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Suda A, Sikdar A, Nivsarkar S, Phatak S, Agarwal R. Reflux Symptom Index (RSI), Videolaryngostroboscopy and Voice Analysis: A Triad of Non-Invasive Tools to Study Treatment Outcomes of Laryngopharyngeal Reflux Disease (LPRD). Indian J Otolaryngol Head Neck Surg 2024; 76:250-261. [PMID: 38440605 PMCID: PMC10908943 DOI: 10.1007/s12070-023-04136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/07/2023] [Indexed: 03/06/2024] Open
Abstract
Study post treatment improvement of Laryngopharyngeal Reflux Disease (LPRD) using non-invasive tools of Reflux symptom index (RSI), Reflux finding score (RFS) grading of videolaryngostroboscopy (VLS) and voice analysis. This study from December 2020 to April 2022 enrolled 100 adults with complaints suggestive of reflux symptoms and having Reflux Symptom Index (RSI) more than 13. All patients underwent VLS along with voice analysis. VLS findings were graded using Reflux Finding Score (RFS). Patients were advised for lifestyle modifications and proton pump inhibitors for 8 weeks when post treatment RSI, VLS and voice analyses were again documented. The age range was from 18 to 75 years. Males predominated. Lifestyle modification compliance was seen in 85% of the patients. We found a significant association (P = 0.001) for difference in pretreatment and posttreatment for both Reflux Symptom Index (RSI) parameters & Reflux Finding Score Index (RFS) parameters. Voice analysis pre and post treatment showed a significant association (P = 0.001) for fundamental frequency, jitter, shimmer, harmonic-to-noise ratio and maximum phonation time. The gold standard of diagnosis of LPRD is 24 h pH monitoring but has many false negatives and false positives due to intermittent reflux and inaccurate probe placement. This costly, time consuming and invasive procedure is not widely available amongst our speciality. Excellent visualisation of VLS allowed accurate RFS calculation. Voice analysis permitted early diagnosis of LPRD induced hoarseness before it became clinically significant. It also documented the treatment outcome. We conclude that an 8-weeks proton pump inhibitor treatment combined with lifestyle modification resulted in a significant improvement in the parameters of the non-invasive tools of RSI and RFS and voice analysis.
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Affiliation(s)
- Anuja Suda
- Department of ENT, Choithram Hospital and Research Center, Indore, MP India
| | - Abhik Sikdar
- Department of ENT, Choithram Hospital and Research Center, Indore, MP India
| | - Sameer Nivsarkar
- Department of ENT, Choithram Hospital and Research Center, Indore, MP India
| | - Shrikant Phatak
- Department of ENT, Choithram Hospital and Research Center, Indore, MP India
| | - Richa Agarwal
- Department of ENT, Choithram Hospital and Research Center, Indore, MP India
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Sikdar A, Khan S, Agarwal R, Phatak S, Bhagat P, Patidar R. Metastatic Renal Cell Carcinoma: An Enigmatic Nasal Mass. Indian J Otolaryngol Head Neck Surg 2023; 75:680-688. [PMID: 37206838 PMCID: PMC10188793 DOI: 10.1007/s12070-022-03234-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
Metastatic Renal Cell Carcinoma rarely presents in head and neck and is even rarer in the sinonasal region. However, a sinonasal metastatic mass is usually of RCC origin. These metastases may present prior to the renal symptoms or may appear after primary treatment. Report a 60-year lady with epistaxis due to metastatic RCC. Calculate total published cases of sino-nasal metastasis of RCC. Classify according to sequence of primary and metastatic presentation. A computer aided search of PubMed and Google scholar databases was done using pertinent combinations of the keywords "renal cell carcinoma", "nose and paranasal sinus", "metastasis", "delayed metastasis" and "unusual presentation", revealing 1350 articles. 38 relevant articles were included in the review. Our case presented with epistaxis 3 years after primary RCC. She had a vascular left sided nasal mass which was excised enblock. Immunohistochemistry confirmed metastatic RCC. She is on oral chemotherapy and asymptomatic 1 year post excision. Literature search revealed 116 such cases. 19 patients presented within 10 years of RCC while 7 more were delayed metastasis. 17 cases presented primarily with nasal symptoms with subsequent incidental renal mass. Chronology of presentation was unavailable in the rest 73 cases. We recommend to consider the diagnosis of sinonasal metastatic RCC in a patient presenting with epistaxis or nasal mass, particularly with a past history of RCC. Also, any person with known diagnosis of RCC should undergo regular ENT examination for early diagnosis of sinonasal metastasis.
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Affiliation(s)
- Abhik Sikdar
- Department of ENT, Choithram Hospital and Research Centre, Indore, India
| | - Sidra Khan
- Department of ENT, Choithram Hospital and Research Centre, Indore, India
| | - Richa Agarwal
- Department of ENT, Choithram Hospital and Research Centre, Indore, India
| | - Shrikant Phatak
- Department of ENT, Choithram Hospital and Research Centre, Indore, India
| | - Priyanka Bhagat
- Department of Pathology, Choithram Hospital and Research Centre, Indore, India
| | - Rajesh Patidar
- Department of Medical Oncology, Choithram Hospital and Research Centre, Indore, India
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Sikdar A, Suda A, Phatak S, Nivsarkar S, Agarwal R. Pattern of Food Allergen Sensitivity Amongst Adult Allergic Rhinitis Patients: A Four Year Central Indian Study. Indian J Otolaryngol Head Neck Surg 2023; 75:994-1002. [PMID: 37206762 PMCID: PMC10188673 DOI: 10.1007/s12070-023-03544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023] Open
Abstract
AIMS Only limited Indian data is available regarding the food allergy pattern among allergic rhinitis patients in Indian population. This study aims to assess the pattern of food allergen sensitivity amongst allergic rhinitis patients in central India. MATERIAL AND METHODS A total of 218 subjects with allergic rhinitis were enrolled in the study (from May 2018 to August 2022). Skin prick test was done in all subjects with proper technique and precautions by using 125 common food allergens and 75 aero allergens. The test readings were noted after 20 minutes by comparing the wheals so formed with the negative control of Saline and positive control of Histamine. Any reaction with a wheal diameter of 3mm or greater was considered as positive. RESULTS While test results of both food and inhalant allergens were issued to individual patients, this study was restricted to detection and analysis of pattern of food allergens. Our study observed male preponderance with predominantly a third decade affliction. The most common food allergen in the study population was beetle nut (29.3%) followed by chilli powder and spinach (28.8% each). CONCLUSION Along with aeroallergens, food allergens are also important provocateurs of allergic rhinitis. Diagnosing the offending food allergens and its avoidance reduces patient morbidity, need for pharmaceutical agents and subsequently drug dependence and its side effects. Offering subjects a replacement diet with food items of similar taste and nutritive character helps in sustainable avoidance therapy.
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Affiliation(s)
- Abhik Sikdar
- Department of ENT, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, Opp Phalbag, AB Road, 452012 Indore, MP India
| | - Anuja Suda
- Department of ENT, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, Opp Phalbag, AB Road, 452012 Indore, MP India
| | - Shrikant Phatak
- Department of ENT, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, Opp Phalbag, AB Road, 452012 Indore, MP India
| | - Sameer Nivsarkar
- Department of ENT, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, Opp Phalbag, AB Road, 452012 Indore, MP India
| | - Richa Agarwal
- Department of ENT, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, Opp Phalbag, AB Road, 452012 Indore, MP India
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Itigi S, Sikdar A, Phatak S, Nivsarkar S. Comparative Study of Videolaryngostroboscopic Findings and Voice Handicap Index Before and After Treatment in Patients Presenting with Hoarseness Due to Non Malignant Lesions. Indian J Otolaryngol Head Neck Surg 2022; 74:5160-5168. [PMID: 36742882 PMCID: PMC9895267 DOI: 10.1007/s12070-021-03047-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 02/07/2023] Open
Abstract
Voice personifies an individual. Change in voice can be the only presentation for a benign malady like vocal nodule or acute laryngitis but can also indicate life threatening malignancy. Hence every voice change must be evaluated. The aim of this pioneering study was to assess patients with voice change due to non-malignant conditions, using Videolaryngostroboscopy (VLS) and Voice Handicap Index (VHI) pre and post1 month therapy. Diagnosis determined conservative therapy or Co2 laser phonosurgery according to accepted medical protocol. On VLS, glottic closure pattern and wave form was noted both before and after treatment. Patient completed VHI form before and after treatment. There is no previous study comparing pre and post treatment VHI and VLS in a extensive etiology of conservatively managed patients. In our study, 100 patients were enrolled in the age group between 10 years to the eighties, with majority in their thirties. The male to female ratio was 1.9:1. The majority of patients belonged to level IV occupation. A wide gamut of diagnosis was noted, majority being vocal nodules, followed by polyps, cysts, vocal cord palsy etc. A statistically significant improvement was seen pre and post treatment VLS in glottic closure pattern, waves presence along with improvement in VHI. Thus, Voice Handicap Index and Videostroboscopy can be used to prognosticate the vocal cord lesions and measure the effectiveness of treatment in both surgically and conservatively managed patients.
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Affiliation(s)
- Sphoorthy Itigi
- Department of ENT, Choithram Hospital and Research Centre, Flat 902, Block A3 Avasa, Indore, Madhya Pradesh 452012 India
- Present Address: Department of ENT, Sri Lalithambigai Medical College, Chennai, Tamil Nadu India
| | - Abhik Sikdar
- Department of ENT, Choithram Hospital and Research Centre, Flat 902, Block A3 Avasa, Indore, Madhya Pradesh 452012 India
| | - Shrikant Phatak
- Department of ENT, Choithram Hospital and Research Centre, Flat 902, Block A3 Avasa, Indore, Madhya Pradesh 452012 India
| | - Sameer Nivsarkar
- Department of ENT, Choithram Hospital and Research Centre, Flat 902, Block A3 Avasa, Indore, Madhya Pradesh 452012 India
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Sikdar A, Khan S, Nivsarkar S, Phatak S. Juvenile Nasopharyngeal Angiofibroma in Adolescent Female with Subsequent ICA Canal Dehiscence: An Unknown Entity. Indian J Otolaryngol Head Neck Surg 2022; 74:4680-4687. [PMID: 36742805 PMCID: PMC9895723 DOI: 10.1007/s12070-021-03008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023] Open
Abstract
Juvenile Nasopharyngeal Angiofibroma (JNA) is a benign vascular tumour typically occurring in adolescent males. Presentation beyond this age group and in female is rare. Classically it was surgically removed by various external approaches. Present gold standard of therapy is endoscopic excision. This is less morbid, avoids external scar and allows complete tumour removal under magnified view. Dehiscent internal carotid artery (ICA) canal is a rare condition which presents mostly as a pulsatile tinnitus or otalgia. Accidental injury to the exposed vessel during ear surgery may cause devastating consequences. Present case is a lady who was operated for left NPA 10 years back when she was 11 years age. Presently she presented with left ear pain which was diagnosed to be due to dehiscent ICA canal. We present a comprehensive review of world literature on the incidence of nasopharyngeal and extra-nasopharyngeal angiofibroma in women in the region of nose and para-nasal sinuses. There has been only 3 cases of NPA in adolescent females documented till date. This is the first documented case of NPA in adolescent female with subsequent ICA dehiscence. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-03008-7.
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Affiliation(s)
- Abhik Sikdar
- Department of ENT, Choithram Hospital And Research Centre, Indore, India
| | - Sidra Khan
- Department of ENT, Choithram Hospital And Research Centre, Indore, India
| | - Sameer Nivsarkar
- Department of ENT, Choithram Hospital And Research Centre, Indore, India
| | - Shrikant Phatak
- Department of ENT, Choithram Hospital And Research Centre, Indore, India
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Sikdar A, Mahajan A, Nivsarkar S, Phatak S, Agarwal R. A Novel Two Surgeons Approach to Bronchial Foreign Body Removal by Optical Instruments- An 11 Years Institutional Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:469-475. [PMID: 34540648 PMCID: PMC8435297 DOI: 10.1007/s12070-021-02847-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/31/2021] [Indexed: 12/14/2022] Open
Abstract
A potentially life-threatening emergency in ENT practice is the aspiration of tracheobronchial foreign body. This commonly affects young children and requires early extraction. Successful removal provides immediate relief. However procedural complications can cause devastating morbidity like anoxic encephalopathy or instant death. The aim of this study is to describe the experience in our institution with two surgeons approach for removal of tracheobronchial foreign bodies by telescope and optical forceps. This is an observational study from the period of March 2010 to April 2021 in which 96 patients (59 males, 37 females; age range 3 months to 15 years) were diagnosed with foreign body aspiration. In all cases rigid bronchoscopy and FB removal under general anaesthesia was performed using the two surgeons technique. This technique was instituted once Storz make paediatric telescope (2.9 mm diameter 36 cm length), optical grasping forceps and optical suction were procured in March 2010. Aspirated material was inorganic or organic with varying location in right main bronchus, left main bronchus or the trachea. We highlight the OT setup, surgical algorithm and the advantages of this technique. Visual and tactile coordination between the two surgeons being the crux of this procedure; allows hands on mentoring of the next generation of budding surgeons in a real-life scenario without compromising patient safety. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02847-8.
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Affiliation(s)
- Abhik Sikdar
- Department of ENT, Choithram Hospital and Research Center, Flat No 902, Block A3, Avasa Housing, opp Phalbag, AB Road, Indore, MP 452012 India
| | - Avani Mahajan
- Department of ENT, Choithram Hospital and Research Center, Flat No 902, Block A3, Avasa Housing, opp Phalbag, AB Road, Indore, MP 452012 India
| | - Sameer Nivsarkar
- Department of ENT, Choithram Hospital and Research Center, Flat No 902, Block A3, Avasa Housing, opp Phalbag, AB Road, Indore, MP 452012 India
| | - Shrikant Phatak
- Department of ENT, Choithram Hospital and Research Center, Flat No 902, Block A3, Avasa Housing, opp Phalbag, AB Road, Indore, MP 452012 India
| | - Richa Agarwal
- Department of ENT, Choithram Hospital and Research Center, Flat No 902, Block A3, Avasa Housing, opp Phalbag, AB Road, Indore, MP 452012 India
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Mahajan A, Sikdar A, Nivsarkar S, Phatak S, Agrawal R. A Comparative Study of CT Scan and Nasal Endoscopic Findings of Lateral Wall of Nose, in Headache of Rhinogenic Origin. Indian J Otolaryngol Head Neck Surg 2022; 74:4722-4729. [PMID: 36742466 PMCID: PMC9895760 DOI: 10.1007/s12070-021-03042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023] Open
Abstract
Headache disorders are rated among the ten most disabling conditions worldwide. Contact points like septal spur, septal deviation, concha bullosa and bulla ethmoidalis can cause rhinogenic headache (RH). Diagnostic nasal endoscopy (DNE) is an essential part of evaluation of sinonasal disease and is the key to understanding anatomical variations. As compared to CT paranasal sinus (CT PNS), DNE is cheaper and has wider availability, being part of the basic training of present ENT curriculum. We conducted a prospective observational study from September 2018 to June 2020 on 202 patients who were diagnosed to have RH. The aim of this study was to the define the role of DNE as the primary examination for early and accurate diagnosis of rhinogenic headache as compared to CT PNS. RH patients were evaluated with DNE followed by CT PNS. Evaluation of the findings of anatomical variations of lateral wall of nose on DNE and CT PNS was done. In our study the most common anatomic variations in order of frequency in both DNE and CT PNS was deviated nasal septum, impacting spur and unilateral concha bullosa. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DNE for the various anatomical variations was statistically better than CT PNS findings. We conclude that DNE is a better than CT PNS as a diagnostic technique to detect various anatomical variations, thus initiating early management of RH.
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Affiliation(s)
- Avani Mahajan
- Department of Ent, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, opp Phalbag, AB Road, Indore, 452012 MP India
| | - Abhik Sikdar
- Department of Ent, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, opp Phalbag, AB Road, Indore, 452012 MP India
| | - Sameer Nivsarkar
- Department of Ent, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, opp Phalbag, AB Road, Indore, 452012 MP India
| | - Shrikant Phatak
- Department of Ent, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, opp Phalbag, AB Road, Indore, 452012 MP India
| | - Richa Agrawal
- Department of Ent, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, opp Phalbag, AB Road, Indore, 452012 MP India
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Aggarwal A, Phatak S, Srivastava P, Lawrence A, Agarwal V, Misra R. Outcomes in juvenile onset lupus: single center cohort from a developing country. Lupus 2018; 27:1867-1875. [DOI: 10.1177/0961203318791046] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction About 10–20% of systemic lupus erythematosus (SLE) patients have onset in childhood and have more severe organ involvement. Survival of juvenile SLE patients is improving worldwide. Long-term data of childhood onset SLE from developing countries is scarce. Methods Clinical and laboratory data at initial presentation and follow-up visits were retrieved from clinic files, hospital information system and personal interviews. Treatment received, complications, flares, outcomes and death were recorded. Survival was calculated using Kaplan–Meier survival curves and regression analysis was done for predictors of mortality. Results Children with SLE ( n = 273, 250 girls) had a median age at onset of 14 years and duration of illness prior to diagnosis at our hospital of 1 year. Fever and arthritis were the most common presenting manifestations. Renal disease was seen in 60.5% and central nervous system (CNS) disease in 29%. The median follow-up period in 248 patients was 3.5 years. Fourteen children died, and 10 of these had active disease at the time of death. The mean actuarial survival was 24.5 years and survival rates at 1, 5 and 10 years were 97.9%, 95% and 89% respectively. Fever, CNS disease, anti-dsDNA levels and serious infections predicted death on univariate and multivariate analysis. Infections were seen in 72 children (26.3%), and 38 of these infections were serious. One-third of the patients had damage on the last follow-up. Flares were seen in 120 children, the majority being major flares. Conclusion Outcomes of pediatric SLE in North Indian children are similar to those seen in developed countries. Infections pose a major challenge in these patients.
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Affiliation(s)
- A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S Phatak
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - P Srivastava
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A Lawrence
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - V Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Sikdar A, Mishra S, Nivsarkar S, Agrawal R, Phatak S. Glottic Foreign Body Removal: A Novel Approach. Indian J Pediatr 2018; 85:597. [PMID: 29335885 DOI: 10.1007/s12098-018-2615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Abhik Sikdar
- Department of ENT & Head and Neck Surgery, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, 452014, India.
| | - Sanjeev Mishra
- Department of ENT & Head and Neck Surgery, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, 452014, India
| | - Sameer Nivsarkar
- Department of ENT & Head and Neck Surgery, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, 452014, India
| | - Richa Agrawal
- Department of ENT & Head and Neck Surgery, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, 452014, India
| | - Shrikant Phatak
- Department of ENT & Head and Neck Surgery, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, 452014, India
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Phatak S, Chaurasia S, Mishra SK, Gupta R, Agrawal V, Aggarwal A, Misra R. Urinary B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL): potential biomarkers of active lupus nephritis. Clin Exp Immunol 2016; 187:376-382. [PMID: 27804111 DOI: 10.1111/cei.12894] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/23/2022] Open
Abstract
B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) help in B cell activation, maintenance and plasma cell survival. B cell infiltration has been demonstrated in kidneys of patients with lupus nephritis (LN). Serum levels of BAFF and APRIL have shown inconsistent relationships with lupus disease activity. We evaluated urinary levels of BAFF and APRIL as biomarker for LN. Thirty-six patients with proliferative lupus nephritis (AN), 10 with active lupus without nephritis (AL) and 15 healthy controls (HC) were studied. APRIL and BAFF levels were measured in both serum and urine using enzyme-linked immunosorbent assay (ELISA). Urine levels were normalized for urinary creatinine excretion. Urine levels were correlated with conventional disease activity markers and histology. Levels were reassessed in 20 AN patients at 6 months after treatment with cyclophosphamide. Urinary APRIL (uAPRIL) and BAFF (uBAFF) levels were raised significantly in AN. uAPRIL, but not uBAFF, correlated moderately with renal Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in AN (r = 0·36, P < 0·05). On receiver operator curve (ROC) analysis, uBAFF and uAPRIL showed an area under the curve (AUC) of 0·825 and 0·781, respectively, in differentiating between nephritis and non-nephritis, which performed better than low C3, C4 and raised anti-dsDNA antibodies. There was no correlation of serum levels with uBAFF (r = 0·187, P = 0·261) and uAPRIL (r = 0·114, P = 0·494). uAPRIL levels reduced after treatment (mean 125 pg/mg to 36 pg/mg, P < 0·05). uBAFF levels reduced in 16 responders while two of four non-responders had increase in levels. Thus, uBAFF and uAPRIL are potential biomarkers of proliferative lupus nephritis.
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Affiliation(s)
- S Phatak
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S Chaurasia
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S K Mishra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - V Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Contreras K, Cuthbert J, Phatak S, Larson D, Benninghoff A. 0204 Effect of the total Western diet via direct or ancestral exposure on estrous cycling in third-generation offspring in mice. J Anim Sci 2016. [DOI: 10.2527/jam2016-0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- S Phatak
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - L Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Bhatt D, Chauhan N, Sharma A, Dhawan D, Bhatt RV, Phatak S, Padh H. Investigating the Role of Plasma Glucose Concentration as a Phenotypic Marker for CYP2C9 Genetic Variants, in the Diabetic Population of Gujarat. Indian J Pharm Sci 2014; 76:72-7. [PMID: 24799741 PMCID: PMC4007258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 12/19/2013] [Accepted: 12/26/2013] [Indexed: 12/02/2022] Open
Abstract
The present study was aimed to investigate the role of plasma glucose concentration as a phenotypic marker and to study the frequency distribution of CYP2C9 genetic variants in Gujarat state diabetic population. One hundred and nine unrelated diabetes mellitus patients treated with sulfonylureas were genotyped for CYP2C9*2 and CYP2C9*3 alleles. Their pre- and posttreatment postprandial blood glucose levels were recorded and mean glucose drop per milligram of drug values were calculated and further used as an index for phenotypic correlation. The frequencies of CYP2C9*1, CYP2C9*2 and CYP2C9*3 alleles in the Gujarat state diabetic population were 0.84, 0.07 and 0.09, respectively. The distribution of CYP2C9*1/*1, CYP2C9*1/*2, CYP2C9*1/*3, CYP2C9*2/*2, CYP2C9*2/*3 and CYP2C9*3/*3 genotypes were 0.73, 0.08, 0.13, 0.0, 0.06 and 0.0, respectively. Patients with CYP2C9*1/*2 genotype did not show any significant difference in the mean glucose drop per milligram of drug values when compared with wild-type patients in glipizide-treatment group. Patients with CYP2C9*1/*3 genotype showed greater mean glucose drop per milligram of drug values than patients with CYP2C9*1/*1 wild-type genotype for both glipizide and glimepiride while patients with CYP2C9*2/*3 genotype showed greater drop than patients with CYP2C9*1/*1 genotype only in the glipizide-treatment group. The presence of CYP2C9*3 allele significantly affected plasma glucose drop per milligram of drug values in patients taking glipizide and glimepiride, while effects of CYP2C9*2 allele were insignificant. Further studies are needed to confirm the effects of CYP2C9*2 allele on plasma glucose drop per milligram of drug values. However, plasma glucose concentration is a complex physiological marker that cannot be used to establish perfect genotype-phenotype correlation. Hence studies exploring robust phenotypic markers must be initiated.
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Affiliation(s)
- D. Bhatt
- Department of Pharmacology, L. M. College of Pharmacy, Navrangpura, Ahmedabad-380 009, India
| | - N. Chauhan
- Departments of Cellular and Molecular Biology, B. V. Patel PERD Centre, Thaltej, Ahmedabad-380 054, India,Address for correspondence: E-mail:
| | - A. Sharma
- Departments of Cellular and Molecular Biology, B. V. Patel PERD Centre, Thaltej, Ahmedabad-380 054, India
| | - D. Dhawan
- Departments of Cellular and Molecular Biology, B. V. Patel PERD Centre, Thaltej, Ahmedabad-380 054, India
| | - R. V. Bhatt
- Department of Pharmacology, L. M. College of Pharmacy, Navrangpura, Ahmedabad-380 009, India
| | - S. Phatak
- Vijayratna Diabetes Clinic, Paldi, Ahmedabad-380 007, India
| | - H. Padh
- Departments of Cellular and Molecular Biology, B. V. Patel PERD Centre, Thaltej, Ahmedabad-380 054, India
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Srivastava A, Shah S, Maseeh A, Vyasa B, Balaji M, Bhatter S, Buch P, Dantara D, Karnani J, Kumar V, Lodha S, Maji D, Moses A, Phatak S, Polarappu S, Shah S, Upadhayay B. A clinical study to compare the efficacy and safety of pregabalin sustained release formulation with pregabalin immediate release formulation in patients of diabetic peripheral neuropathic pain. Indian J Endocrinol Metab 2012; 16:S477-S479. [PMID: 23565472 PMCID: PMC3603120 DOI: 10.4103/2230-8210.104137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of sustained release (SR) formulation of pregabalin with immediate release (IR) formulation in patient with diabetic peripheral neuropathic pain. MATERIALS AND METHODS In this open label, randomized, comparative, multicentric study, the primary efficacy measure was reduction in visual analogue scale (VAS) of short form McGill pain questionnaire (SF-MPQ) score from baseline to last visit. The secondary evaluation measures included reduction in SF-MPQ descriptive score and present pain intensity score and change in clinical global impression - improvement of illness (CGI-I) and clinical global impression - severity of illness (CGI-S) from baseline to last visit. Total duration of the study was 12 weeks. Safety evaluation was done by recording treatment emergent adverse events and laboratory investigations at baseline and end of treatment. RESULTS Of 265 randomized patients, 133 received pregabalin SR tablets and 132 pregabalin IR. Patients randomized to both treatments responded to respective treatments. The least square means of VAS score in both the groups were reduced significantly (P <0.01). Reduction in both groups was similar (P = ns). At the end of the trial in both the groups, there was a significant reduction in the SF-MPQ descriptive score (P <0.01), severity of illness as well as clinically significant improvement in the symptoms. Difference between the groups for CGI-I (P = 0.37) and CGI-S (P = 0.41) score was not statistically significant. Treatment in both the groups was found safe and well tolerated. CONCLUSION The study shows that the pregabalin SR is safe and effective in patients of diabetic peripheral neuropathic pain. The results of the study demonstrated that pregabalin SR has comparable efficacy and safety as pregabalin IR.
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Affiliation(s)
- A. Srivastava
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Shah
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - A. Maseeh
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - B. Vyasa
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - M. Balaji
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Bhatter
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - P. Buch
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - D. Dantara
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - J. Karnani
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - V. Kumar
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Lodha
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - D. Maji
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - A. Moses
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Phatak
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Polarappu
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Shah
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - B. Upadhayay
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
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Abstract
A case of metallic foreign body getting impacted into maxillary antrum and orbit due to a blast in a furnace, presenting primarily with 20% facial burn & ocular symptoms is presented for its rarity.
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Affiliation(s)
- S Phatak
- Choithram Hospital & Research Centre, 23, Lokmanya Nagar, Indore, 452 009 Indore MP
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Phatak S, Dakwale V, Phatak S. Embryonal rhabdomyosarcoma with intracranial extension. Indian J Otolaryngol Head Neck Surg 1999; 51:42-4. [PMID: 23119543 PMCID: PMC3451046 DOI: 10.1007/bf02996528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A case of embryonal rhabdomyosarcoma of the middle ear presenting with facial paralysis and a polypoidal aural mass who subsequently had convulsions due to intracranial extension is presented for its rarity.
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Affiliation(s)
- S Phatak
- Choithram Hospital & Research Centre Indore, India
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Phatak S, Gupta N, Phatak S. Congenital teratoid tumour of nasopharynx with cleft palate. Indian J Otolaryngol Head Neck Surg 1998; 50:374-6. [DOI: 10.1007/bf03000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Reddy UR, Phatak S, Allen C, Nycum LM, Sulman EP, White PS, Biegel JA. Localization of the human Ror1 gene (NTRKR1) to chromosome 1p31-p32 by fluorescence in situ hybridization and somatic cell hybrid analysis. Genomics 1997; 41:283-5. [PMID: 9143508 DOI: 10.1006/geno.1997.4653] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ror1 is an orphan cell surface receptor with strong homology to the tyrosine kinase domain of growth factor receptors, in particular the Trk family. Southern blot analysis of genomic DNA from somatic cell hybrids revealed that Ror1 is located on chromosome 1. We have mapped the Ror1 gene to chromosome 1p12-p32 using PCR on a somatic cell hybrid panel that subdivides chromosome 1p. We have further localized the gene to chromosome 1p31-p32 by fluorescence in situ hybridization using a PAC clone that contains the Ror1 gene.
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Affiliation(s)
- U R Reddy
- Division of Neurology Research, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
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Reddy UR, Phatak S, Pleasure D. Human neural tissues express a truncated Ror1 receptor tyrosine kinase, lacking both extracellular and transmembrane domains. Oncogene 1996; 13:1555-9. [PMID: 8875995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Human heart, lung and kidney express a 6 kb mRNA encoding Ror1, a member of the receptor tyrosine kinase (RTK) family with as yet unknown ligand specificity. We used a Ror1 cDNA probe to screen a cDNA library prepared from the human neuronogenic teratocarcinoma line, NTera2, and cloned a 2373 nucleotide transcript. This transcript contains an open reading frame that encodes a 388 amino acid protein identical with the cytosolic, C-terminal region of ror1 but lacking the ror1 transmembrane and entire extracellular domains. Northern blots demonstrate that mRNA encoding this truncated Ror1 ('t-Rorl') is abundantly expressed in fetal and adult human CNS, in human leukemia, lymphoma cell lines, and in a variety of human cancers derived from neuroectoderm. While previous studies have documented alternative splicing patterns within 5' and 3' regions of mRNAs encoding various RTKs altering their ligand binding specificity or their intracellular signaling, the present report is the first to demonstrate tissue-specific alternative mRNA splicing causing loss of the entire extracellular and transmembrane regions of an RTK.
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Affiliation(s)
- U R Reddy
- Division of Neurology Research, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA
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Phatak S, Rangneker PV. Some observations on the ultrastructure of the sinus gland of the lobster, Palinurus polyphagus (Herbst). Riv Biol 1976; 69:59-76. [PMID: 1013594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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