 121.81 cGy, respectively. The statistical mean difference of Total Reference Air Kerma rate, V (cc), bladder, rectum and sigmoid, was found significant.

Conclusions: It has been found that the position of revised Manchester (A) and ICRU-89 Point A does not match on CT images/radiograph, which resulted in variation in doses to the tumor, V (cc), organ at risk, and Total Reference Air Kerma.
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http://dx.doi.org/10.1016/j.brachy.2020.07.009DOI Listing
August 2020

New 'ZISIS' (Zigzag Incision-Suction-Irrigation System) Technique for Endoscopic-Assisted Forehead Tumour Excision.

J Maxillofac Oral Surg 2020 Sep 13;19(3):414-419. Epub 2019 Sep 13.

Max Institute of Reconstructive, Aesthetic, Cleft and Craniofacial Surgery (MIRACLES), Max Super Specialty Hospital, 1-2, Press Enclave Road, Saket, New Delhi, 110017 India.

Background: Endoscopic-assisted excision of forehead tumours like osteomas and lipomas is well established, but the conventional techniques suffer from many limitations like inadequate access, fogging of the endoscope and unclear vision due to collection of blood and debris.

Method: Three simple modifications of the conventional endoscopic forehead technique for benign tumour excisions are described by the acronym 'ZISIS'. Zigzag scalp incision increases the surface area of the opening permitting easy insertion of multiple instruments along with the endoscope. Suction tubing made from a disposable suction catheter tube is taped along the endoscope sheath for continuous suctioning and good vision. Irrigation system of warm saline made with an infant feeding tube is also taped along the endoscope just opening in the front of the suction tube.

Results: A total of 12 consecutive patients underwent endoscopic excision of forehead benign tumours in 2 years. This included 2 lipomas and 10 osteomas cases. All patients achieved excellent hidden scars in the scalp. All patients rated their results as excellent with respect to the hidden scar and aesthetic result. No early or late complications were reported with follow-up ranging from 6 months to 2 years.

Conclusion: A new simple modification called 'ZISIS' endoscopic forehead excision technique is described for benign forehead tumours excision making it easier, efficient and ergonomic.

Level Of Evidence Iv: Evidence obtained from multiple time series with or without the intervention, such as case studies.
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http://dx.doi.org/10.1007/s12663-019-01282-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410997PMC
September 2020

A radiobiological and dosimetrical comparison between simultaneous integrated and sequential boost intensity-modulated arc treatment of locally advanced head-and-neck cancer.

J Cancer Res Ther 2020 Apr-Jun;16(3):508-512

Department of Otorhinolaryngology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Purpose: The study aimed to compare the radiobiological and dosimetric parameters between sequential boost (SEQB) and simultaneous integrated boost (SIB) treatment regimen using intensity-modulated arc therapy technique in locally advanced head-and-neck cancer (LAHNC) patients.

Materials And Methods: A total of 24 previously untreated LAHNC patients were randomized into SIB (n= 11) and SEQB (n = 13) arms. The planning computed tomography data set was transferred to the treatment planning system. All the target volumes and organ at risk volumes were delineated. Single plan for SIB group and three plans (three phases) were generated for SEQB group of patients. Radiobiological and dosimetric parameters were compared.

Results: The BED(planned) value for high-risk (HR) planning target volume (PTV) was same in both groups, whereas for intermediate-risk (IR) PTV and low-risk (LR) PTV, the values were higher in SEQB arm than SIB arm. The V values were 100% for all the target volumes in both arms of patients. The average D value for gross target volume, HR PTV, and IR PTV was higher in SEQB arm than that in the SIB arm. The average D value for LR PTV was higher in the SIB arm compared to that of the SEQB arm. The BED(achieved) was calculated using D values of target volumes. The difference of BED(achieved) values between SEQB arm and SIB arm further increased than the BED(planned) values for all target volumes. The maximum doses for spinal cord, spinal cord planning risk volume, and brain stem were within the tolerance dose in both groups of patients. The left and right parotid glands sparing was comparable in both groups of patients. Average integral dose was higher in the SIB group than SEQB group. The average total monitor unit per fraction was higher in the SEQB arm than that in the SIB arm.

Conclusion: SIB regimen may be considered as more logical and efficient over SEQB regimen in the treatment of LAHNC with comparable radiobiological and dosimetric parameters.
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http://dx.doi.org/10.4103/jcrt.JCRT_211_19DOI Listing
October 2020

Plan evaluation indices: A journey of evolution.

Rep Pract Oncol Radiother 2020 May-Jun;25(3):336-344. Epub 2020 Mar 4.

Department of Radiotherapy, Balco Medical Center, New Raipur, Sector 36, Raipur, Chattisgarh 493661, India.

Aim: A systemic review and analysis of evolution journey of indices, such as conformity index (CI), homogeneity index (HI) and gradient index (GI), described in the literature.

Background: Modern radiotherapy techniques like VMAT, SRS and SBRT produce highly conformal plans and provide better critical structure and normal tissue sparing. These treatment techniques can generate a number of competitive plans for the same patients with different dose distributions. Therefore, indices like CI, HI and GI serve as complementary tools in addition to visual slice by slice isodose verification while plan evaluation. Reliability and accuracy of these indices have been tested in the past and found shortcomings and benefits when compared to one another.

Material And Methods: Potentially relevant studies published after 1993 were identified through a pubmed and web of science search using words "conformity index", "Homogeneity index", "Gradient index"," Stereotactic radiosurgery"," stereotactic Body radiotherapy" "complexity metrics" and "plan evaluation index". Combinations of words "plan evaluation index conformity index" were also searched as were bibliographies of downloaded papers.

Results And Conclusions: Mathematical definitions of plan evaluation indices modified with time. CI definitions presented by various authors tested at their own and could not be generalized. Those mathematical definitions of CI which take into account OAR sparing grant more confidence in plan evaluation. Gradient index emerged as a significant plan evaluation index in addition to CI whereas homogeneity index losing its credibility. Biological index base plan evaluation is becoming popular and may replace or alter the role of dosimetrical indices.
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http://dx.doi.org/10.1016/j.rpor.2020.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082629PMC
March 2020

Suprazygomatic Aponeurotic McLaughlin Myoplasty for Facial Reanimation.

Ann Plast Surg 2020 08;85(2):149-157

From the Max Institute of Reconstructive Aesthetic Cleft and Craniofacial Surgery, Max Super Specialty Hospital, Saket New Delhi, India.

Background: Suprazygomatic aponeurotic McLaughlin (SAM) myoplasty technique for facial reanimation is based on the classical McLauglin's lengthening temporalis myoplasty with a series of new modifications. A comprehensive review of previously described other orthodromic temporalis myoplasty techniques is also included to give a succinct comparison.

Methods: Twelve adult patients of facial palsy underwent SAM myoplasty for a period of 4 years. Three had congenital facial palsy, 4 patients had facial palsy secondary to acoustic neuromas, 3 were posttraumatic, and 2 patients had Bell's palsy.

Results: Range of modiolus excursion achieved as measured at 3 months postoperatively on reanimation in our patients was 5 mm to 20 mm with an average of 12.6 mm. With SAM myoplasty technique, we were able to achieve excellent result in 4 patients and good results in 8 patients as evaluated with May and Druker scoring system.

Conclusions: Suprazygomatic aponeurotic McLaughlin myoplasty for facial reanimation demonstrates a successful modification of the classical McLaughlin lengthening temporalis myoplasty, making it more customizable, simple, and predictable by taking the level of transection to the temporalis aponeurosis without the need for zygomatic osteotomy. A new classification of orthodromic temporalis myoplasty based on level of transections is also proposed for the first time. Good to excellent outcomes coupled with high patient satisfaction and low morbidity should make this technique popular among the facial reanimation surgeons.
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http://dx.doi.org/10.1097/SAP.0000000000002266DOI Listing
August 2020

A comparison of six fractions per week chemoradiation versus five fractions per week of conventional chemoradiation in carcinoma cervix: A prospective controlled study.

J Cancer Res Ther 2019 Oct-Dec;15(6):1296-1303

Department of Radiotherapy and Radiation Medicine, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Aims: The standard of care for carcinoma cervix stage IB2-IVA is five fractions per week of radiotherapy (RT) with concurrent cisplatin. We compared the standard treatment with six fractions per week of RT with concurrent Cisplatin to see whether the later had improved survival outcomes with comparable toxicities.

Settings And Design: 46 patients of carcinoma cervix with stage IB2-IVAwere randomized into two arms.

Materials And Methods: Study arm: 46 Gy/23 fractions/26 days, 6 fractions/week with injection CDDP 40 mg/m and Control arm: 46 Gy/23 fractions/31 days, 5 fractions/week with injection Cisplatin 40mg/m. Patients in both the arms received LDR brachytherapy to a dose of 29 Gy at point A.

Statistical Analysis Used: The primary end points were disease-free survival (DFS) and overall survival (OS). Compliance to treatment and treatment toxicities were the secondary end points. P value ≤0.05 were considered significant.

Results: The study was carried out during June, 2014-April, 2015. Statistical analysis was done in May, 2019. Of 46 patients, 39 patients completed the treatment. The study and control arms had 17 and 22 patients, respectively. Median follow-up period is 45 months (range: 1-54 months). 3-year DFS rates and OS was 69.5% vs. 72.7% (P = 0.73) and 63% vs. 68% (P = 0.45) in study and in control arm, respectively. There was no significant difference in acute and late radiation toxicities between two arms.

Conclusion: Chemoradiotherapy with six fractions per week seems feasible and equally efficacious in terms of survival outcomes and toxicity profile. Further prospective randomized controlled study is required to prove the merit of altered fractionation with concurrent cisplatin.
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http://dx.doi.org/10.4103/jcrt.JCRT_698_19DOI Listing
May 2020

Component Restoration in the Unilateral Intermediate Cleft Tip Rhinoplasty: Technique and Long-Term Outcomes.

Plast Reconstr Surg 2020 01;145(1):208e-209e

Max Institute of Reconstructive Aesthetic Cleft and Craniofacial Surgery, New Delhi, India.

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http://dx.doi.org/10.1097/PRS.0000000000006349DOI Listing
January 2020

Rojiroti microfinance and child nutrition: a cluster randomised trial.

Arch Dis Child 2020 03 10;105(3):229-235. Epub 2019 Oct 10.

Division of Child Health, Obstetrics & Gynaecology, Nottingham University, Nottingham, UK

Objective: To determine whether Rojiroti microfinance, for poor Indian women, improves child nutrition.

Design: Cluster randomised trial.

Setting: Tolas (village communities) in Bihar State.

Participants: Women and children under 5 years.

Interventions: With Rojiroti microfinance, women form self-help groups and save their money to provide loans to group members. After 6 months, they receive larger external loans. Tolas were randomised to receive Rojiroti immediately or after 18 months.

Outcome Measures: The primary analysis compared the mean weight for height Z score (WHZ) of children under 5 years in the intervention versus control tolas who attended for weight and height measurement 18 months after randomisation. Secondary outcomes were weight for age Z score (WAZ), height for age Z score, mid-upper arm circumference (MUAC), wasting, underweight and stunting.

Results: We randomised 28 tolas to each arm and collected data from 2469 children (1560 mothers) at baseline and 2064 children (1326 mothers) at follow-up. WHZ was calculated for 1718 children at baseline and 1377 (674 intervention and 703 control) at follow-up. At 18 months, mean WHZ was significantly higher for intervention (-1.02) versus controls (-1.37; regression coefficient adjusted for clustering β0.38, 95% CI 0.16 to 0.61, p=0.001). Significantly fewer children were wasted in the intervention group (122, 18%) versus control (200, 29%; OR=0.46, 95% CI 0.28 to 0.74, p=0.002). Mean WAZ was better in the intervention group (-2.13 vs -2.37; β0.27, 95% CI 0.11 to 0.43, p=0.001) as was MUAC (13.6 cm vs 13.4 cm; β0.22, 95% CI 0.03 to 0.40, p=0.02). In an analysis adjusting for baseline nutritional measures (259 intervention children and 300 control), only WAZ and % underweight showed significant differences in favour of the intervention.

Conclusion: In marginalised communities in rural India, child nutrition was better in those who received Rojiroti microfinance, compared with controls.

Trial Registration Number: NCT01845545.
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http://dx.doi.org/10.1136/archdischild-2018-316471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041497PMC
March 2020

The Gold Standard: It's Time to Shun the Term.

Ann Plast Surg 2019 05;82(5):485

From the Max Institute of Reconstructive Aesthetic Cleft and Craniofacial Surgery, Max Super Specialty Hospital, Press Enclave Marg Saket, Delhi, India.

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http://dx.doi.org/10.1097/SAP.0000000000001836DOI Listing
May 2019

Search of an ideal location of isocenter in intensity-modulated radiotherapy treatment plans: A dosimetrical approach.

J Cancer Res Ther 2019 Jan-Mar;15(1):211-215

Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Aim: The aim of this study is to identify an ideal location of isocenter in intensity-modulated radiotherapy (IMRT) treatment plans.

Materials And Methods: A total of 28 clinical target volumes and 4 English capital letters (C, L, T, and H) target volumes were considered in this study. Two IMRT treatment plans were generated for each target volume in the ECLIPSE treatment planning system (TPS), first one with isocenter automatically placed (ISO) by TPS and the second one with geometric center-based isocenter (ISO). The geometric center of a cuboid volume, which was formed encompassing around the target volume in sagittal, transverse, and frontal planes, is considered as the geometric center of the target volume as well as the isocenter (ISO) of the IMRT plans. While performing the IMRT treatment plans using the beam angle optimization and dose volume optimization, the normal tissue objectives and target volume objectives were kept similar in both the plans. The dosimetrical parameters between the two groups of plans were compared.

Results: The distance between ISO and ISO ranged from 0.16 cm to 3.04 cm with a mean and median of 0.85 cm and 0.69 cm, respectively. The ISO-based IMRT plans exhibited statistically significant advantages in total monitor units reduction (100% of cases, P ≤ 0.001), total number of field reduction (66% of cases, P ≤ 0.001), and reduction of patient mean dose (69% of cases, P ≤ 0.001) over ISO-based IMRT plans. The conformity index, homogeneity index and target mean dose were comparable between both group of plans.

Conclusion: Significant dosimetrical advantages may be observed, when the geometric centroid of target volume is considered as isocenter of IMRT treatment plan.
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http://dx.doi.org/10.4103/jcrt.JCRT_985_16DOI Listing
July 2019

Modulation of the immune response and infection pattern to Leishmania donovani in visceral leishmaniasis due to arsenic exposure: An in vitro study.

PLoS One 2019 5;14(2):e0210737. Epub 2019 Feb 5.

Division of Microbiology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India.

The arsenic contamination of ground water in visceral leishmaniasis (VL) endemic areas in Bihar, India leads to human exposure through drinking water. Possibly, the consumed arsenic (As) accumulates in the tissues of VL patients, who subsequently internalize intracellular amastigotes to confer resistance against chemotherapy to the parasite, leading to modulation in the host's immune response. This hypothesis appears to be consistent with the in vitro findings that in arsenic-exposed parasites, the mitochondrial membrane potential became depolarized, whereas the reduced thiol and lactate production was overexpressed with enhanced glucose consumption; therefore, the reduced thiol possibly supports an immunosuppressive state in the host cells. This observation was well supported by the down-regulated expression of pro-inflammatory cytokines (IL-2, IL-12, IFN-γ, and TNF-α) with a suppressed anti-leishmanial function of macrophage (NO, ROS). In contrast, the pathophysiological mechanism of VL has received ample support by the promotion of Th2 cytokines (IL-4 and IL-10) in the presence of arsenic-exposed Leishmania parasites (LdAS). Dysfunction of mitochondria and the overexpression of lactate production raise the possibility of the Warburg effect being operative through the up-regulation of glucose consumption by parasites to enhance the energy production, possibly augmenting virulence. Therefore, we surmise from our data that arsenic exposure to Leishmania donovani modulates the immune response and infection pattern by impairing parasite function, which may affect the anti-leishmanial effect in VL.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210737PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363178PMC
October 2019

Rapidly Resorbable Skin Sutures: Story Retold!

Aesthetic Plast Surg 2017 04 26;41(2):470-471. Epub 2016 Oct 26.

Max Institute of Reconstructive, Aesthetic, Cleft and Craniofacial Surgery (MIRACLES), Max Super Speciality Hospital, 1-2, Press Enclave Road, New Delhi, 110017, India.

Rapidly resorbable skin sutures have an elaborate use not only in facial surgeries but also in breast, abdomen, and hand wound closure. Its removal may not require trimming, as gentle rubbing with a moisturizing agent makes them fall off easily in 10-14 days postoperatively. This practice has a good acceptance, especially among children, and gives a favorable aesthetic outcome.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A3 online Instructions to Authors. www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-016-0717-7DOI Listing
April 2017

Impact of Induction Chemotherapy Followed by Radiotherapy in Patients of Invasive Cervical Carcinoma with Inadvertent Hysterectomy: A Retrospective Study.

Authors:
Sunil Choudhary

J Clin Diagn Res 2015 Oct 1;9(10):XC01-XC04. Epub 2015 Oct 1.

Assistant Professor, Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi, India .

Background: The standard of care for patients who undergo an inadvertent hysterectomy for invasive cervical carcinoma is not well established.

Aim: The aim of this study was to evaluate the role of induction chemotherapy followed by external beam radiotherapy and brachytherapy in patients who had an inadequate hysterectomy for carcinoma of the cervix.

Materials And Methods: Patients with history of inadequate hysterectomy with no residual disease at presentation to our outpatients department of Radiotherapy and registered between October 2011 to June 2014 were retrospectively analyzed. Most of these patients had received three cycles of induction chemotherapy using Paclitaxel and Carboplatin regime. Thereafter, these patients had received external beam radiotherapy and vaginal brachytherapy. The primary end points were overall survival and disease-free survival. Survival analysis was done using Kaplan-Meier method and the differences in survival rates were compared using log-rank test.

Results: A total of 34 patients were eligible for the study. Overall survival and Disease-free survival at 3-years were 70% and 68%. Patients who had Taxane-based chemotherapy had significantly better survival outcomes than their counterparts. Vaginal vault boost with brachytherapy had a significant impact on prognosis of these patients.

Conclusion: Induction chemotherapy using Paclitaxel and Carboplatin followed by external beam radiotherapy and brachytherapy is a good treatment option for patients of carcinoma of the cervix who have undergone inadvertent hysterectomy.
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http://dx.doi.org/10.7860/JCDR/2015/15739.6640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625318PMC
October 2015

Impact of Adjuvant Therapy on Survival in Curatively Resected Gallbladder Carcinoma.

J Clin Diagn Res 2015 Sep 1;9(9):XC01-XC04. Epub 2015 Sep 1.

Professor, Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi, India .

Background: Gallbladder carcinoma (GBC) has the propensity to fail at loco-regional (LR) and distant sites despite aggressive radical surgery. Adjuvant therapy in the form of radiotherapy (RT), systemic chemotherapy (CT) and chemoradiation (CRT) is the usual practice. Due to rarity of this disease, there is limited evidence to suggest the type of adjuvant treatment which should be offered to the patients.

Aim: The study was conducted to evaluate the impact of adjuvant treatment on curatively resected GBC patients.

Settings And Design: Histological proven patients of GBC registered between June, 2008 and July, 2014 were identified from our hospital database and retrospective analysis was done.

Materials And Methods: Patients of GBC who had curative resection followed by adjuvant treatment as RT alone, CT alone or CRT were included in the study.

Statistical Analysis: Adverse prognostic factors and the effect of adjuvant treatment on overall survival (OS) and disease free survival (DFS) were evaluated using Cox Regression Method and Kaplan Meier plot.

Results: We identified 33 patients of which 23 were Stage I or II disease (Early disease) and the remaining 10 were Stage III or IV disease (Advanced disease). All except one patient had adenocarcinoma. A total of 5 patients were treated with RT alone while 16 patients received CT alone. The remaining 12 patients were treated with CRT. Median follow-up period was 8.5 months. At analysis 4 were alive while the remaining 29 were dead due to disease. With regard to "Early disease" patients who had RT alone, CT alone and CRT, the median OS was 22.3, 10.3 and 15.2 months respectively (p = .440). Cohort of patients with "Advanced disease" who were treated with CT alone and CRT the median OS was 7.5 and 7.0 months respectively (p = .643). On multivariate analysis none of the prognostic factors had an adverse impact on survival.

Conclusion: The impact of adjuvant treatment in the form of RT, CT or CRT after curative resection in GBC patients was seen in terms of improved survival but was not statistically significant.
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http://dx.doi.org/10.7860/JCDR/2015/15113.6436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606323PMC
September 2015

Radiotherapy-Induced Vitiligo in a Patient with Carcinoma Buccal Mucosa: A Case Report.

Authors:
Sunil Choudhary

J Clin Diagn Res 2015 Aug 1;9(8):XD06-XD07. Epub 2015 Aug 1.

Assistant Professor, Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi, India .

Vitiligo significantly affects self-esteem and deteriorates the quality of life of affected persons. Radiotherapy has several early and late effects but it is not known to induce vitiligo. This is a case report of a patient suffering from carcinoma buccal mucosa that had developed vitiligo in the radiotherapy portal. To the best of my knowledge this is a one of the first case reports of its kind as this patient had no history of vitiligo but developed it soon after radiotherapy. Since radiotherapy is an essential component of cancer management, the radiation oncologist must be aware of this toxicity of radiotherapy. Choosing the high energy of photon beam may reduce the risk of such toxicities.
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http://dx.doi.org/10.7860/JCDR/2015/15096.6369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576626PMC
August 2015

"Bottle cap as bite block": An innovative intraoral splint.

Indian J Plast Surg 2014 Sep-Dec;47(3):475-7

Department of Plastic Surgery, Max Super Speciality Hospital, Saket, New Delhi, India.

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http://dx.doi.org/10.4103/0970-0358.146694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4292143PMC
January 2015

Feasibility and pilot study of the effects of microfinance on mortality and nutrition in children under five amongst the very poor in India: study protocol for a cluster randomized controlled trial.

Trials 2014 Jul 23;15:298. Epub 2014 Jul 23.

Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Queen's Medical Center, Derby Road, NG7 2UH Nottingham, UK.

Background: The United Nations Millennium Development Goals include targets for the health of children under five years old. Poor health is linked to poverty and microfinance initiatives are economic interventions that may improve health by breaking the cycle of poverty. However, there is a lack of reliable evidence to support this. In addition, microfinance schemes may have adverse effects on health, for example due to increased indebtedness. Rojiroti UK and the Centre for Promoting Sustainable Livelihood run an innovative microfinance scheme that provides microcredit via women's self-help groups (SHGs). This pilot study, conducted in rural Bihar (India), will establish whether it is feasible to collect anthropometric and mortality data on children under five years old and to conduct a limited cluster randomized trial of the Rojiroti intervention.

Methods/design: We have designed a cluster randomized trial in which participating tolas (small communities within villages) will be randomized to either receive early (SHGs and microfinance at baseline) or late intervention (SHGs and microfinance after 18 months). Using predesigned questionnaires, demographic, and mortality data for the last year and information about participating mothers and their children will be collected and the weight, height, and mid upper arm circumference (MUAC) of children will be measured at baseline and at 18 months. The late intervention group will establish SHGs and microfinance support at this point and data collection will be repeated at 36 months.The primary outcome measure will be the mean weight for height z-score of children under five years old in the early and late intervention tolas at 18 months. Secondary outcome measures will be the mortality rate, mean weight for age, height for age, prevalence of underweight, stunting, and wasting among children under five years of age.

Discussion: Despite economic progress, marked inequalities in child health persist in India and Bihar is one of the worst affected states. There is a need to evaluate programs that may alleviate poverty and improve health. This study will help to inform the design of a definitive trial to determine if the Rojiroti scheme can improve the nutrition and survival of children under five years of age in deprived rural communities.

Trial Registration: Clinicaltrials.gov (study ID: NCT01845545). Registered on 24 April 2013.
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http://dx.doi.org/10.1186/1745-6215-15-298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119203PMC
July 2014

Genome sequence of Ensifer sp. TW10; a Tephrosia wallichii (Biyani) microsymbiont native to the Indian Thar Desert.

Stand Genomic Sci 2013 Dec 15;9(2):304-14. Epub 2013 Dec 15.

Centre for Rhizobium Studies, Murdoch University, Western Australia, Australia.

Ensifer sp. TW10 is a novel N2-fixing bacterium isolated from a root nodule of the perennial legume Tephrosia wallichii Graham (known locally as Biyani) found in the Great Indian (or Thar) desert, a large arid region in the northwestern part of the Indian subcontinent. Strain TW10 is a Gram-negative, rod shaped, aerobic, motile, non-spore forming, species of root nodule bacteria (RNB) that promiscuously nodulates legumes in Thar Desert alkaline soil. It is fast growing, acid-producing, and tolerates up to 2% NaCl and capable of growth at 40(o)C. In this report we describe for the first time the primary features of this Thar Desert soil saprophyte together with genome sequence information and annotation. The 6,802,256 bp genome has a GC content of 62% and is arranged into 57 scaffolds containing 6,470 protein-coding genes, 73 RNA genes and a single rRNA operon. This genome is one of 100 RNB genomes sequenced as part of the DOE Joint Genome Institute 2010 Genomic Encyclopedia for Bacteria and Archaea-Root Nodule Bacteria (GEBA-RNB) project.
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http://dx.doi.org/10.4056/sigs.4598281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4062627PMC
December 2013

Twisted pyrene-fused azaacenes.

Chem Commun (Camb) 2014 Feb;50(16):1976-9

POLYMAT, University of the Basque Country UPV/EHU, Avenida de Tolosa 72, E-20018 Donostia-San Sebastian, Spain.

An approach for introducing twists in pyrene-fused azaacenes is reported. Depending on the volume and the rigidity of the silyl groups, different-sized twist angles, which oscillate between 4° and 24°, are induced along the longitudinal conjugated backbone.
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http://dx.doi.org/10.1039/c3cc48742cDOI Listing
February 2014

Hexaazatrinaphthylenes with different twists.

Chemistry 2014 Feb 9;20(6):1525-8. Epub 2013 Dec 9.

School of Soft Matter Research, Freiburg Institute for Advanced Studies (FRIAS), Albert-Ludwigs-Universität Freiburg, Albertstrasse 19, 79104 Freiburg (Germany); Institut für Organische Chemie und Biochemie, Albert-Ludwigs-Universität Freiburg, Albertstrasse 21, 79104 Freiburg (Germany).

A synthetic strategy that allows the induction of twist angles of different sizes in 5,6,11,12,17,18-hexaazatrinaphthylene (HATNA) chromophores is reported. The different twist angles are accompanied by measurable changes in the emission and electrochemical characteristics of HATNA.
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http://dx.doi.org/10.1002/chem.201304071DOI Listing
February 2014

Versatile 2,7-substituted pyrene synthons for the synthesis of pyrene-fused azaacenes.

Org Lett 2012 Aug 6;14(16):4170-3. Epub 2012 Aug 6.

Freiburg Institute for Advanced Studies (FRIAS), Albert-Ludwigs-Universität Freiburg, Albertstrasse 19, D-79104 Freiburg im Breisgau, Germany.

A new synthetic route to prepare a series of versatile 2,7-substituted pyrene synthons for the synthesis of pyrene-fused azaacenes is described. By using such synthons, a library of eight pyrene-fused azacenes with different electronic structures and in most cases with enhanced solubility has been synthesized and characterized.
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http://dx.doi.org/10.1021/ol301841hDOI Listing
August 2012

Melanoma of the lacrimal gland: a case report.

J Surg Oncol 2012 Nov 11;106(6):796-7. Epub 2012 Jun 11.

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http://dx.doi.org/10.1002/jso.23193DOI Listing
November 2012

Chemical analysis of groundwater of Nathnagar Block under Bhagalpur District, Bihar (India).

J Environ Sci Eng 2011 Oct;53(4):469-74

Environmental Biology Laboratory, University Department of Botany, T.M. Bhagalpur University, Bhagalpur--812 007 India.

The chemical analysis of groundwater samples from hundred handpumps in five villages of the Nathnagar Block under Bhagalpur District, Bihar, India indicates that the water samples in the area were slightly alkaline and the concentration of total hardness and heavy metal like arsenic were above the drinking water specifications as prescribed by World Health Organization (1999) and ISI (2003); whereas other chemical parameters were well within the permissible limit. The results of the present study suggest that the groundwater sources under investigation were suitable for domestic purposes including drinking except for arsenic. The concentration of arsenic in most of the handpumps analyzed was high, and that might be attributed to the excessive withdrawal of the groundwater and changes in the geo-chemical environment of the Ganga river. Moreover, the Ganga River System itself carries high sediment bed loads which contain several trace elements, including arsenic. Some effective measures like rainwater harvesting and artificial recharge techniques are urgently required and suggested for water quality management in this region.
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October 2011

Antioxidants and skin care: the essentials--old wine in a new bottle.

Plast Reconstr Surg 2010 Dec;126(6):2297-2298

Department of Plastic Surgery, Max Institute of Aesthetic and Reconstructive Plastic Surgery, Saket, New Delhi, India.

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http://dx.doi.org/10.1097/PRS.0b013e3181f61d8fDOI Listing
December 2010