ABSTRACTBackgroundGallbladder Cancer (GBC) is one of the most common cancers of the biliary tract... more ABSTRACTBackgroundGallbladder Cancer (GBC) is one of the most common cancers of the biliary tract and the third commonest gastrointestinal (GI) malignancy worldwide. The disease is characterized by the late presentation and poor outcome despite treatment, and hence, newer therapies and targets need to be identified.MethodsThe current study investigated various functionally enriched pathways in GBC pathogenesis involving the genes identified through Next Generation Sequencing (NGS). The Pathway enrichment analysis and Gene Ontology (GO) were carried out after NGS, followed by the construction of the protein-protein interaction (PPI) network to discover associations among the genes.ResultsOf the thirty-three patients with GBC who were screened through next-generation sequencing (NGS), 27somatic mutations were identified. These mutations involved a total of 14 genes. The p53 and KRAS were commonly found to be mutated, while mutations in other genes were seen in one case each, the mean ...
Abstract Objective Role of Magnetic Resonance Imaging (MRI) in diagnosis of tuberculous tubo-ovar... more Abstract Objective Role of Magnetic Resonance Imaging (MRI) in diagnosis of tuberculous tubo-ovarian (TO) mass. Methods MRI was performed on 33 patients of tuberculous TO mass of female genital tuberculosis (FGTB). Results Mean age, BMI, and parity was 27.5± 4.2 years, 22.7±3.6 kg/m2, and 0.27±0.13. All patients (100%) had infertility; primary infertility (72.72%) and secondary infertility (27.23%) with mean 5.8 years. Abdominal/pelvic pain 33 (100%) cases, abdominal lump 4(12.12%), adnexal mass 33(100%). MRI findings showed pelvic masses 33(100%), bilateral TO masses 11 (33.33%), cystic lesion 4(12.12%), solid cystic lesion 3(9.09%) with bilateral pyosalpinx 1(3.3%), homogeneous content with ascites 1(3.03%), rim enhancing lesion abutting pelvic wall in 1(3.03%). Right adnexal mass 11(33.33%), right adnexal cyst 2 (6.06%), right adnexal cystic mass in 1(3.03%), right sided complex TO mass 1(3.03%), right sided hydroslapinx in 1(3.03%) case, right sided TO mass in 4(12.12%) cases and right sided para-ovarian cyst in 2(6.06%). Left sided adnexal mass was seen in 11(33.33%), cystic lesion in 1(3.03%), ovarian cyst in 3(9.09%) cases, left sided hydrosalpinx in 2(6.06%), left ovarian cyst 2(6.06%) cases, left sided ovarian cyst with encysted ascites 1(3.03%) case and with left sided paraovarian cyst 2(6.06%) case. Miscellaneous finding were generalised ascites (6.06%), encysted ascites (3.03%), pelvic (1;3.03%) and mesenteric lymphadenopathy 1(3.03%). Incidental finding were fibroid 3(9.09%) and adenomyosis 1(3.03%) case. Conclusion MRI appears to be useful diagnostic modality for tuberculous TO masses where differential diagnosis is malignancy but molecular diagnosis remains the gold standard.
Background India encountered two waves of COVID-19 pandemic with variability in its characteristi... more Background India encountered two waves of COVID-19 pandemic with variability in its characteristics and severity. Concerns were raised over the safety of treatment, and higher morbidity was predicted for oncological surgery. The present study was conducted to evaluate and compare the rate of morbidity and mortality in patients undergoing curative surgery for cancer before and during the COVID-19 pandemic. Method The prospectively obtained clinical data of 1576 patients treated between April 2019 and May 2021 was reviewed; of these, 959 patients were operated before COVID-19 and 617 during the pandemic. The data on complications, deaths, confirmed or suspected COVID-19 cases, and COVID-19 infection among health workers (HCW) was extracted. Results A 35% fall in number of surgeries was seen during the COVID period; significant fall was seen in genital and esophageal cancer. There was no difference in postoperative complication; however, the postoperative mortality was significantly hi...
Introduction Peritonitis associated with fungal species Curvularia lunata seldom occurs with only... more Introduction Peritonitis associated with fungal species Curvularia lunata seldom occurs with only five cases reported in the literature, all in middle-age patients with comorbidities undergoing dialysis. Case report A 21-year-old female who was referred to surgical oncology OPD with a diagnosis of ovarian malignancy, based on raised cancer antigen 125 (CA 125) and suspected tubo-ovarian mass (TOM) on magnetic resonance imaging (MRI). A review of the MRI showed a pelvic collection with TOM, suggestive of infective pathology. Fungal culture and mass spectroscopy of the cystic collection identified the presence of Curvularia lunata. She was treated with oral itraconazole which showed symptomatic improvement and radiological response. In the follow-up period, the patient developed chest wall swelling, aspiration and geneXpert® revealed multidrug-resistant (MDR) tuberculosis, and treatment was started. Conclusions Unusual causes of TOM and raised CA 125 should be kept in mind when dealin...
Gestational Trophoblastic Neoplasia presenting after a normal delivery is very rare & seen in 1 i... more Gestational Trophoblastic Neoplasia presenting after a normal delivery is very rare & seen in 1 in 1,60,000 pregnancies and is associated with a poor outcome due to delay in diagnosis. Only three cases have been reported in the literature till date. A 27 year old lady, P2L1 delivered a stillborn baby in some peripheral hospital. Intrapartumand post-partum period were uneventful. After a period of 2 months, in view of persistent bleeding pervaginumshe underwent dilatation & evacuation in the same hospital. Ultrasonography showed circumscribed lesion 4.1 x 3.6 cm in lower uterine segment indenting the endometrium. MRI showed a heterogeneous space (4.2 x 3.2 x 3.3 cm) occupying lesion extending to involve the anterior myometrium. She was discharged on single dose of methotrexate 50 mg intramuscular injection. After one month, she again had an episode of heavy bleeding pervaginum leading to shock, for which she was referred to Safdarjung Hospital for further management. At Safdarjung Ho...
Abstract We compared the labour pattern in the active phase of labour, defined at 4 cm versus 6 c... more Abstract We compared the labour pattern in the active phase of labour, defined at 4 cm versus 6 cm cervical dilatation, in a South Asian population. This was a prospective observational study where 500 low risk nulliparous women were recruited. Our aim was to study, the average labour pattern curve of all parturients. Mean duration of the active phase from 4 to 10 cm was 5.12 ± 2.10 hours and from 6 to 10 cm was 2.79 ± 1.72 hours. The 95th percentile values suggests that it takes 5–6 hours to progress from 4 to 6 cm and again 5–6 hours from 6 to 10 cm. The minimum labour progression rate can be as low as 0.5 cm/hour with vaginal delivery (VD) still being achieved. The slope of labour curve steepens after 6 cm, suggesting 6 cm as the onset of the active phase. Allowing labour to continue for a longer period before 6 cm of cervical dilation may reduce the rate of unnecessary intrapartum intervention and caesarean section (CS) for labour dystocia. Impact Statement What is already known on this subject ? Friedman’s definitions of normal labour and abnormal labour are widely accepted in current obstetric practises. Friedman’s normal dilatation rate of 1 cm/h that is universally accepted is becoming questionable in our current obstetric population because of escalating rates of unnecessary labour interventions like oxytocin augmentation and CS. What the results of this study add ? The rule of 1 cm/hour of labour progression cannot be applied to every woman and inappropriate interventions should be withheld until labour progression does falls below 0.5 cm/hour. What the implications are of these findings for clinical practice and/or further research? Six centimetres rather than 4 cm of cervical dilatation is a more appropriate landmark for the start of the active phase. Allowing labour to continue for a longer period before 6 cm of cervical dilation may reduce the rate of unnecessary intrapartum interventions and CS for labour dystocia.
Background: Perivascular epitheloid cell tumor (PEComas) are characterised by expression of both ... more Background: Perivascular epitheloid cell tumor (PEComas) are characterised by expression of both muscles, most often smooth muscle actin (in ~80% of cases) and melanocytic markers (mainly HMB-45 and Melan A). TFE 3 associated PEComas are new variant which are poorly defined due to their limited reports in literature. These tumors lack response to targeted mTOR inhibitor therapy due to lack of mutation in TSC gene. Hereby we are reporting a case of TFE3 associated pelvic PEComa showing excellent response to Everolimus. Case presentation: A 45-year-old female presented with complaint of abdominal mass and bleeding per vaginum for 4 months. She had a history of total abdominal hysterectomy 3 years back in view of abnormal uterine bleeding and exploratory laprotomy 7 months back to remove some pelvic mass. Imaging suggested of ill-defined heterogenous mass of 9.3 x 9.2 x 16 cm involving uterus, cervix and upper 1/3 vagina. Multiple omental and peritoneal deposits were also seen, making ...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Gonadal dysgenesis is a group of heterogeneous disorders with very rare presentation. The spectru... more Gonadal dysgenesis is a group of heterogeneous disorders with very rare presentation. The spectrum of disease not only includes primary amenorrhoea but also secondary amenorrhoea. Herein, we are reporting a case of 16-year-old phenotypic female who presented with amenorrhoea with 46, XX karyotype with hypoplastic uterus with absent ovaries (on imaging), with high gonadotropins level and low estradiol. Suspecting Mayer–Rokitansky–Küster–Hauser syndrome (due to hypoplastic uterus) with gonadal dysgenesis she was started on cyclic hormones for development of secondary sexual characters and to prevent bone loss. But, during follow up, after giving estrogen for 8 months, her hypoplastic uterus again starts reappearing with attainment of cyclic menses on estrogen and progesterone withdrawal. We concluded that, in the presence of rudimentary or hypoplastic uterus, straightforward diagnosis of MRKH is to be avoided without seeing peripheral estrogenisation, hormone profile and karyotype ana...
ABSTRACT Present study is focused on the preparation of two layers composite wound dressing for d... more ABSTRACT Present study is focused on the preparation of two layers composite wound dressing for drug release. The outer layer is made of hydrogel which contains of drug and the core layer is made of fabric. The two layers structure of composite dressing is formed by grafting of polyacrylamide-co-acrylic acid hydrogel on cotton fabric using ammonium per sulphate (APS) as chemical initiator and polyethylene glycol (PEG) as crosslinker. The major factors affecting graft copolymerization of hydrogel on cotton fabric are optimized by varying concentration of monomers & initiator, reaction temperature and addition time of crosslinker. Maximum grafting of hydrogel is obtained at 5 % (w/v) APS and 15 % acrylamide/acrylic acid (1:1 w/w ratio) concentration. The FTIR spectra of composite dressing shows characteristics peak of acrylic acid and acrylamide. The composite wound dressing material is loaded with model drug bovine serum albumin (BSA) and drug release behaviour is studied at different pH. The dressing shows drug release in different pH with maximum release of drug in acidic medium.
ABSTRACTBackgroundGallbladder Cancer (GBC) is one of the most common cancers of the biliary tract... more ABSTRACTBackgroundGallbladder Cancer (GBC) is one of the most common cancers of the biliary tract and the third commonest gastrointestinal (GI) malignancy worldwide. The disease is characterized by the late presentation and poor outcome despite treatment, and hence, newer therapies and targets need to be identified.MethodsThe current study investigated various functionally enriched pathways in GBC pathogenesis involving the genes identified through Next Generation Sequencing (NGS). The Pathway enrichment analysis and Gene Ontology (GO) were carried out after NGS, followed by the construction of the protein-protein interaction (PPI) network to discover associations among the genes.ResultsOf the thirty-three patients with GBC who were screened through next-generation sequencing (NGS), 27somatic mutations were identified. These mutations involved a total of 14 genes. The p53 and KRAS were commonly found to be mutated, while mutations in other genes were seen in one case each, the mean ...
Abstract Objective Role of Magnetic Resonance Imaging (MRI) in diagnosis of tuberculous tubo-ovar... more Abstract Objective Role of Magnetic Resonance Imaging (MRI) in diagnosis of tuberculous tubo-ovarian (TO) mass. Methods MRI was performed on 33 patients of tuberculous TO mass of female genital tuberculosis (FGTB). Results Mean age, BMI, and parity was 27.5± 4.2 years, 22.7±3.6 kg/m2, and 0.27±0.13. All patients (100%) had infertility; primary infertility (72.72%) and secondary infertility (27.23%) with mean 5.8 years. Abdominal/pelvic pain 33 (100%) cases, abdominal lump 4(12.12%), adnexal mass 33(100%). MRI findings showed pelvic masses 33(100%), bilateral TO masses 11 (33.33%), cystic lesion 4(12.12%), solid cystic lesion 3(9.09%) with bilateral pyosalpinx 1(3.3%), homogeneous content with ascites 1(3.03%), rim enhancing lesion abutting pelvic wall in 1(3.03%). Right adnexal mass 11(33.33%), right adnexal cyst 2 (6.06%), right adnexal cystic mass in 1(3.03%), right sided complex TO mass 1(3.03%), right sided hydroslapinx in 1(3.03%) case, right sided TO mass in 4(12.12%) cases and right sided para-ovarian cyst in 2(6.06%). Left sided adnexal mass was seen in 11(33.33%), cystic lesion in 1(3.03%), ovarian cyst in 3(9.09%) cases, left sided hydrosalpinx in 2(6.06%), left ovarian cyst 2(6.06%) cases, left sided ovarian cyst with encysted ascites 1(3.03%) case and with left sided paraovarian cyst 2(6.06%) case. Miscellaneous finding were generalised ascites (6.06%), encysted ascites (3.03%), pelvic (1;3.03%) and mesenteric lymphadenopathy 1(3.03%). Incidental finding were fibroid 3(9.09%) and adenomyosis 1(3.03%) case. Conclusion MRI appears to be useful diagnostic modality for tuberculous TO masses where differential diagnosis is malignancy but molecular diagnosis remains the gold standard.
Background India encountered two waves of COVID-19 pandemic with variability in its characteristi... more Background India encountered two waves of COVID-19 pandemic with variability in its characteristics and severity. Concerns were raised over the safety of treatment, and higher morbidity was predicted for oncological surgery. The present study was conducted to evaluate and compare the rate of morbidity and mortality in patients undergoing curative surgery for cancer before and during the COVID-19 pandemic. Method The prospectively obtained clinical data of 1576 patients treated between April 2019 and May 2021 was reviewed; of these, 959 patients were operated before COVID-19 and 617 during the pandemic. The data on complications, deaths, confirmed or suspected COVID-19 cases, and COVID-19 infection among health workers (HCW) was extracted. Results A 35% fall in number of surgeries was seen during the COVID period; significant fall was seen in genital and esophageal cancer. There was no difference in postoperative complication; however, the postoperative mortality was significantly hi...
Introduction Peritonitis associated with fungal species Curvularia lunata seldom occurs with only... more Introduction Peritonitis associated with fungal species Curvularia lunata seldom occurs with only five cases reported in the literature, all in middle-age patients with comorbidities undergoing dialysis. Case report A 21-year-old female who was referred to surgical oncology OPD with a diagnosis of ovarian malignancy, based on raised cancer antigen 125 (CA 125) and suspected tubo-ovarian mass (TOM) on magnetic resonance imaging (MRI). A review of the MRI showed a pelvic collection with TOM, suggestive of infective pathology. Fungal culture and mass spectroscopy of the cystic collection identified the presence of Curvularia lunata. She was treated with oral itraconazole which showed symptomatic improvement and radiological response. In the follow-up period, the patient developed chest wall swelling, aspiration and geneXpert® revealed multidrug-resistant (MDR) tuberculosis, and treatment was started. Conclusions Unusual causes of TOM and raised CA 125 should be kept in mind when dealin...
Gestational Trophoblastic Neoplasia presenting after a normal delivery is very rare & seen in 1 i... more Gestational Trophoblastic Neoplasia presenting after a normal delivery is very rare & seen in 1 in 1,60,000 pregnancies and is associated with a poor outcome due to delay in diagnosis. Only three cases have been reported in the literature till date. A 27 year old lady, P2L1 delivered a stillborn baby in some peripheral hospital. Intrapartumand post-partum period were uneventful. After a period of 2 months, in view of persistent bleeding pervaginumshe underwent dilatation & evacuation in the same hospital. Ultrasonography showed circumscribed lesion 4.1 x 3.6 cm in lower uterine segment indenting the endometrium. MRI showed a heterogeneous space (4.2 x 3.2 x 3.3 cm) occupying lesion extending to involve the anterior myometrium. She was discharged on single dose of methotrexate 50 mg intramuscular injection. After one month, she again had an episode of heavy bleeding pervaginum leading to shock, for which she was referred to Safdarjung Hospital for further management. At Safdarjung Ho...
Abstract We compared the labour pattern in the active phase of labour, defined at 4 cm versus 6 c... more Abstract We compared the labour pattern in the active phase of labour, defined at 4 cm versus 6 cm cervical dilatation, in a South Asian population. This was a prospective observational study where 500 low risk nulliparous women were recruited. Our aim was to study, the average labour pattern curve of all parturients. Mean duration of the active phase from 4 to 10 cm was 5.12 ± 2.10 hours and from 6 to 10 cm was 2.79 ± 1.72 hours. The 95th percentile values suggests that it takes 5–6 hours to progress from 4 to 6 cm and again 5–6 hours from 6 to 10 cm. The minimum labour progression rate can be as low as 0.5 cm/hour with vaginal delivery (VD) still being achieved. The slope of labour curve steepens after 6 cm, suggesting 6 cm as the onset of the active phase. Allowing labour to continue for a longer period before 6 cm of cervical dilation may reduce the rate of unnecessary intrapartum intervention and caesarean section (CS) for labour dystocia. Impact Statement What is already known on this subject ? Friedman’s definitions of normal labour and abnormal labour are widely accepted in current obstetric practises. Friedman’s normal dilatation rate of 1 cm/h that is universally accepted is becoming questionable in our current obstetric population because of escalating rates of unnecessary labour interventions like oxytocin augmentation and CS. What the results of this study add ? The rule of 1 cm/hour of labour progression cannot be applied to every woman and inappropriate interventions should be withheld until labour progression does falls below 0.5 cm/hour. What the implications are of these findings for clinical practice and/or further research? Six centimetres rather than 4 cm of cervical dilatation is a more appropriate landmark for the start of the active phase. Allowing labour to continue for a longer period before 6 cm of cervical dilation may reduce the rate of unnecessary intrapartum interventions and CS for labour dystocia.
Background: Perivascular epitheloid cell tumor (PEComas) are characterised by expression of both ... more Background: Perivascular epitheloid cell tumor (PEComas) are characterised by expression of both muscles, most often smooth muscle actin (in ~80% of cases) and melanocytic markers (mainly HMB-45 and Melan A). TFE 3 associated PEComas are new variant which are poorly defined due to their limited reports in literature. These tumors lack response to targeted mTOR inhibitor therapy due to lack of mutation in TSC gene. Hereby we are reporting a case of TFE3 associated pelvic PEComa showing excellent response to Everolimus. Case presentation: A 45-year-old female presented with complaint of abdominal mass and bleeding per vaginum for 4 months. She had a history of total abdominal hysterectomy 3 years back in view of abnormal uterine bleeding and exploratory laprotomy 7 months back to remove some pelvic mass. Imaging suggested of ill-defined heterogenous mass of 9.3 x 9.2 x 16 cm involving uterus, cervix and upper 1/3 vagina. Multiple omental and peritoneal deposits were also seen, making ...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Gonadal dysgenesis is a group of heterogeneous disorders with very rare presentation. The spectru... more Gonadal dysgenesis is a group of heterogeneous disorders with very rare presentation. The spectrum of disease not only includes primary amenorrhoea but also secondary amenorrhoea. Herein, we are reporting a case of 16-year-old phenotypic female who presented with amenorrhoea with 46, XX karyotype with hypoplastic uterus with absent ovaries (on imaging), with high gonadotropins level and low estradiol. Suspecting Mayer–Rokitansky–Küster–Hauser syndrome (due to hypoplastic uterus) with gonadal dysgenesis she was started on cyclic hormones for development of secondary sexual characters and to prevent bone loss. But, during follow up, after giving estrogen for 8 months, her hypoplastic uterus again starts reappearing with attainment of cyclic menses on estrogen and progesterone withdrawal. We concluded that, in the presence of rudimentary or hypoplastic uterus, straightforward diagnosis of MRKH is to be avoided without seeing peripheral estrogenisation, hormone profile and karyotype ana...
ABSTRACT Present study is focused on the preparation of two layers composite wound dressing for d... more ABSTRACT Present study is focused on the preparation of two layers composite wound dressing for drug release. The outer layer is made of hydrogel which contains of drug and the core layer is made of fabric. The two layers structure of composite dressing is formed by grafting of polyacrylamide-co-acrylic acid hydrogel on cotton fabric using ammonium per sulphate (APS) as chemical initiator and polyethylene glycol (PEG) as crosslinker. The major factors affecting graft copolymerization of hydrogel on cotton fabric are optimized by varying concentration of monomers & initiator, reaction temperature and addition time of crosslinker. Maximum grafting of hydrogel is obtained at 5 % (w/v) APS and 15 % acrylamide/acrylic acid (1:1 w/w ratio) concentration. The FTIR spectra of composite dressing shows characteristics peak of acrylic acid and acrylamide. The composite wound dressing material is loaded with model drug bovine serum albumin (BSA) and drug release behaviour is studied at different pH. The dressing shows drug release in different pH with maximum release of drug in acidic medium.
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