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Agrawal A, Singal A, Devanda R, Arora VK. Scabies surrepticius masquerading as perforating dermatosis. Indian J Dermatol Venereol Leprol 2024; 0:1-4. [PMID: 38314973 DOI: 10.25259/ijdvl_834_2023] [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] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/25/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Akanksha Agrawal
- Department of Pathology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Rajendra Devanda
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, New Delhi, India
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Arora VK, Chopra KK. Pathways to end TB- challenges. Indian J Tuberc 2024; 71:1-2. [PMID: 38296381 DOI: 10.1016/j.ijtb.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Affiliation(s)
- V K Arora
- TB Association of India, 3 Red Cross Rd, Gokul Nagar, Sansad Marg Area, New Delhi, Delhi 110001, India.
| | - Kamal Kishore Chopra
- New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, Delhi Gate, New Delhi 110002, India.
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Arora VK, Kishore Chopra K. Pediatric tuberculosis - A diagnostic Dilemma. Indian J Tuberc 2023; 70 Suppl 1:S6-S7. [PMID: 38110262 DOI: 10.1016/j.ijtb.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 12/20/2023]
Affiliation(s)
- V K Arora
- TB Association of India, 3, Red Cross Rd, Gokul Nagar, Sansad Marg Area, New Delhi, Delhi, 110001, India.
| | - Kamal Kishore Chopra
- New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, Delhi Gate, New Delhi, 110002, India.
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Yadav M, Jain AK, Singhal R, Chadha M, Arora VK, Bhargava A. Incidence and Patterns of Drug Resistance in Patients with Spinal Tuberculosis: a Prospective, Single-Center Study from a Tuberculosis-Endemic Country. Indian J Orthop 2023; 57:1833-1841. [PMID: 37881297 PMCID: PMC10593722 DOI: 10.1007/s43465-023-00986-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 08/20/2023] [Indexed: 10/27/2023]
Abstract
Background There is paucity of data on incidence and pattern of drug resistance in spinal TB. This prospective observational study was conducted to document the incidence and drug-resistance pattern among primary and presumptive resistant cases. Methods 59 consecutive cases diagnosed clinico-radiologically (imaging) were grouped into Group A (n = 51, primary cases) and Group B (n = 8, presumptive resistant cases) based on pre-defined criteria (INDEX-TB guidelines). Tissue samples obtained percutaneously (37.29%, 22/59) and on surgery (62.71%, 37/59) were subjected to genotypic DST (CBNAAT, LPA) and phenotypic DST (BACTEC MGIT 960 culture and sensitivity using fixed critical concentration of drugs). Results Etiological diagnosis was ascertained in all. 13/51 (25.49%) in Group A, while 3/8 (37.5%) in Group B and 16/59 (27.12%) overall demonstrated drug resistance. 12/16 (75%) had no prior history of ATT intake. 4 demonstrated INH (Isoniazid) mono-resistance. 12 polydrug resistance demonstrated: 5MDR, 3pre-XDR, while RIF + FQ (fluoroquinolones), FQ + Lz (linezolid), only SLID (second-line injectable drugs), and only FQ resistance observed in 1 case each. Isolated RIF (Rifampicin) resistance and XDR pattern were not observed. Overall frequency of RIF resistance was 16.4% (9/55) and INH was 25% (12/48) with low-(n-2) and high-level INH resistance (n-10). Among second-line drugs, FQ resistance was more than SLID resistance and within FQ, levofloxacin resistance was more frequent than moxifloxacin. MGIT demonstrated positive growth in 16/59 samples, out of which 1 sample was positive for nontuberculous mycobacteria (M. chelonae) but on genotypic testing demonstrated MTB resistant to RIF and FQ. Conclusion This is the first report on incidence and drug-resistant pattern in culture-positive/negative cases. High (25.49%) primary drug resistance is worrisome. This being the first study in spinal TB cases which document prevalent drug-resistant pattern as evaluated for consecutive culture-positive/negative cases. The tissue obtained must be submitted for AFB culture and molecular tests to ascertain drug resistance in culture-positive/negative cases. However, in the presence of insufficient tissue sample histology and CBNAAT can ascertain etiological diagnosis in 100% cases. INH resistance is more than RIF with isolated RIF resistance unreported.
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Affiliation(s)
- Manish Yadav
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095 India
| | - Anil K. Jain
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095 India
| | - Ritu Singhal
- National Reference Laboratory & Center of Excellence (TB) WHO, Department of Microbiology, National Institute of Tuberculosis & Respiratory Diseases, New Delhi, Delhi 110030 India
| | - Manish Chadha
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095 India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095 India
| | - Aayush Bhargava
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095 India
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Arora VK, Jindal SK, Katiyar SK, Behra D, Talwar D, Sarin R, Dhar R, Mehta P, Bhargava S, Singhal P, Joshi S, Tiwaskar M, Nikam C, Chatterjee A, Vora A. Genomic revolution: Transforming tuberculosis diagnosis and treatment with the use of Whole Genome Sequencing - A consensus statement. Indian J Tuberc 2023; 70:383-389. [PMID: 37968042 DOI: 10.1016/j.ijtb.2023.10.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 11/17/2023]
Abstract
Tuberculosis (TB) is a preventable, treatable, and curable disease. However, in 2020, 9∙9 million people were estimated to have developed tuberculosis, and 1.5 million people were estimated to have died from it. Whereas in India, 2.6 million were diagnosed with TB and 436,000 succumbed to TB in 2019. India (26%) is the major contributor to the global drop in TB cases. The COVID-19 pandemic has substantially reduced access to services for the diagnosis and treatment of TB, resulting in an increase in deaths and a reversal in global progress. [1] Presently, TB incidence is falling at a rate of 2% per year, obstructed mainly by the rearing pandemic of drug-resistant tuberculosis (DRTB). Particularly concerning is multi-drug resistant TB (MDRTB), defined as resistance towards isoniazid (INH) and rifampicin (RIF). [2] The World Health Organization (WHO) targeted to reduce worldwide TB incidence by 90% until 2035. (1) Early initiation of effective treatment based on susceptibility patterns of the Mycobacterium tuberculosis complex (MTBC) is considered key to successful TB control in countries with high DRTB incidence. Worldwide MDRTB treatment outcomes are poor, with cure rates less than 60% (2) due to the lack of comprehensive Drug Susceptibility Testing (DST) in most high MDRTB burden countries. This is leading to the inadequate anti-TB activity of the provided regimens (3-5), unlike regimens advised for DST assure optimal results. (6) In addition to resistances to the established regimens, the resistance to the newer DRTB drugs is increasing. On World TB Day 2022, Academy of Advanced Medical Education, Thyrocare Technologies Limited and HyastackAnalytics - IITB along with expert pulmonologist and renowned physicians from India convened for an advisory board meeting in Delhi on 20th March 2022 to discuss the role of Whole Genome Sequencing (WGS) in the diagnosis and management of TB. Objectives and specific topics relating to WGS in MDRTB were discussed, each expert shared their views, which led to a group discussion with a commitment to putting the patient first, and increasing their collective efforts, the organizations recognized that it is possible to make this goal a reality. The organizations involved in the discussion have declared their commitment to engaging in collaborative efforts to tackle DRTB detection efficiently. They advocate for strengthening access to WGS TB services, controlling and preventing TB, improving surveillance and drug resistance management, and investing in research and development. This Round Table serves as a framework to build on and ensure that the goal of ending TB is achievable with WGS services wherever needed. Post discussion, a uniform consensus was said to be arrived if more than 80% board members agreed to the statement. The present paper is the outcome of aspects presented and discussed in the advisory board meeting.
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Affiliation(s)
- V K Arora
- Pulmonologist and Tuberculous and Chest Diseases Specialist, Delhi, India
| | - S K Jindal
- Director, Jindal Clinics, Chandigarh, India
| | - S K Katiyar
- Pulmonologist, TB & Chest Diseases Specialist, Kanpur, India
| | - Digambar Behra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Talwar
- Senior Consultant & Chairman - Metro Respiratory Center Pulmonology & Sleep Medicine, Noida, India
| | - Rohit Sarin
- Principal Consultant and Former Director, National Institute of Tuberculosis and Respiratory Diseases, Delhi, India
| | - Raja Dhar
- Department of Pulmonology C K Birla Group of Hospitals Kolkata, India
| | | | - Salil Bhargava
- Professor of Chest and TB at M G M Medical College, Indore, India
| | | | | | | | - Chaitali Nikam
- HaystackAnalytics, IITB, Mumbai, India; Thyrocare Technologies Limited, Mumbai, India
| | | | - Agam Vora
- Brahma Kumari's Global Hospital & Research Centre, Mumbai, India.
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Vora A, Mehta P, Arora VK, Behera D, Kar A, Katiyar SK, Samaria JK, Koul P, Jaychandra A, Singh BP, Kandi S, Nazir Shah N, Jain NK, Najeeb R, Ahmad S, Najib R, Faisal M, Dewan B. Aviptadil: A promising treatment option for acute respiratory distress syndrome. Indian J Tuberc 2023; 70:510-511. [PMID: 37968060 DOI: 10.1016/j.ijtb.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/28/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Agam Vora
- Vora Clinic, Borivali West, Mumbai, Maharashtra, India
| | - Parthiv Mehta
- Mehta Hospital, Drive-in Road, Thaltej, Ahmedabad, Gujarat, India
| | - V K Arora
- Arora Clinic, C151, Sector 51, Kendriya Vihar, Noida, Uttar Pradesh, India
| | - D Behera
- Department of Pulmonology, Fortis Hospital, Mohali, Punjab, India
| | - Arindam Kar
- Department of Critical Care Medicine, HN Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - S K Katiyar
- Chest Care Centre, Swaroop Nagar, Kanpur, Uttar Pradesh, India
| | - J K Samaria
- Samaria Multi-Speciality & Chest Centre, Kabir Nagar Colony, Varanasi, Uttar Pradesh, India
| | - Parvaiz Koul
- Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu & Kashmir, India
| | - A Jaychandra
- Department of Pulmonology, Care Hospitals, Banjara Hills, Hyderabad, Telangana, India
| | - B P Singh
- Department of Respiratory & Critical Care, Midland Healthcare & Research Center, Lucknow, Uttar Pradesh, India
| | | | - Naveed Nazir Shah
- Chest Disease Hospital, Buchwara, Srinagar, Jammu and Kashmir, India
| | - N K Jain
- 57/58, Shastri Nagar, Jaipur, Rajasthan, India
| | - Rukhsana Najeeb
- SMHS Hospital, Karan Nagar, Srinagar, Jammu and Kashmir, India
| | - Sadiq Ahmad
- SMHS Hospital, Karan Nagar, Srinagar, Jammu and Kashmir, India
| | - Rayees Najib
- SMHS Hospital, Karan Nagar, Srinagar, Jammu and Kashmir, India
| | - Mir Faisal
- Magarmal Bagh, Near Shifa Hospital, Srinagar, Jammu and Kashmir, India
| | - Bhupesh Dewan
- Department of Medical Services, Zuventus Healthcare Limited, Zuventus House, Plot Y2, CTS No.: 358/A2, Near Nahur Railway Station, Nahur West, Mumbai 400078, Maharashtra, India.
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Ahmad P, Arora VK. Prevalance of tuberculosis amongst healthcare workers, working in DOTS/sputum microscopy centre in two different districts of state of Uttarakhand & Uttar Pradesh of India. Indian J Tuberc 2023; 70:405-408. [PMID: 37968045 DOI: 10.1016/j.ijtb.2023.03.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/04/2023] [Accepted: 03/22/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND & OBJECTIVE The Healthcare workers (HCWs) who work in DOTS/Sputum microscopy centre are exposed to higher risk of contacting tuberculosis (TB) comparatively to other health workers who are serving the other health sectors. The HCWs in DOTS are more exposed due to direct contact with patients suffering from TB or through sharing the infected air space with the infectious patients. The aim of the study is to know the prevalance of TB disease amongst the HCWs who are working in DOTS cum Sputum Microscopy Centre's under RNTCP in two different districts of state of Uttar Pradesh (UP) and Uttarakhand (UK) of india. METHODS The prospective cross-sectional study is conducted in two districts of different states having high burden of TB disease in UP and low burden of TB disease in UK state. All 100% (130) staff i.e. Medical officers, Sputum microscopy technicians, DOTS providers of DOTS cum Sputum Microscopy centre's of both selected Ghaziabad (UP) and Dehradun (UK) districts are covered in the study. RESULTS The 4.6% (6) healthcare workers of both the districts were taking ATT at the time of interview and 13.8% (18) HCWs had taken the ATT in past. The 62.5% (15) HCWs i.e 55.5% (5) from Dehradun district and 66.6% (10) from Ghaziabad district preferred to have a ATT from the private medical store inspite of taking DOTS with assumption of low efficacy of drugs and high toxicity. The 58.33% (14) HCWs ie 55.5% (5) staff members of DOTS/sputum microscopy centre in Dehradun & 60.0% (9) staff members of DOTS/sputum microscopy centre in Ghaziabad district had not notified about the status of their disease to the health care authority due the assumption that they may be asked to leave the job or to go on a long unpaid leave. CONCLUSION The 18.4% (24) HCWs of both the district got TB disease during their working in DOTS/Sputum microscopy centre and 4.6% (6) HCWs of both the districts were taking the ATT at the time of interview.
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Affiliation(s)
- Parvez Ahmad
- Department of Chest & TB, Santosh Medical College & University, Ghaziabad, UP, India.
| | - V K Arora
- Santosh University, Ghaziabad, UP, India
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Agrawal S, Singal A, Grover C, Das S, Arora VK, Madhu SV. Prevalence of onychomycosis in patients with diabetes mellitus: A cross-sectional study from a tertiary care hospital in North India. Indian J Dermatol Venereol Leprol 2023; 89:710-717. [PMID: 37067104 DOI: 10.25259/ijdvl_360_2022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 12/11/2022] [Indexed: 04/05/2023]
Abstract
Background Though diabetes mellitus (DM) is a well-recognised risk factor for onychomycosis (OM), the epidemiology of OM in diabetic patients remains largely unexplored, especially from the Indian subcontinent. Aims and objectives To estimate the prevalence of OM in diabetic patients, to identify and analyse risk factors, and correlate the severity of nail changes with glycemic control (HBA1c). Methods This cross-sectional, analytical study involved 300 diabetic patients. Patients with the clinical diagnosis of OM, supplanted by at least two of the four tests (KOH, culture, onychoscopy and nail histopathology) were considered cases of OM. Demographic and haematological profile was analysed using chi-square test/ Fischer's exact test. Logistic regression was applied to assess the independent risk factors. Results The prevalence of OM in DM patients was 34% (102/300) and significant risk factors included; age >60 years, male gender, closed shoes, disease duration >5 years, high BMI (>25) and lack of awareness about nail changes. Distal and lateral subungual OM (78%) was the commonest presentation followed by proximal subungual OM, superficial OM and total dystrophic OM. Correlation between HbA1c and the number of nails involved was found to be significant. Limitation As cases were recruited from a hospital setting, there could be chances of Berksonian bias. Conclusion The prevalence of OM in diabetic patients is high and the severity of nail changes correlates with HbA1C levels. It is important to diagnose OM early in order to treat and prevent complications.
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Affiliation(s)
- Sonia Agrawal
- Department of Dermatology & STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology & STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Chander Grover
- Department of Dermatology & STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - V K Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - S V Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, Delhi, India
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Jha T, Diwaker P, Arora VK, Sharma S. Prognostic Value of IMP3 and Its Role as an Epithelial-Mesenchymal Transition Promoter in Breast Carcinoma. Indian J Surg Oncol 2023:1-9. [PMID: 37363710 PMCID: PMC10029789 DOI: 10.1007/s13193-023-01735-7] [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: 01/09/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023] Open
Abstract
Breast carcinoma is now the most common cancer in the world. In view of its high mortality, there is a need to identify new prognostic biomarkers. Both IMP3 and SLUG have been implicated in cancer metastasis. This was a retrospective study conducted on 60 breast carcinoma cases using tissue microarrays. Demographic and clinicopathological details were recorded. Immunohistochemistry for IMP3 and SLUG was performed and evaluated in terms of percentage-cell-positivity and intensity of staining. A proforma was used to store data and was analyzed using SPSS v20. IMP3 positivity was found in 87% breast carcinoma cases and was significantly associated with tumor size (p = 0.03) and TNM stage (p = 0.024). IMP3 staining intensity showed significant association with histological grade (p = 0.009), TNM stage (p = 0.036), and molecular subtype (p = 0.03). SLUG immunoexpression was seen in 90% breast carcinoma cases and was significantly associated with TNM stage (p = 0.006). SLUG staining intensity was significantly associated with age (p = 0.025) and TNM stage (p = 0.004). IMP3 and SLUG immunopositivity and their staining intensities were significantly associated (p <0.001, p <0.001). IMP3 and SLUG percentage cell positivities were also significantly correlated (p <0.001). IMP3 and SLUG are, thus, poor prognostic markers with a role in tumor invasiveness and aggressiveness via epithelial-mesenchymal transition. Hence, IMP3 and SLUG-based targeted therapies may be useful in the treatment of breast carcinoma.
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Affiliation(s)
- Tanvi Jha
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Fourth Floor, Dilshad Garden, Delhi, 110095 India
| | - Preeti Diwaker
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Fourth Floor, Dilshad Garden, Delhi, 110095 India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Fourth Floor, Dilshad Garden, Delhi, 110095 India
| | - Sonal Sharma
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Fourth Floor, Dilshad Garden, Delhi, 110095 India
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Bhavya, Rajaram S, Gupta B, Banerjee BD, Arora VK, Thakur G, Jain S. PAX1 Methylation Status in Cervical Scrapes as Novel Diagnostic Biomarker in CIN 2/3 and Invasive Squamous Cell Carcinoma. J Obstet Gynaecol India 2022; 72:522-528. [PMID: 36506900 PMCID: PMC9732169 DOI: 10.1007/s13224-022-01680-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/28/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives DNA methylation of paired box-1 (PAX-1) gene has been shown to be a potential biomarker for the detection of high-grade cervical intra-epithelial neoplasia (CIN) and invasive cervical cancer. The objective of this pilot study was to quantify and compare methylation percentage of PAX1 gene in benign cervical lesion, pre-invasive and invasive cervical cancer. Methods A total of 200 screen positive women (VIA, VILI and Pap test) underwent colposcopy. Cervical scrapes taken were taken and stored for DNA analysis and PAX 1 methylation status. Women with Swede score of 5 or more (n = 98) were biopsied. Cervical scrapes and biopsy were taken from women with obvious cervical growth (n = 14), without prior colposcopy. Sixty women were recruited to the study and allocated into three groups on the basis of histopathology, i.e., benign cervix (Group 1; n = 20), CIN 2/3 (Group 2; n = 20) and invasive cervical carcinoma (Group; n = 20). PAX 1 methylation percentage was calculated from the DNA extracted from the cervical scrapes of the women recruited. Results The mean PAX1 methylation percentage in benign lesions, CIN 2/3 and invasive cancer was 9.58% (SD ± 2.37%), 18.21% (SD ± 2.67%) and 24.34% (SD ± 4.09%), respectively, with p-value of < 0.001. Conclusions PAX 1 gene methylation has a promising role in identifying high-grade lesions and invasive cancer.
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Affiliation(s)
- Bhavya
- Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, A-318, Mangal Apartments, Vasundhara Enclave, Delhi, India
| | | | - Bindiya Gupta
- Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, A-318, Mangal Apartments, Vasundhara Enclave, Delhi, India
| | - B. D. Banerjee
- Department of Biochemistry, UCMS & GTB Hospital, Delhi, India
| | | | - Gaurav Thakur
- Department of Biochemistry, UCMS & GTB Hospital, Delhi, India
| | - Sandhya Jain
- Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, A-318, Mangal Apartments, Vasundhara Enclave, Delhi, India
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Chopra KK, Matta S, Arora VK. Drug resistant tuberculosis among elderly: Challenges. Indian J Tuberc 2022; 69 Suppl 2:S202-S204. [PMID: 36400509 DOI: 10.1016/j.ijtb.2022.10.022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
The article deals with challenges faced by the geriatric populations while on MDR treatment. Risk factors like tobacco use, low socio-economic status, previous disease, longer delays in seeking treatment and reduced mobility are some of the challenges while initiating MDR treatment. Other issues like drug-related adverse events and increased co-morbidity pose a major challenge while treating patients. Susceptibility among the geriatric age group includes various anatomical and physiological changes including nutritional deficiencies and co morbidities.
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Affiliation(s)
- K K Chopra
- Director New Delhi Tuberculosis Centre, India
| | - S Matta
- Epidemiologist New Delhi Tuberculosis centre, India.
| | - V K Arora
- Vice Chairman (P & R) and Hony, Technical advisor, Tuberculosis Association of India, India
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12
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Katiyar SK, Gaur SN, Solanki RN, Sarangdhar N, Suri JC, Kumar R, Khilnani GC, Chaudhary D, Singla R, Koul PA, Mahashur AA, Ghoshal AG, Behera D, Christopher DJ, Talwar D, Ganguly D, Paramesh H, Gupta KB, Kumar T M, Motiani PD, Shankar PS, Chawla R, Guleria R, Jindal SK, Luhadia SK, Arora VK, Vijayan VK, Faye A, Jindal A, Murar AK, Jaiswal A, M A, Janmeja AK, Prajapat B, Ravindran C, Bhattacharyya D, D'Souza G, Sehgal IS, Samaria JK, Sarma J, Singh L, Sen MK, Bainara MK, Gupta M, Awad NT, Mishra N, Shah NN, Jain N, Mohapatra PR, Mrigpuri P, Tiwari P, Narasimhan R, Kumar RV, Prasad R, Swarnakar R, Chawla RK, Kumar R, Chakrabarti S, Katiyar S, Mittal S, Spalgais S, Saha S, Kant S, Singh VK, Hadda V, Kumar V, Singh V, Chopra V, B V. Indian Guidelines on Nebulization Therapy. Indian J Tuberc 2022; 69 Suppl 1:S1-S191. [PMID: 36372542 DOI: 10.1016/j.ijtb.2022.06.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.
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Affiliation(s)
- S K Katiyar
- Department of Tuberculosis & Respiratory Diseases, G.S.V.M. Medical College & C.S.J.M. University, Kanpur, Uttar Pradesh, India.
| | - S N Gaur
- Vallabhbhai Patel Chest Institute, University of Delhi, Respiratory Medicine, School of Medical Sciences and Research, Sharda University, Greater NOIDA, Uttar Pradesh, India
| | - R N Solanki
- Department of Tuberculosis & Chest Diseases, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - J C Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Raj Kumar
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, National Centre of Allergy, Asthma & Immunology; University of Delhi, Delhi, India
| | - G C Khilnani
- PSRI Institute of Pulmonary, Critical Care, & Sleep Medicine, PSRI Hospital, Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Dhruva Chaudhary
- Department of Pulmonary & Critical Care Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rupak Singla
- Department of Tuberculosis & Respiratory Diseases, National Institute of Tuberculosis & Respiratory Diseases (formerly L.R.S. Institute), Delhi, India
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
| | - Ashok A Mahashur
- Department of Respiratory Medicine, P. D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - A G Ghoshal
- National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - D Behera
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
| | | | - H Paramesh
- Paediatric Pulmonologist & Environmentalist, Lakeside Hospital & Education Trust, Bengaluru, Karnataka, India
| | - K B Gupta
- Department of Tuberculosis & Respiratory Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Haryana, India
| | - Mohan Kumar T
- Department of Pulmonary, Critical Care & Sleep Medicine, One Care Medical Centre, Coimbatore, Tamil Nadu, India
| | - P D Motiani
- Department of Pulmonary Diseases, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - P S Shankar
- SCEO, KBN Hospital, Kalaburagi, Karnataka, India
| | - Rajesh Chawla
- Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Randeep Guleria
- All India Institute of Medical Sciences, Department of Pulmonary Medicine & Sleep Disorders, AIIMS, New Delhi, India
| | - S K Jindal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Luhadia
- Department of Tuberculosis and Respiratory Medicine, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - V K Arora
- Indian Journal of Tuberculosis, Santosh University, NCR Delhi, National Institute of TB & Respiratory Diseases Delhi, India; JIPMER, Puducherry, India
| | - V K Vijayan
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, University of Delhi, Delhi, India
| | - Abhishek Faye
- Centre for Lung and Sleep Disorders, Nagpur, Maharashtra, India
| | | | - Amit K Murar
- Respiratory Medicine, Cronus Multi-Specialty Hospital, New Delhi, India
| | - Anand Jaiswal
- Respiratory & Sleep Medicine, Medanta Medicity, Gurugram, Haryana, India
| | - Arunachalam M
- All India Institute of Medical Sciences, New Delhi, India
| | - A K Janmeja
- Department of Respiratory Medicine, Government Medical College, Chandigarh, India
| | - Brijesh Prajapat
- Pulmonary and Critical Care Medicine, Yashoda Hospital and Research Centre, Ghaziabad, Uttar Pradesh, India
| | - C Ravindran
- Department of TB & Chest, Government Medical College, Kozhikode, Kerala, India
| | - Debajyoti Bhattacharyya
- Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, Army Hospital (Research & Referral), New Delhi, India
| | | | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Centre for Research and Treatment of Allergy, Asthma & Bronchitis, Department of Chest Diseases, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Jogesh Sarma
- Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Lalit Singh
- Department of Respiratory Medicine, SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - M K Sen
- Department of Respiratory Medicine, ESIC Medical College, NIT Faridabad, Haryana, India; Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Mahendra K Bainara
- Department of Pulmonary Medicine, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi PostGraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nilkanth T Awad
- Department of Pulmonary Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, M.K.C.G. Medical College, Berhampur, Orissa, India
| | - Naveed N Shah
- Department of Pulmonary Medicine, Chest Diseases Hospital, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Neetu Jain
- Department of Pulmonary, Critical Care & Sleep Medicine, PSRI, New Delhi, India
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Pawan Tiwari
- School of Excellence in Pulmonary Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - R Narasimhan
- Department of EBUS and Bronchial Thermoplasty Services at Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Vijai Kumar
- Department of Pulmonary Medicine, MediCiti Medical College, Hyderabad, Telangana, India
| | - Rajendra Prasad
- Vallabhbhai Patel Chest Institute, University of Delhi and U.P. Rural Institute of Medical Sciences & Research, Safai, Uttar Pradesh, India
| | - Rajesh Swarnakar
- Department of Respiratory, Critical Care, Sleep Medicine and Interventional Pulmonology, Getwell Hospital & Research Institute, Nagpur, Maharashtra, India
| | - Rakesh K Chawla
- Department of, Respiratory Medicine, Critical Care, Sleep & Interventional Pulmonology, Saroj Super Speciality Hospital, Jaipur Golden Hospital, Rajiv Gandhi Cancer Hospital, Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - S Chakrabarti
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | - Surya Kant
- Department of Respiratory (Pulmonary) Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - V K Singh
- Centre for Visceral Mechanisms, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kumar
- All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Virendra Singh
- Mahavir Jaipuria Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Vishal Chopra
- Department of Chest & Tuberculosis, Government Medical College, Patiala, Punjab, India
| | - Visweswaran B
- Interventional Pulmonology, Yashoda Hospitals, Hyderabad, Telangana, India
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Gupta S, Arora VK, Gupta AK, Bandhu Gupta M. Utilization of health care services by elderly for respiratory diseases including TB - Challenges. Indian J Tuberc 2022; 69 Suppl 2:S246-S252. [PMID: 36400518 DOI: 10.1016/j.ijtb.2022.10.013] [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: 08/22/2022] [Revised: 08/27/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022]
Abstract
Progressive functional decline of all body organ systems in association with decreased immunity makes elderly vulnerable to all types of diseases including respiratory diseases. Advances in medical fields have resulted in increasing proportion of elderly globally. Healthcare demands of elderly population are complex. Provision of healthcare services for this continuously increasing population subgroup & ensuring their adequate utilization is full of challenges. These are demographic, socioeconomic, financial, physical accessibility, quality of healthcare services, attitudinal & transportation related. Large size of this subgroup with special healthcare needs in context of limited available resources of middle income country like India is the biggest challenge. Poor educational status & socioeconomic condition of Indian elderly, dependence on family, absence of formal social security & healthcare security complicates situation further. Condition of elderly females is particularly worse. In view of poor physical ability with often associated physical disability makes accessibility of healthcare services also significant factor. Overcoming negative attitudinal factors prevalent in Indian elderly & make them utilize available healthcare services is another huge challenge. Quality of healthcare services in form of availability of required expertise & equipments, attitude of healthcare providers towards elderly patients & convenience in utilization of these services also play an important role. Special provisions in TB control program for elderly in view of their complex needs, high prevalence, morbidity & mortality are also required.
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Affiliation(s)
- Sonisha Gupta
- Department of Respiratory Medicine, SMSR, Sharda University, Greater Noida, India.
| | - V K Arora
- Respiratory Diseases, Senior Consultant, Ex-Vice Chancellor, Santosh University, NCR, Delhi
| | | | - Mohan Bandhu Gupta
- Department of Respiratory Medicine, SMSR, Sharda University, Greater Noida, India
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Padmapriyadarsini C, Banurekha V, Arora VK. Challenges in TB control and the anticipated COVID-19 third wave: Way forward. Indian J Tuberc 2021; 68:425-427. [PMID: 34752307 PMCID: PMC8316627 DOI: 10.1016/j.ijtb.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Affiliation(s)
- C Padmapriyadarsini
- ICMR-National Institute for Research in Tuberculosis, Chetput, Chennai, India.
| | - V Banurekha
- ICMR-National Institute for Research in Tuberculosis, Chetput, Chennai, India
| | - V K Arora
- Tuberculosis Association of India, India
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Chopra KK, Matta S, Arora VK. Impact of COVID-19 and tobacco on TB control. Indian J Tuberc 2021; 68S:S4-S6. [PMID: 34538390 PMCID: PMC8384480 DOI: 10.1016/j.ijtb.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - S Matta
- New Delhi Tuberculosis Centre, New Delhi, India
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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16
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Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - S Matta
- New Delhi Tuberculosis Centre, New Delhi, India
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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17
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Bhargava S, Chopra KK, Arora VK. NATCON virtual 2020 - Challenges and way ahead. Indian J Tuberc 2021; 68:1-2. [PMID: 33641828 DOI: 10.1016/j.ijtb.2021.02.002] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Salil Bhargava
- Pulmonary Medicine, M G M Medical College, Indore, India
| | - K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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18
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Matta S, Arora VK, Chopra KK. Lessons to be learnt from 100 year old 1918 influenza pandemic viz a viz 2019 corona pandemic with an eye on NTEP. Indian J Tuberc 2020; 67:S132-S138. [PMID: 33308659 PMCID: PMC7543972 DOI: 10.1016/j.ijtb.2020.09.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022]
Abstract
The article is about the 1918 H1N1 flu pandemic also called the “Spanish flu“ which killed 50 million plus people worldwide, and the coronavirus pandemic (Covid-19) which has spread in the world at an alarming pace. As of now there are 11,327,790 cases and 532,340 deaths globally. Aim of this article is to draw conclusions and share knowledge from both the pandemics and apply these lessons in other health programmes.
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Affiliation(s)
| | - V K Arora
- Honorary Treasurer & Trustee TAI, TB Association of India
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19
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Abstract
The present article highlights morbidity and mortality trends of Covid 19 in the last 3 months in top 10 countries of the world. In spite of efforts being undertaken, all countries are showing an increasing trend in terms of morbidity and mortality. The order of countries in terms of mortality and morbidity has changed in the last 3 months. Various efforts are being undertaken by WHO and other agencies world over including the vaccine development initiative.
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Affiliation(s)
| | - K K Chopra
- STDC, Delhi New Delhi TB Centre, New Delhi, India
| | - V K Arora
- Honorary Treasurer & Trustee TAI TB Association of India, India
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20
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Rajpal S, Arora VK. Latent TB (LTBI) treatment: Challenges in India with an eye on 2025: "To Treat LTBI or not to treat, that is the question". Indian J Tuberc 2020; 67:S43-S47. [PMID: 33308671 DOI: 10.1016/j.ijtb.2020.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
Latent tuberculosis infection (LTBI) is defined as a consistent immune response to Mycobacterium tuberculosis antigens without evidence of clinically evident active tuberculosis (TB). Diagnosis and treatment for LTBI are important for TB, especially in high-risk populations especially in high prevalent country like India. Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are used to diagnose LTBI. Therefore an unequivocal policy /of diagnosis and treatment of LTBI will serve to ameliorate the standards of the Indian health scenario and bring the TB infection to the propinquity of its ultimate elimination.
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Affiliation(s)
| | - V K Arora
- Vice Chairman Publication & Research, Honorary Treasurer, Honorary Technical Advisor, TB Association of India, India
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21
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Reddy JC, Vaddavalli PK, Sharma N, Sachdev MS, Rajashekar YL, Sinha R, Agarwal A, Porwal A, Chakrabarti A, Nayak BK, Jain BK, Chandrasekhar D, Ramamurthy C, Mehta CK, Bhattacharya D, Luthra G, Aravind H, Bhattacharjee H, Mehta HR, Titiyal JS, Ram J, Bhalla JS, Dasari KK, Mehta KR, Kudlu KP, Prasad RK, Murugesan K, Singh MJ, Rajan M, Rohit OP, Gogate P, Biswas P, Padmanabhan P, Parekh RH, Khanna R, Honavar SG, Murthy SI, Goel S, Ganesh S, Arora VK. A new normal with cataract surgery during COVID-19 pandemic. Indian J Ophthalmol 2020; 68:1269-1276. [PMID: 32587150 PMCID: PMC7574133 DOI: 10.4103/ijo.ijo_1528_20] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022] Open
Abstract
Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI.
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Affiliation(s)
- Jagadesh C Reddy
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pravin K Vaddavalli
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Namrata Sharma
- Secretary, All India Ophthalmological Society, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mahipal S Sachdev
- President, All India Ophthalmological Society, Chairman, Centre for Sight, New Delhi, India
| | | | - Rajesh Sinha
- Treasurer, All India Ophthalmological Society, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amar Agarwal
- Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
| | - Amit Porwal
- Choithram Netralaya, Indore, Madhya Pradesh, India
| | | | | | | | | | | | | | | | | | | | | | | | - J S Titiyal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jagat Ram
- Postgraduate Institute of Medical Education and Research Chandigarh, India
| | | | | | - Keiki R Mehta
- Mehta International Eye Institute, Mumbai, Maharashtra, India
| | | | | | | | | | - Mohan Rajan
- Rajan Eye Care Hospiral, Chennai, Tamil Nadu, India
| | | | | | | | | | | | - Rohit Khanna
- LV Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Somasheila I Murthy
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sonu Goel
- Anand Eye Hospital, Jaipur, Rajasthan, India
| | - Sri Ganesh
- Nethradhama Hospital Pvt. Ltd., Bengaluru, Karnataka, India
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22
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Abstract
A group of senior doctors with vast clinical experience met on 19th July'20 under the aegis of Academy of Advanced Medical Education. The panel looked at Ivermectin, one of the old molecule and evaluated it's use in COVID 19 (Novel Coronavirus Disease 2019) management. After critical panel discussion, all the attending doctors came to a conclusion that Ivermectin can be a potential molecule for prophylaxis and treatment of people infected with Coronavirus, owing to its anti-viral properties coupled with effective cost, availability and good tolerability and safety.
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Affiliation(s)
- Agam Vora
- Academy of Advanced Medical Education, Vora Clinic, 302, Soni Shopping Center, L T Road, Borivali West, Mumbai, 400092, Maharashtra, India.
| | - V K Arora
- Academy of Advanced Medical Education, Vora Clinic, 302, Soni Shopping Center, L T Road, Borivali West, Mumbai, 400092, Maharashtra, India
| | - D Behera
- Academy of Advanced Medical Education, Vora Clinic, 302, Soni Shopping Center, L T Road, Borivali West, Mumbai, 400092, Maharashtra, India
| | - Surya Kant Tripathy
- Department of Respiratory Medicine, King George's Medical University, Lucknow, U.P, India
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23
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Rajaram S, Khan MB, Gupta B, Arora VK, Ahmed R, Upreti L. Clinicopathological correlation of serum vascular endothelial growth factor and tissue carbonic anhydrase factor IX in stage IA to IIA carcinoma cervix. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e18012] [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: 11/20/2022] Open
Abstract
e18012 Background: VEGF initiates endothelial cell proliferation and angiogenesis in tumour cells while CA IX has an important role in pH regulation and elimination of hypoxia generated acid load during glycolysis.The present study was designed to identify these biomarkers and their correlation with tissue spread and behavior and eventually could lead to development of novel target therapies. The objective of this study was to correlate serum VEGF levels and tissue CA IX expression with clinicopathological features of carcinoma cervix stage IA to IIA. Methods: This exploratory case-control study included 19 cases with carcinoma cervix FIGO 2009 stage IA to IIA and 19 age matched controls. Out of the 19 cases, 12 underwent surgery and 7 received chemoradiation. Pre-therapy blood samples were collected for serum VEGF estimation from both cases and controls. For CA IX expression estimation, cervical tissue was taken for analysis. For cases, post-operative / post chemoradiation blood samples were taken for VEGF level estimation after 6 weeks. Results: The difference in mean serum VEGF levels between cases 1235.84 pg/ml (SD± 433.67) and controls 153.74 pg/ml (SD± 108.11) was statistically significant (p = 0.001). Mean serum VEGF level between pre and post-operative cases was 1108 pg/ml (SD± 407.62) and 391.42 pg/ml (SD± 270.71) while in pre and post chemoradiation cases it was 1455 pg/ml (SD± 413.38) and 623 pg/ml (SD± 238.41). This decrease was statistically significant (p = 0.00 & p = 0.018). VEGF positively correlated with histopathologic type (p = 0.016), grade (p = 0.012), and lymphovascular space invasion (p = 0.042).CA IX expression was seen in all cases while in controls no expression was seen. CA IX expression had a positive association with lymphnode metastasis (p = 0.041). Conclusions: Elevated pre-therapeutic serum VEGF suggests spread of tumor and can be used as a prognostic marker for cancer cervix. CA IX immunostaining in cervical biopsy samples can be used as a surrogate marker for tumor aggressiveness and distant spread.
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Affiliation(s)
- Shalini Rajaram
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | | | - Bindiya Gupta
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Vinod Kumar Arora
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rafat Ahmed
- University College of Medical Sciences, Delhi, India
| | - Lalendra Upreti
- Rajiv Gandhi SUPER Specialty Hospital, Tahirpur, Delhi, India
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Sharma A, Bisht D, Das S, Rai G, Dutt S, Arora VK. Molecular Detection of Aspergillus in Sputum of Patients with Lower Respiratory Tract Infections. Int J Appl Basic Med Res 2020; 10:86-90. [PMID: 32566523 PMCID: PMC7289198 DOI: 10.4103/ijabmr.ijabmr_364_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/02/2018] [Revised: 03/30/2019] [Accepted: 02/13/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Raised incidences of respiratory tract infections due to fungal agents in immunocompetent individuals are a cause of concern due to the unavailability of rapid diagnostic methods. MATERIALS AND METHODS Sputum and serum samples were collected from patients having lower respiratory tract infections (LRTIs), serum samples were screened for the presence of anti Aspergillus antibodies and sputum samples were homogenized and processed for identification of Aspergillus by conventional methods and further subjected to polymerase chain reaction (PCR) using genus-specific ITS 4-5 primers. RESULTS PCR identified Aspergillus in 28% sputum samples, which was high as compared to conventional methods. CONCLUSION Simple conventional PCR technique proves to be useful screening in for early identification of Aspergillus colonization in patients with LRTI, which can prevent irreversible damage in their lungs by fungal invasion.
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Affiliation(s)
- Alosha Sharma
- Department of Microbiology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Dakshina Bisht
- Department of Microbiology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Shukla Das
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - Gargi Rai
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - Shyama Dutt
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - V K Arora
- Department of TB and Chest, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
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Affiliation(s)
- K K Chopra
- Director, New Delhi Tuberculosis Centre, New Delhi, India; Associate Executive Editor, Indian Journal of Tuberculosis, India
| | - V K Arora
- Vice Chairman (P&R), TB Association of India, India; Executive Editor, Indian Journal of Tuberculosis, India.
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Affiliation(s)
- V K Arora
- TB Association of India, Indian Journal of Tuberculosis, NITRD, Delhi, India.
| | - K K Chopra
- New Delhi Tuberculosis Centre, Indian Journal of Tuberculosis, New Delhi, India
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Chopra KK, Arora VK. Changing climate and respiratory diseases. Indian J Tuberc 2019; 66:431-432. [PMID: 31813427 DOI: 10.1016/j.ijtb.2019.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, Indian Journal of Tuberculosis, New Delhi, India.
| | - V K Arora
- TB Association of India, Indian Journal of Tuberculosis, India
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Sharma A, Ahuja S, Diwaker P, Wadhwa N, Arora VK. Acinic cell carcinoma of the parotid gland: A diagnostic dilemma on cytology. Malays J Pathol 2019; 41:191-194. [PMID: 31427555] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Acinic cell carcinoma (ACC) represents 1-6% of parotid gland neoplasms. CASE REPORT We report cytomorphological features of two uncommon variants of acinic cell carcinoma. The first case was an eleven-year-old female with a nodular mass in parotid and the FNA smears demonstrated a lymphoepithelial lesion composed of epithelial tumour cells with features of acinar cells in a lymphoid background. The second case was a 62-year-old male with a large parotid mass. The FNA smears revealed presence of extracellular, acellular amyloid-like material with tumour cells arranged in follicles. DISCUSSION Awareness of cytomorphological features of these unusual variants of acinic cell carcinoma may help to avoid diagnostic pitfall.
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Affiliation(s)
- A Sharma
- University College of Medical Sciences, Department of Pathology, Delhi, India.
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Chopra KK, Arora VK. Geriatric TB: Needs focussed attention under RNTCP. Indian J Tuberc 2019; 66:323-324. [PMID: 31439174 DOI: 10.1016/j.ijtb.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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Khan MA, Ahmed RS, Chandra N, Arora VK, Ali A. In vivo, Extract from Withania somnifera Root Ameliorates Arthritis via Regulation of Key Immune Mediators of Inflammation in Experimental Model of Arthritis. Antiinflamm Antiallergy Agents Med Chem 2019; 18:55-70. [PMID: 30444203 PMCID: PMC6446523 DOI: 10.2174/1871523017666181116092934] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 05/14/2023]
Abstract
BACKGROUND Rheumatoid Arthritis (RA) is a devastating disease characterized by continual addition of leukocytes and T cells within the articular cavity causing inflammation and cartilage destruction. Withania somnifera is one of the most precious medicinal herbs, reported to have antioxidant, anti-inflammatory, and immunomodulatory properties. OBJECTIVE The purpose of this study was to evaluate anti-inflammatory activity of aqueous extract of Withania somnifera roots (WSAq) in Collagen Induced Arthritic (CIA) rats. METHODS To achieve this, we assessed the level of inflammatory cytokines such as Tumor Necrosis Factor (TNF)-α, IL-1β, IL-6 and IL-10 in CIA rats. Further, transcription factor, oxidative stress parameters and CD+8 expressions were also analyzed in CIA rats. RESULTS Arthritic rats showed a greater increase in the levels of pro inflammatory cytokines such as TNF-α, IL-1β, IL-6, transcription factor NF-κB and a decrease in IL-10 concentration than controls rats. Oral administration of WSAq at a dose of 300mg/kg.wt. (WSAq300) appreciably attenuated the production of these pro inflammatory cytokines. This anti-inflammatory activity of WSAq300 might be partly mediated through an increase in the secretion of IL-10 and inhibition of NF-κB activity. Further, arthritic rats also show increased oxidative stress as compared to control rats. This increased oxidative stress in the arthritic rats appears to be the outcome of both an activated pro-oxidant and a poor antioxidant defense system. Treatment with WSAq300 strongly ameliorates all these ROS parameters significantly to near normal. Additional, metalloproteinase MMP-8 levels were also measured and found to be increased in CIA rats, which after treatment with WSAq300 came down to near normal. CONCLUSION From the above results, it can be concluded that the use of WSAq300 may be a valuable supplement which can improve human arthritis.
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Affiliation(s)
- Mahmood Ahmad Khan
- Address correspondence to this author at the Department of Biochemistry, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India; E-mail:
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Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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Arora VK, Chandra K, Chandra M. Occupational tuberculosis in sewage workers: A neglected domain. Indian J Tuberc 2019; 66:3-5. [PMID: 30797278 DOI: 10.1016/j.ijtb.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/14/2018] [Indexed: 06/09/2023]
Affiliation(s)
- V K Arora
- Santosh University, Ghaziabad, Uttar Pradesh, India
| | | | - Mina Chandra
- Department of Psychiatry, PGIMER and Dr RML Hospital, New Delhi, India
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Murry WT, Sharma S, Arora VK, Bhattacharya SN, Singal A. Cytomorphological spectrum and immunochemistry of cutaneous tuberculosis. Diagn Cytopathol 2018; 47:458-468. [DOI: 10.1002/dc.24138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Wonchibeni T. Murry
- Department of PathologyUniversity College of Medical Sciences and Guru Teg Bahadur Hospital Delhi India
| | - Sonal Sharma
- Department of PathologyUniversity College of Medical Sciences and Guru Teg Bahadur Hospital Delhi India
| | - Vinod Kumar Arora
- Department of PathologyUniversity College of Medical Sciences and Guru Teg Bahadur Hospital Delhi India
| | - Sambit Nath Bhattacharya
- Department of Dermatology and STDUniversity College of Medical Sciences and Guru Teg Bahadur Hospital Delhi India
| | - Archana Singal
- Department of Dermatology and STDUniversity College of Medical Sciences and Guru Teg Bahadur Hospital Delhi India
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Chopra KK, Hanif K M M, Arora VK, Vashistha H. Can sputum microscopy be replaced? Indian J Tuberc 2018; 65:275-276. [PMID: 30522611 DOI: 10.1016/j.ijtb.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 06/09/2023]
Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, New Delhi, India; Indian Journal of Tuberculosis, India.
| | - M Hanif K M
- New Delhi Tuberculosis Centre, New Delhi, India
| | - V K Arora
- TB Association of India, India; Indian Journal of Tuberculosis, India
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Abstract
Background & objectives: Psoriasis is a recurrent hyper-proliferative skin disease which is often associated with free radical generation, abnormal lipid metabolism and increased inflammatory secretion that induce cardiovascular risk in these patients. The present study was intended to evaluate serum lipids, lipoprotein and oxidants-antioxidants status and to establish their relationship with atherogenic risk markers [oxidized low-density lipoprotein (oxLDL) and high-sensitivity C-reactive protein (hsCRP)] in patients with psoriasis. Methods: The study was conducted on 150 psoriasis patients and 150 age- and sex-matched healthy controls. Overnight fasting blood samples were obtained for lipids, lipoproteins, lipid oxidation and peroxidation products [oxLDL, malondialdehyde (MDA)], antioxidant enzymes [reduced glutathione (GSH) and total antioxidant status] levels and hsCRP estimations. Results: The mean levels of atherogenic lipids [total cholesterol (P<0.001), triacylglycerol (P<0.01)], lipid peroxidation products (P<0.001) and oxLDL and hsCRP (P<0.001) levels in patients with psoriasis were found to be significantly higher than those of healthy controls. On the other hand, ferric-reducing ability of plasma (FRAP, P<0.001) and antioxidant enzyme activities (reduced GSH, P<0.01) were significantly lower when compared to healthy controls. The plasma oxLDL was positively correlated to LDL cholesterol (P<0.001) and MDA (P<0.001) and negatively associated with antioxidant status in these patients. Serum MDA, FRAP and oxLDL were correlated with risk of atherosclerosis in the patients with psoriasis; however, no significant association was found between reduced GSH and hsCRP. Interpretation & conclusions: The study results suggest that LDL oxidation and reactive oxygen species in addition to inflammatory markers may play a pivotal role in inducing atherosclerosis in patients of psoriasis.
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Affiliation(s)
- Kumari Asha
- Department of Biochemistry, University College of Medical Sciences (University of Delhi), Delhi, India
| | - Archana Singal
- Department of Dermatology, University College of Medical Sciences (University of Delhi), Delhi, India
| | - Suman Bala Sharma
- Department of Biochemistry, University College of Medical Sciences (University of Delhi), Delhi, India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences (University of Delhi), Delhi, India
| | - Amitesh Aggarwal
- Department of Medicine, University College of Medical Sciences (University of Delhi), Delhi, India
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Affiliation(s)
- V K Arora
- Vice Chairman (P&R), TB Association of India, India; Executive Editor, Indian Journal of Tuberculosis, India
| | - K K Chopra
- Director, New Delhi Tuberculosis Centre, New Delhi, India; Associate Executive Editor, Indian Journal of Tuberculosis, India.
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Singal A, Kaur I, Arora VK. Solitary Digital Nodule in an Infant. Skin Appendage Disord 2018; 4:44-46. [PMID: 29457015 DOI: 10.1159/000478269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/08/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
| | - Ishmeet Kaur
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
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Sharma A, Gogoi P, Arora VK. Myoepithelial carcinoma of the tongue- spindle cell morphology with high mitosis: A case report and review of literature. INDIAN J PATHOL MICR 2018; 60:560-561. [PMID: 29323073 DOI: 10.4103/ijpm.ijpm_758_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Myoepithelial carcinomas represent <1% of salivary gland tumors. Tongue is a rare site of occurrence. We present a case of a 30 year old female with myoepithelial carcinoma seen over dorsum of tongue with predominantly spindle cell morphology with clear cytoplasm and mitotic count of 6-7/10 hpf. We need to differentiate it from a spindle cell squamous cell carcinoma which can be seen at this location, i.e., tongue. In our case, there was no connection of the tumor with overlying squamous epithelium.
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Affiliation(s)
- Abhimanyu Sharma
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Priyanka Gogoi
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Wadhwa N, Diwaker P, Lotha N, Arora VK, Singh N. Cytokeratin 20 immunocytochemistry on urine sediments: A potential low-cost adjunct to cytology in the diagnosis of low-grade urothelial carcinoma. Cytopathology 2017; 28:531-535. [PMID: 28940433 DOI: 10.1111/cyt.12463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Urine cytology is the corner-stone for the diagnosis of urothelial neoplasia; however, a substantial proportion of low-grade carcinomas are reported as inconclusive owing to scant cellularity and subtle cytological features. Biomarkers applied on urine sediment smears of such patients are likely to be clinically relevant. Access to Food and Drug Administration approved urinary biomarkers in resource limited setting is poor. Detection of cytokeratin 20 (CK20) in urine sediments, although still a research tool, is a promising marker as immunocytochemistry is performed regularly in several Indian laboratories. OBJECTIVE We tested the clinical utility of CK20 immunocytochemistry as a potential low-cost adjunct to urine cytology in diagnosis of low-grade urothelial carcinoma. One hundred and fifty fresh, voided urine specimens from 42 cases of biopsy proven urothelial neoplasia (14 high grade, 28 combined low-grade [n=26]) and low malignant potential [n=2]), and 20 non-neoplastic lesions were included in the study sample. RESULTS Confident diagnosis of malignancy was possible in five (17.8%) low-grade malignancies. Thirteen of 16 (81.3%) low-grade malignancies with inconclusive cytology showed positive CK20 expression. This reduced the proportion of low-grade cases with inconclusive cytology from 57.1% to 10.7% (P=.021). In addition, we could correctly classify one case of bladder lithiasis with false positive urine cytology. Discrepant CK20 staining (positive) was seen in one patient with acute cystitis. CONCLUSIONS CK20 expression in non-umbrella cells is a robust marker of urinary bladder carcinoma. It has potential clinical utility for identification of low-grade urothelial malignancy with inconclusive cytological diagnosis.
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Affiliation(s)
- N Wadhwa
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, Delhi, India
| | - P Diwaker
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, Delhi, India
| | - N Lotha
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, Delhi, India
| | - V K Arora
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, Delhi, India
| | - N Singh
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, Delhi, India
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Tanwani R, Chandki R, Joshi A, Arora VK, Nyati P, Sutay S. Perception and Attitude of Medical Students towards Communication Skills Lab and Teaching Module. J Clin Diagn Res 2017; 11:JC12-JC14. [PMID: 28764200 DOI: 10.7860/jcdr/2017/24858.10120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/19/2016] [Accepted: 04/21/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The knowledge of proper communication skills with the patients plays a pivotal role in success of medical professionals. A practical approach would be to initiate its training at an early stage of education period of undergraduate medical students. AIM To assess perception and attitude of medical students towards Communication Skills Lab (CSL) and teaching module in Central India. MATERIALS AND METHODS This cross-sectional study was conducted in Department of General Surgery at Index Medical College, Indore, India. Undergraduate medical students were trained as per a systematic teaching module in a well equipped 'CSL'. Feedback was obtained via Likert scale and analysed after completion of the training course of eight days. RESULTS A majority of the students (96.43%) opined that the training had improved their communication with the patients. They also felt that such training should be integrated in regular teaching curriculum of our country. CONCLUSION The training of basic communication skills can be introduced at an early stage of undergraduate medical curriculum in form of an effective, interesting and acceptable teaching module.
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Affiliation(s)
- Rahul Tanwani
- Associate Professor, Department of Surgery, Index Medical College, Indore, India
| | - Rita Chandki
- Associate Professor, Department of Conservative Dentistry and Endodontics, Modern Dental College and Research Center, Indore, India
| | - Ajay Joshi
- Professor, Department of Surgery, Index Medical College, Indore, India
| | - Vinod Kumar Arora
- Professor, Department of Community Medicine, Index Medical College, Indore, India
| | - Prem Nyati
- Professor, Department of Pharmacology, Index Medical College, Indore, India
| | - Seema Sutay
- Professor, Department of Forensic Medicine, Index Medical College, Indore, India
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Arora VK, Chopra KK. India's approach to the standards of TB care. Indian J Tuberc 2017; 64:1-4. [PMID: 28166909 DOI: 10.1016/j.ijtb.2017.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- V K Arora
- Vice Chairman (P&R), TB Association of India, India; Executive Editor, Indian Journal of Tuberculosis, India
| | - K K Chopra
- Director, New Delhi Tuberculosis Centre, New Delhi, India; Associate Executive Editor, Indian Journal of Tuberculosis, India.
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Goyal S, Rathore R, Sharma S, Arora VK, Das GK, Singal A. Cutaneous basal cell carcinoma with mixed histology: Cytomorphological features of two unusual cases. J Cytol 2017; 34:115-118. [PMID: 28469323 PMCID: PMC5398019 DOI: 10.4103/0970-9371.203566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cutaneous basal cell carcinoma (BCC) is a slow growing locally aggressive malignant tumor. It is usually diagnosed on histopathological examination of the excised biopsy. Recently, fine needle aspiration cytology (FNAC) is emerging as a simple alternative technique for rapid diagnostic work of nodular and plaque-like skin lesions. We report the cytomorphological features of two cases of cutaneous BCC having unusual clinical presentation and mixed histology (MH); emphasizing the diagnostic difficulties encountered on cytology, the plausible explanation and the precautions to keep in mind to avoid misdiagnosis.
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Affiliation(s)
- Surbhi Goyal
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Ruchi Rathore
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Sonal Sharma
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Gopal Krushna Das
- Department of Ophthalmology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
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Kava S, Rajaram S, Arora VK, Goel N, Aggarwal S, Mehta S. Conventional cytology, visual tests and evaluation of P16(INK4A) as a biomarker in cervical intraepithelial neoplasia. Indian J Cancer 2016; 52:270-5. [PMID: 26905107 DOI: 10.4103/0019-509x.176729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES (1) To detect cervical intraepithelial neoplasia (CIN) using Papanicolaou test (PAP test), visual tests (visual inspection after the application of acetic acid [VIA], visual inspection after the application of Lugol's iodine [VILI]), colposcopy, and biopsy. (2) To study the biomarker p16(INK4A) expression by immunostaining. MATERIALS AND METHODS Experimental study was conducted from November 2009 to April 2011. 1500 women were screened for cancer cervix using conventional PAP test, VIA, and VILI. Sensitivity, specificity, positive, and negative predictive values of these tests were calculated individually, sequentially, and in parallel. Women having positive results underwent colposcopy and biopsy if required. p16(INK4A) expression in biopsy samples was studied using immunohistochemistry. RESULTS All test positive cases (n = 235) underwent colposcopy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PAP with atypical squamous cells of undetermined significance (ASCUS) as cut-off was 40%, 99.25%, 35.25%, and 99.39%; VIA was 60%, 93.06%, 8.03%, and 99.56% and VILI was 80%, 86.06%, 5.4%, and 99.76%, respectively. When PAP, VIA, and VILI were used in parallel sensitivity, specificity, PPV, and NPV improved to 100%, 85.18%, 6.38%, and 100%, respectively. Colposcopic abnormalities were detected in 83 and biopsy proven CIN in 15. p(16INK4A) expression was seen in eight of 15 CIN cases. CONCLUSIONS (1) PAP test and visual techniques are complementary. (2) p(16INK4A) expression was seen in majority of CIN 2 lesions suggesting a higher grade lesion.
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Affiliation(s)
| | - S Rajaram
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Sharma A, Tyagi M, Gupta S, Arora VK. Primary synovial sarcoma of the parotid gland: An unusual entity. INDIAN J PATHOL MICR 2016; 59:559-560. [PMID: 27721300 DOI: 10.4103/0377-4929.191768] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Abhimanyu Sharma
- Department of Pathology, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, India
| | - Mayurika Tyagi
- Department of Pathology, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, India
| | - Sanjay Gupta
- Department of Surgery, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, India
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Singal A, Daulatabad D, Pandhi D, Arora VK. Facial Basal Cell Carcinoma Treated with Topical 5% Imiquimod Cream with Dermoscopic Evaluation. J Cutan Aesthet Surg 2016; 9:122-5. [PMID: 27398014 PMCID: PMC4924409 DOI: 10.4103/0974-2077.184040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common skin cancer worldwide. Surgical excision is considered to be the primary therapeutic modality wherever possible. For inoperable cases, 5% imiquimod seems to be a good alternative. We present two cases of nodular pigmented BCCs on the face in elderly women successfully treated with 5% imiquimod cream application resulting in complete clinical clearance of lesion as well as on histology and dermatoscopy. There was no recurrence of the lesion on 2 years follow-up for the first and 1.5 years for the second patient.
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Affiliation(s)
- Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
| | - Deepashree Daulatabad
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
| | - Deepika Pandhi
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
| | - V K Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
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Arora VK, Chopra N, Singh P, Venugopal VK, Narang S. Hydatid cyst of parotid: Report of unusual cytological findings extending the cytomorphological spectrum. Diagn Cytopathol 2016; 44:770-3. [PMID: 27324277 DOI: 10.1002/dc.23515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/07/2016] [Revised: 05/18/2016] [Accepted: 05/23/2016] [Indexed: 11/09/2022]
Abstract
Hydatid disease is a zoonotic infestation caused by larval cestode of genus Echinococcus. Cystic form of this infection mostly involves liver and lung. Hydatid disease of the parotid gland is very rare even in endemic areas and is often clinically mistaken for parotid tumors or cysts. The presence of protoscolices, laminated membranes, and isolated hooklets are characteristic cytological features observed on fine-needle aspirate from hydatid cysts. We report unusual cytological features from a hydatid cyst of parotid in a 13-year-old girl. She presented with a slowly enlarging hard mass in left parotid. Fine-needle aspiration yielded slightly turbid fluid. Smears from the sediment revealed naked parasitic micronuclei, fragments of germinative layer (endocyst), and abortive brood capsules (buds from endocyst) seen as spherical structures with multiple parasitic nuclei. Some of these spherical structures were degenerated with recognizable nuclei and others were completely necrotic. Diagn. Cytopathol. 2016;44:770-773. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Neha Chopra
- Department of Pathology, UCMS and GTB Hospital, Delhi, India
| | - Poorva Singh
- Department of Pathology, UCMS and GTB Hospital, Delhi, India
| | | | - Salil Narang
- Department of Pathology, UCMS and GTB Hospital, Delhi, India
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Khan MA, Subramaneyaan M, Arora VK, Banerjee BD, Ahmed RS. Effect of Withania somnifera (Ashwagandha) root extract on amelioration of oxidative stress and autoantibodies production in collagen-induced arthritic rats. J Complement Integr Med 2016; 12:117-25. [PMID: 25803089 DOI: 10.1515/jcim-2014-0075] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/25/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rheumatoid arthritis is an inflammatory autoimmune disorder. Withania somnifera Dunal (Solanaceae) (WS), is a common medicinal plant used in traditional systems of medicine for the treatment of arthritis, and is an ingredient of anti-arthritic polyherbal formulations such as Habb-e-Asgand® and Arthritin™. In the present study, we evaluated the antioxidant and anti-arthritic activity of aqueous extract of WS root (WSAq) in collagen-induced arthritic (CIA) rats. METHODS CIA rats were treated by using three doses of WSAq (100, 200, 300 mg/kg b. wt., orally) and methotrexate (MTX, 0.25 mg/kg b. wt. i.p.) as a standard reference drug for 20 days. The anti-arthritic effect was assayed by measuring the arthritic index, autoantibodies such as rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (a-CCP), anti-nuclear antibody (ANA), anti-collagen type II antibody (a-CII) and inflammatory marker like C-reactive protein (CRP). The oxidative stress parameters were also measured. RESULTS Treatment with WSAq resulted in a dose-dependent reduction in arthritic index, autoantibodies and CRP (p < 0.05) with maximum effect at dose of 300 mg/kg b. wt. and the results were comparable to that of MTX-treated rats. Similarly, oxidative stress in CIA rats was ameliorated by treatment with different doses of WSAq, as evidenced by a decrease in lipid peroxidation and glutathione-S-transferase activity and an increase in the glutathione content and ferric-reducing ability of plasma (p < 0.05). CONCLUSIONS The results showed that WSAq exhibited antioxidant and anti-arthritic activity and reduced inflammation in CIA rats and suggests the potential use of this plant in the treatment of arthritis.
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Abstract
Background: Studies on ultrasonography (USG) guided fine needle aspiration cytology (FNAC) have been conducted in specialized settings such as thyroid, breast, and intra-abdominal aspirates. There is a paucity of literature on the practices of guided FNAC in a general cytopathology service. Aim: The aim was to determine prevailing practices of USG guided FNAC in a general cytopathology service of a teaching hospital. Settings and Design: Metropolitan hospital, clinical audit. Materials and Methods: Audit of 112 USG guided percutaneous FNAC done over 12 months. Statistical Analysis: Data were coded, entered in an excel spreadsheet and analyzed by translating into percentages and proportions. Results: The 112 guided FNACs included constituted 36 thyroid (32.14%), 45 intra-abdominal (40.17%), 11 breast (9.82%), 10 superficial lymph node (8.92%) and 10 soft tissue and miscellaneous (8.92%) lesions. Previous freehand FNAC was documented on the requisition forms in 14 cases. The reports were: Inadequate 33 (29.46%), nondiagnostic descriptive 35 (31.25%) or diagnostic 44 (39.28%). Inadequacy rates of aspirates from thyroid were 11 (30.56%) breast were 2 (18.18%), and intra-abdominal lesions were 13 (28.88%). Majority of the reports were nonstructured: 108 (96.42%) and nonrecommendatory: 101 (90.17%). Conclusions: Reporting practices varied and did not conform to a uniform structure. The inadequacy rates of breast and thyroid aspirates were comparable to the rates in the literature. Comparable studies were not available for intra-abdominal aspirates.
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Affiliation(s)
- Gunjan Mangla
- Department of Pathology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Navjeevan Singh
- Department of Pathology, University College of Medical Sciences and GTB Hospital, New Delhi, India
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Arora VK, Singh N. Viewpoint: Is it right time for undergraduate curriculum change based on our National Health Programmes--Tuberculosis Programme a perfect example? Indian J Tuberc 2015; 62:64-65. [PMID: 26117473 DOI: 10.1016/j.ijtb.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- V K Arora
- Vice Chancellor, Santosh University, Ghaziabad, India.
| | - Narendra Singh
- Associate Professor, Department of Community Medicine, Santosh Medical College, Ghaziabad, India
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Goyal S, Parihar A, Puri V, Sharma N, Goyal A, Arora VK. An unusual large abdominal malakoplakia following trauma: Diagnosed on FNAC. Diagn Cytopathol 2015; 43:490-4. [PMID: 25694063 DOI: 10.1002/dc.23267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 11/15/2014] [Accepted: 01/31/2015] [Indexed: 11/08/2022]
Abstract
Malakoplakia is a rare chronic granulomatous inflammatory disease, related to immune deficiency and impaired bactericidal macrophage activity. Common sites of involvement include urinary bladder and kidney followed by gastrointestinal tract. We present an unusual case of abdominal malakoplakia diagnosed preoperatively on ultrasound-guided fine-needle aspiration cytology (FNAC). It presented as a large locally aggressive mass with extensive involvement of multiple bowel loops in an 18-year-old boy following blunt trauma to the abdomen. The demonstration of calcified laminated intracytoplasmic Michaelis-Gutman bodies in histiocytes is a reliable diagnostic feature of malakoplakia on FNAC smears, which can guide an appropriate medical management.
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Affiliation(s)
- Surbhi Goyal
- Department of Pathology, University College of Medical Sciences & GTB Hospital, Delhi, India
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