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Sundriyal D, Arya L, Saha R, Walia M, Nayak PP. Hypercalcemia of Malignancy: Time to Pull the Brakes. Indian J Surg Oncol 2022; 13:28-32. [PMID: 35462669 PMCID: PMC8986951 DOI: 10.1007/s13193-020-01131-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 06/08/2020] [Indexed: 02/07/2023] Open
Abstract
Hypercalcemia of malignancy (HOM) is usually seen in advanced stage and carries a poor prognosis. Survival outcomes are dismal and most of the patients are unable to receive subsequent definite anti-cancer therapy. There is lack of any retrospective or prospective data regarding hypercalcemia of malignancy in Indian population. We aim to describe survival outcomes in hypercalcemia associated with solid organ malignancies. Forty-five patients diagnosed with HOM associated with solid organ malignancies were included in the study. Patients were followed up till death. Clinical features and survival outcomes were noted. Squamous cell carcinoma of head and neck region and lung comprised most of the cases associated with HOM. Most of the patients presented with poor performance status. Median overall survival (OS) was 20 days (2-78 days). Median OS was 35 days (9-58 days) in those who received definite anti-cancer therapy. Four-week mortality rate was estimated as 59.5%, while this increased to 75.7% within 6 weeks from the diagnosis of hypercalcemia. Survival outcomes are poor after the diagnosis of hypercalcemia in cancer patients. Best supportive care including hospice care should be strongly considered at this point of time instead of definite systemic anti-cancer therapy.
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Affiliation(s)
- Deepak Sundriyal
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Lima Arya
- Max Superspeciality Hospital, New Delhi, India
| | - Rajat Saha
- Max Superspeciality Hospital, New Delhi, India
| | - Meenu Walia
- Max Superspeciality Hospital, New Delhi, India
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2
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Walia M, Singhal MK, Kamle MS. Ideal sequencing in Stage IV epidermal growth factor receptor mutant Non-Small-Cell Lung Cancer. Indian J Cancer 2022; 59:S80-S89. [PMID: 35343193 DOI: 10.4103/ijc.ijc_50_21] [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] [Indexed: 06/14/2023]
Abstract
Evidence from several studies has shown improved progression-free survival (PFS) with first- or second-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) compared with chemotherapy for advanced NSCLC patients. But resistance to first or second-generation TKI therapies after 9 to 12 months of treatment initiation is a concern. Osimertinib is a third-generation, irreversible, oral EGFR-TKI that potently and selectively inhibits both EGFRm (epidermal growth factor receptor mutated) and EGFR T790M and has demonstrated efficacy in NSCLC central nervous system (CNS) metastases. Trials have reported significantly longer PFS and higher median duration of response with osimertinib compared with first-generation EGFR-TKIs (erlotinib, gefitinib) and chemotherapy, respectively. And relatively lower rates of discontinuation due to adverse events (AEs). Significant improvement in overall survival was also observed when used as first-line treatment. Because EGFR-mutated tumors are highly dependent on EGFR signaling, optimal sequence of available TKIs - erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib - is necessary. The sequencing of EGFR-TKIs has changed over the past decade and depends on factors such as expected efficacy, CNS activity, tolerability, and options available after progression. Third-generation TKI may be the preferred first-line treatment because patients may not opt for or die before the start of second-line therapy, and it is difficult to predict which patients will eventually develop T790M mutation. The favorable tolerability profile alongside a longer time to disease progression makes osimertinib a preferred first-line treatment. Though clinical practice guidelines do not provide clear consensus on the most preferred EGFR-TKI, recent updates recommend osimertinib as a first-line treatment for advanced NSCLC patients. Also, improved patient selection incorporating clinical and molecular characteristics will help translate to better survival outcomes and improved quality of life. This review aims to determine the optimal sequence of administration of the EGFR-TKIs considering toxicity, quality of life, and survival outcomes among advanced NSCLC patients.
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Affiliation(s)
- Meenu Walia
- Department of Medical Oncology, Max Super Specialty Hospital, Patparganj, New Delhi, India
| | - Manish K Singhal
- Department of Medical Oncology, Apollo Hospital, Sarita Vihar, New Delhi, India
| | - Mangesh S Kamle
- Department of Oncology, AstraZeneca Pharma India Limited, India
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3
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Sundriyal D, Arya L, Srivastava R, Walia M, Sehrawat A. Leptomeningeal relapse in primary cutaneous DLBCL: Implications for a prophylactic CNS therapy. Cancer Rep (Hoboken) 2021; 4:e1295. [PMID: 33026176 PMCID: PMC7941546 DOI: 10.1002/cnr2.1295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/22/2020] [Revised: 08/24/2020] [Accepted: 09/07/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Isolated leptomeningeal relapse in a case of cutaneous lymphoma is an uncommon event more so in a case of primary cutaneous diffuse large B-cell lymphoma (PCDLBCL). This phenomenon is of great significance as the subsequent prognosis becomes poor and the prophylactic central nervous system (CNS) therapy if administered, can reduce the chances of relapse, however, the survival benefit remains uncertain. The role of prophylactic CNS therapy is not well defined in the case of PCDLBCL. CASE We report a case of PCDLBCL leg type with a low CNS International Prognostic Index (CNS-IPI) risk, who developed isolated leptomeningeal relapse in the form of bilateral facial nerve palsy. He was managed by 2nd line chemotherapy and CNS directed therapy and achieved complete remission. CONCLUSION PCDLBCL leg type is an aggressive malignancy. Molecular/genomic mechanism likely responsible for CNS dissemination should be identified by prospective multi-centric studies that can better define the subsets of patients eligible for prophylactic therapy in the absence of a high CNS-IPI risk.
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Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, HematologyAll India Institute of Medical SciencesRishikeshIndia
| | - Lima Arya
- Department of Medical OncologyMax Superspeciality HospitalNew DelhiIndia
| | - Ruchi Srivastava
- Department of PathologyMax Superspeciality HospitalNew DelhiIndia
| | - Meenu Walia
- Department of Medical OncologyMax Superspeciality HospitalNew DelhiIndia
| | - Amit Sehrawat
- Department of Medical Oncology, HematologyAll India Institute of Medical SciencesRishikeshIndia
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Sundriyal D, Arya L, Srivastava R, Walia M, Sehrawat A. Leptomeningeal relapse in primary cutaneous
DLBCL
: Implications for a prophylactic
CNS
therapy. Cancer Rep (Hoboken) 2021. [DOI: https:/doi.org/10.1002/cnr2.1295] [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: 01/17/2023] Open
Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh India
| | - Lima Arya
- Department of Medical Oncology Max Superspeciality Hospital New Delhi India
| | - Ruchi Srivastava
- Department of Pathology Max Superspeciality Hospital New Delhi India
| | - Meenu Walia
- Department of Medical Oncology Max Superspeciality Hospital New Delhi India
| | - Amit Sehrawat
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh India
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Bhattacharyya GS, Walia M, Nandi M, Murli A, Salim S, Rajpurohit S, Shinde S, Aggarwal S, Parikh PM. Practical consensus recommendations for neo-adjuvant chemotherapy in triple negative breast cancer. South Asian J Cancer 2020; 7:156-158. [PMID: 29721485 PMCID: PMC5909296 DOI: 10.4103/sajc.sajc_126_18] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This manuscript provides a practical and easy to use consensus recommendation to community oncologists on how to use neoadjuvant chemotherapy in triple negative breast cancer patients.
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Affiliation(s)
- G S Bhattacharyya
- Department of Medical Oncology, Fortis Hospital, Kolkata, West Bengal, India
| | - M Walia
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - M Nandi
- Department of Medical Oncology, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - A Murli
- Department of Medical Oncology, Sarvodaya Hospital, Faridabad, Haryana, India
| | - S Salim
- Department of Oncology, Hakim Sanaullah Cancer Center, Sopore, Jammu and Kashmir, India
| | - S Rajpurohit
- Department of Medical Oncology, RGCI, New Delhi, India
| | - S Shinde
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - P M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
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6
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Gupta S, Singh M, Vora A, Babu G, Walia M, Nautial V, Saha R, Smruti BK, Sharma JB, Koul R, Parikh PM, Aggarwal S. Practical consensus recommendations on duration of adjuvant hormonal therapy in breast cancer. South Asian J Cancer 2020; 7:142-145. [PMID: 29721482 PMCID: PMC5909293 DOI: 10.4103/sajc.sajc_122_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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Optimization of adjuvant systemic therapy in women with early-stage hormone receptor-positive breast cancer includes the consideration of chemotherapy and duration of hormone therapy. Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). Expert oncologist discussed on the duration of adjuvant hormonal therapy for improvement of OS and quality of life of breast cancer patients by providing reduction in recurrence and mortality. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- S Gupta
- Department of Medical Oncology, Tata Memorial Center, Mumbai, Maharashtra, India
| | - M Singh
- Department of Medical Oncology, Mahaveer Cancer Sansthan, Patna, Bihar, India
| | - Amish Vora
- Department of Medical Oncology, Hope Clinic, New Delhi, India
| | - G Babu
- Department of Medical Oncology, KMIO, Bengaluru, Karnataka, India
| | - M Walia
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - V Nautial
- Department of Medical Oncology, Jolly Grant Himalayan Institute, Dehradoon, Uttarakhand, India
| | - R Saha
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - B K Smruti
- Department of Medical Oncology, Bombay Hospital, Mumbai, Maharashtra, India
| | - J B Sharma
- Department of Medical Oncology, Action Balajee Cancer Hospital, New Delhi, India
| | - R Koul
- Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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7
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Sundriyal D, Arya L, Srivastava R, Walia M, Sehrawat A. Leptomeningeal relapse in primary cutaneous
DLBCL
: Implications for a prophylactic
CNS
therapy. Cancer Rep (Hoboken) 2020. [DOI: https://doi.org/10.1002/cnr2.1295] [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: 01/15/2023] Open
Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh India
| | - Lima Arya
- Department of Medical Oncology Max Superspeciality Hospital New Delhi India
| | - Ruchi Srivastava
- Department of Pathology Max Superspeciality Hospital New Delhi India
| | - Meenu Walia
- Department of Medical Oncology Max Superspeciality Hospital New Delhi India
| | - Amit Sehrawat
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh India
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8
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Selvakumar VPP, Garg S, Kaur J, Kadayaprath G, Rohatgi N, Walia M, Rangaraju RR, Julka PK, Chaturvedi HK, Verma A. Genetic testing for hereditary breast and ovarian cancer in Indian population: A single institutional study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13153] [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: 11/20/2022] Open
Abstract
e13153 Background: Women with Hereditary breast ovarian cancer have an increased lifetime risk of developing breast, ovarian and other second primary cancers . A number of genes including BRCA 1 & 2 have been implicated in Hereditary Breast Ovarian Cancer. In this background we sought to analyze the genetic pattern of patients who underwent genetic testing as per the NCCN criteria for hereditary breast ovarian cancer syndrome. Methods: All consecutive patients who fit into the NCCN criteria for genetic testing for Hereditary Breast Ovarian Cancer from 2016 to 2018 were referred to our genetic clinic. The data of all the patients who underwent further genetic testing after counselling were collected and analyzed. Results: Out of 155 patients who underwent genetic testing ,131 patients were found eligible for the study.127 were female and 4 were male. There were 27 pathogenic mutations identified while 32 were variants of unknown significance . The remaining 72 were negative for any of the known mutations. 22 were pathogenic for BRCA 1 Mutation , two pathogenic for BRCA 2 and one for TP53 ,PALB2 and ATM each. Out of the 32 VUS, 9 were BRCA 2, 4 in CDH 1, 2 in BRCA1, CHEK2 ,MSH2 and BRIP1 and one each in MLH1, MLH3, ATM, APC, RAD51D, XRCC3, NBN, TP53.Three patients had double VUS reported. BRCA 1 is the most common pathogenic mutation ( 16.79% ) found while BRCA 2 is the most common VUS reported ( 28 %). Conclusions: 20.6 % of eligible patients had pathogenic mutations which is much higher than the western literature. However the VUS rates in Indian population are high 22% owing to a paucity of genetic data of Indian population. Multigene testing helps in identifying other genes asscociated with the Hereditary breast ovarian cancer criteria in addition to BRCA 1 & 2.
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9
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Verma A, Rohatgi N, Julka PK, Walia M, Bahl A, Arora RS, Chaturvedi H, Anand AK, Rao R, Gay LM, Kaur J. FoundationOne as a relevant tool for comprehensive genomic profiling and assessment of tumor mutation burden in the era of precision oncology in India. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e23096] [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
e23096 Background: Comprehensive genomic profiling (CGP) is gaining acceptability globally, but clinical experience in developing countries like India is limited. CGP identifies genomic alterations (GA), with tumor mutation burden (TMB) and microsatellite status (MSI), revealing therapeutic options such as targeted inhibitors and immunotherapies. We sought to evaluate the mutation frequency and actionability across tumors. Methods: Metastatic and/or refractory patients (referred to Personalized Cancer Medicine Clinic) underwent CGP analysis, including calculation of TMB and MSI, using a targeted NGS panel (FoundationOne, 53 samples; FoundationOne Heme, 4 samples). This panel detects all relevant classes of GA: base substitutions, small indels, rearrangements and copy number changes. Mutation frequencies were compared with the larger Foundation database. TMB status was reported as low (≤5 mutations/Mb), intermediate (6-19 mut/Mb) or high (≥20 mut/Mb). Results: The most common tumor types were lung (23%), breast (14%) and sarcoma (12%); other tumor types, including unknown primary constituted the rest (51%). Most samples were from metastatic sites (60%). Oncogenic GA were found in 131 genes across all tumor subtypes and affected major pathways: apoptosis/cell cycle (31%), PI3K (14%), transcriptional regulation (13%), and receptor tyrosine kinases (10%). Among these GA, 38 were considered actionable and were distributed across 43 (75%) samples. Therapies with FDA approval for the tumor type analyzed were indicated for 18 samples; an additional 25 samples had GA associated with therapies FDA approved for another indication. More than 1 actionable GA was identified in 24/43 (56%). TMB status was low in 36 (63%), intermediate in 19 (33%) and high in 2 (3.5%). High TMB status correlated with high MSI status (p < 0.001). Trend observed in the mutation frequency was comparable with the larger Foundation database. Conclusions: This is the first study in India showing CGP identified actionable targets associated with FDA approved therapies in approx. 32% of cases. TMB status identified 2/57 samples with high mutation burden for whom immunotherapy might be relevant.
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10
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Singh R, Jain S, Chabbra R, Naithani R, Upadhyay A, Walia M. Characterization and anti-microbial susceptibility of bacterial isolates: Experience from a tertiary care cancer center in Delhi. Indian J Cancer 2016; 51:477-80. [PMID: 26842169 DOI: 10.4103/0019-509x.175305] [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
BACKGROUND Hospitalization for fever in cancer patients is associated with considerable morbidity, mortality, and cost. AIM The aim of this study was to study the bacterial spectrum and susceptibility patterns of pathogens in culture positive patients from the oncology unit of our hospital. METHODS We retrospectively reviewed the medical records of patients admitted in our cancer center (medical, radiation, and surgical oncology) from January to December 2013. Blood and respiratory secretions from the indoor patients were evaluated. RESULTS Of the total 693 samples, 76.4% were Gram-negative and 23.6% were Gram-positive. The most common bacterial isolates among Gram-negative organisms in blood were Escherichia coli, Salmonella and among the Gram-positive organism were Staphylococcus aureus and Enterococcus. Among the blood isolates extended spectrum of beta-lactamase, multidrug-resistant (carbapenem-resistant) and pan resistant bugs were seen in 47%, 15%, and 5% of the blood isolates. Among the Gram-positive organisms, 25% respiratory isolates were vancomycin-resistant Enterococci. CONCLUSION We observed a high incidence of Gram-negative isolates with clinically significant resistance to first-line antibiotics such as cephalosporin's, piperacillin tazobactum, and fluoroquinolones.
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Affiliation(s)
- R Singh
- Department of Oncology, Max Super Speciality Hospital, Patparganj, New Delhi, India
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11
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Sundriyal D, Walia M. Rash: annoying but prognostic. Indian J Surg Oncol 2015; 6:90-1. [PMID: 25937771 PMCID: PMC4412858 DOI: 10.1007/s13193-015-0390-3] [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: 02/18/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022] Open
Abstract
Targeted therapies are commonly utilised in modern oncology practice. Skin toxicity is a frequently encountered problem associated with them. Some of the skin toxicites carry prognostic significance and it is important to identify them. Though annoying, treatment interruption is seldom required.
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Affiliation(s)
- Deepak Sundriyal
- />Department of Medical Oncology, Dharamshila Hospital & Research Centre, Vasundhara Enclave, New Delhi, 110096 India
- />79, Sector 12, Dwarka, New delhi, 110078 India
| | - Meenu Walia
- />Medical Oncology, Max Superspeciality Hospital, New Delhi, India
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12
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Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, Dharamshila Hospital and Research Center, New Delhi, India
| | - Ruchi Kapoor
- Department of Anesthetist, North Delhi Municipal Corporation Medical College, New Delhi, India
| | - Naveen Kumar
- Department of Internal Medicine, P.G.I.M.E.R. & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Meenu Walia
- Department of Medical Oncology, Dharamshila Hospital and Research Center, New Delhi, India
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13
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Sundriyal D, Kumar N, Kumar G, Walia M. Livedo reticularis heralding hypercalcaemia of malignancy. BMJ Case Rep 2014; 2014:bcr2013201371. [PMID: 24832704 PMCID: PMC4024535 DOI: 10.1136/bcr-2013-201371] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 11/04/2022] Open
Abstract
The term livedo reticularis is used to describe net-like purple rash usually on the lower limbs. It is an important clinical sign with diverse aetiologies. Hypercalcaemia is an uncommon but important clinical entity, sometimes associated with livedo reticularis. Generally, hypercalcaemia of renal failure and secondary hyperparathyroidism has been reported with this condition. We report a case of livedo reticularis heralding onset of hypercalcaemia of malignancy.
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Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, Dharamshila Hospital, New Delhi, India
| | - Naveen Kumar
- Department of Internal Medicine, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Gaurav Kumar
- Department of Medicine, V.M.M.C. and Safdarjung Hospital, New Delhi, India
| | - Meenu Walia
- Department of Medical Oncology, Dharamshila Hospital, New Delhi, India
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Affiliation(s)
- Naveen Kumar
- Department of Internal Medicine, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi, India
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Kant K, Walia M, Agnihotri VK, Pathania V, Singh B. Evaluation of Antioxidant Activity of Picrorhiza kurroa (Leaves) Extracts. Indian J Pharm Sci 2013; 75:324-9. [PMID: 24082348 PMCID: PMC3783750 DOI: 10.4103/0250-474x.117438] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 08/28/2012] [Revised: 03/07/2013] [Accepted: 03/27/2013] [Indexed: 11/04/2022] Open
Abstract
Picrorhiza kurroa is a well-known herb in Ayurvedic medicine. Although it shows antioxidant, antiinflammatory and immunomodulatory activities, it is most valued for its hepatoprotective effect. The rhizomes are widely used against indigestion problems since ancient times due to improper digestive secretions. Aim of this study was to explore antioxidant study of P. kurroa leaves for a new source of naturally occurring antioxidants. Two pure compounds, luteolin-5-O-glucopyranoside (1) and picein (2) were isolated from butanol extract through column chromatography. Different extracts of P. kurroa leaves (ethanol, ethyl acetate, butanol) were quantified for isolated compound (2) by high-performance liquid chromatography. All the extracts and isolated compounds were evaluated for its antioxidant activity using two assays, 2,2-diphenyl-1-picrylhydrazyl radical and 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) assay. The linear detection range was 1.56-200 μg/ml for picein. The limit of detection and limit of quantification for picein were 2.34 and 7.81 μg/ml, respectively. Butanol and ethyl acetate extract showed greater antioxidant activity as compare to ethanol extract. Compound 1 and ascorbic acid showed nearly similar antioxidant activity where as 2 showed no activity at standard concentration. The IC50 values for 2,2-diphenyl-1-picrylhydrazyl radical and 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) assay for ascorbic acid, compound 1, ethanol extract and its different fractions (ethyl acetate and butanol) were found to be 0.81, 1.04, 67.48, 39.58, 37.12 and 2.59, 4.02, 48.36, 33.24, 29.48 μg, respectively.
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Affiliation(s)
- K Kant
- Natural Plant Products Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur-176 061, India
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Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, Dharamshila Hospital, New Delhi, India
| | - Naveen Kumar
- Department of Medicine, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Sumit Kumar Dubey
- Department of Medicine, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Meenu Walia
- Department of Medical Oncology, Dharamshila Hospital, New Delhi, India
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Abstract
We report on two cases of infective spondylodiscitis caused by Gemella haemolysans in otherwise healthy patients. This organism has only rarely been identified as a cause of bone and joint infection, with only two previous reports of infective spondylodiscitis. We describe the clinical features, investigations and treatment options.
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Affiliation(s)
- T S Rajagopal
- Combined Orthopaedic andMedical Microbiology Service (COMMS), Royal Berkshire NHS Foundation Trust, London Road, Reading RG1 5AN, UK
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Kabra SK, Bhargava S, Lodha R, Satyavani A, Walia M. Idiopathic pulmonary hemosiderosis: clinical profile and follow up of 26 children. Indian Pediatr 2007; 44:333-8. [PMID: 17536132] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To describe the clinical details and follow up of children with idiopathic pulmonary hemosiderosis. DESIGN Retrospective case series. SETTING Pediatric chest clinic of a tertiary care hospital. SUBJECTS Children diagnosed as suffering from idiopathic pulmonary hemosiderosis (IPH). METHODS Charts of patients diagnosed as IPH were reviewed for clinical features and treatment regimen. Diagnosis was based on presence of iron deficiency anemia, chest radiography and demonstration of hemosiderin laden macrophages in bronchoalveolar lavage (BAL), gastric aspirate, or sputum. Treatment consisted of oral prednisolone, hydroxychloroquine (HCQ) and inhaled corticosteroids (ICS). RESULTS The common clinical features in 26 children with IPH (mean age 75 months) included: cough, breathlessness, fever, hemoptysis and wheezing in 26 (100%), 22 (85%), 19 (73%),15 (58%) and 14 (54%) children, respectively. Clubbing, hepatomegaly and splenomegaly was seen in 16 (62%), 15 (58%) and 10 (38%) children, respectively. Hemosiderin laden macrophages were documented in BAL and gastric aspirate in 92% and 30% patients, respectively. Symptoms did not recur in 17 patients who received prednisolone and HCQ initially. 5 patients had recurrence of symptoms and required short courses of oral prednisolone, 4 patients required frequent courses of prednisolone and were started on azathioprine. Older age, longer duration of illness, history of hemoptysis and jaundice were associated with poor response. CONCLUSION Treatment with prednisolone and hydroxychloroquine followed by inhaled corticosteroids may improve survival in children with IPH.
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Affiliation(s)
- S K Kabra
- Pediatric Pulmonology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India.
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Abstract
Plasma membrane (PM) Ca2+ pump is a Ca+-Mg2+-ATPase that expels Ca2+ from cells to help them maintain low concentrations of cytosolic Ca2+ . There are no known extracellularly acting PM Ca2+ pump inhibitors, as digoxin and ouabain are for Na+ pump. In analogy with digoxin, we define caloxins as extracellular PM Ca2+ pump inhibitors and describe caloxin 2A1. Caloxin 2A1 is a peptide obtained by screening a random peptide phage display library for binding to the second extracellular domain (residues 401-413) sequence of PM Ca2+ pump isoform 1b. Caloxin 2A1 inhibits Ca2+-Mg2+-ATPase in human erythrocyte leaky ghosts, but it does not affect basal Mg2+-ATPase or Na+-K+-ATPase in the ghosts or Ca2+-Mg2+-ATPase in the skeletal muscle sarcoplasmic reticulum. Caloxin 2A1 also inhibits Ca2+-dependent formation of the 140-kDa acid-stable acylphosphate, which is a partial reaction of this enzyme. Consistent with inhibition of the PM Ca2+ pump in vascular endothelium, caloxin 2A1 produces an endothelium-dependent relaxation that is reversed by N(G)-nitro-L-arginine methyl ester. Thus caloxin 2A1 is a novel PM Ca2+ pump inhibitor selected for binding to an extracellular domain.
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Affiliation(s)
- J Chaudhary
- Department of Medicine, McMaster University, 1200 Main St., Hamilton, Ontario, Canada L8N 3Z5
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Abstract
Peroxides and other reactive oxygen species damage arteries during ischemia-reperfusion. Here, we report on the effects of H(2)O(2) on contractility of pig coronary artery. We either treated 3-mm coronary artery rings with 0 to 0.5 mM H(2)O(2) in organ baths or we perfused the arteries with H(2)O(2) and then cut them into rings. In each instance, we monitored the force of contraction of 3-mm rings in H(2)O(2)-free solution with 30 mM KCl and then we determined the A23187 induced endothelium dependent relaxation as a percent of this contraction. Treatment with H(2)O(2) in the organ bath caused a decrease in the contraction but it did not affect the percent relaxation. Treating arteries with H(2)O(2) by luminal perfusion did not affect the contraction but it decreased the percent relaxation. Perfusion alone decreased the amount of endothelium remaining in the arteries and perfusing with H(2)O(2) decreased it further. The percent relaxation with A23187 correlated well with the endothelium remaining in the arteries. We propose that H(2)O(2) and shear stress can cause a loss of endothelium and that endothelium can also protect the underlying smooth muscle against luminal H(2)O(2).
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Affiliation(s)
- M Walia
- Department of Medicine, McMaster University, Hamilton, L8N3Z5., Ontario, Canada
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21
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Walia M, Agarwal AK, Shah P, Yadav R, Singh CP, Yadav P. Prevalence of coronary risk factors in non-insulin dependent (type 2) diabetics. J Assoc Physicians India 1999; 47:1051-5. [PMID: 10862311] [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: 02/16/2023]
Abstract
OBJECTIVES A cross sectional study was conducted to find the prevalence of coronary risk factors in non-insulin dependent diabetic (NIDDM) patients and to compare and co-relate these risk factors in type II diabetics with and without electrocardiographic and/or symptomatic evidence of coronary heart disease (CHD). METHODS One hundred sixty-seven consecutive NIDDM patients (77 males, and 90 females) attending the diabetic clinic at Dr. RML Hospital, New Delhi were studied. Only known NIDDM cases, already on treatment and without any history of ketosis or congestive heart failure were included. Coronary risk factors comprising of age, gender, duration and treatment for diabetes, smoking, physical activity, hypertension, truncal obesity, lipids, microalbuminuria (semiquantitative) and glycemic control have been particularly ascertained in all the cases. The data was analysed using 'Epi Info version 6.0'. RESULTS The mean age of patients was 53.12 year and 8.86 year was the mean duration of diabetes. 28.6% of the diabetic men were found to be currently smoking and/or consuming alcohol, 82% were involved in sedentary physical activity and 20.4% had family history of CHD. Central obesity was observed in 46.7% of the cases; more so in females. 31.74% of cases were hypertensive; more females than males had hypertension (33.8% vs 30%). Poor glycemic control (HbA1c > = 9.5%) was seen in 16.8% of the cases. In about 52.5% of the total group hypertriglyceridemia was noted. Microalbuminuria could be found in 35.93%. CHD was diagnosed in 15.57% of cases in this study. CONCLUSIONS The present study revealed that high levels of serum cholesterol (p = 0.000004), LDL (p = 0.00003), HbA1c (p = 0.002), microalbuminuria (p = 0.000006) and hypertension (p = 0.00006) are significant associates of CHD in NIDDM (both the sexes). Among the female NIDDM cases, in addition BMI (p = 0.01), Waist-hip ratio (WHR) (p = 0.003) and low HDL level (p = 0.008) are important correlates of CHD. Multiple logistic regression analysis was used to allow for confounding between variables. Microalbuminuria alone entered the 'best' model for CHD prediction. Other risk factors, though significant, provided inadequate models for CHD prediction.
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Affiliation(s)
- M Walia
- Dept. of Medicine and Pathology, Dr. Ram Manohar Lohia Hospital, New Delhi
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Agarwal AK, Yadav R, Jain A, Sangla KS, Arora V, Walia M. Primary pure red cell aplasia. J Indian Med Assoc 1997; 95:53-4. [PMID: 9357245] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A K Agarwal
- Department of Medicine, Dr Ram Monohar Lohia Hospital, New Delhi
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Kumar A, Lal P, Walia M, Arora R, Gulati N. AIDS awareness among nursing students of Delhi. J Commun Dis 1996; 28:20-7. [PMID: 8778176] [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: 02/02/2023]
Abstract
A total of 233 students of nursing school affiliated to a major hospital of Delhi were surveyed anonymously employing a predesigned, pretested and self-administered questionnaire. Although, 78.6 per cent students knew that AIDS stands for "Acquired Immuno-deficiency Syndrome," 15.5 per cent students were unaware of the fact that AIDS had reached India. Majority of them were aware of various aspects of HIV/AIDS. However, they also had few misconceptions particularly regarding HIV transmission. Contrary to our belief, only one-fourth students acquired AIDS information from scientific journals. One training session on AIDS conducted for a small group of students could not bring any significant change in their knowledge. Findings suggest organization of AIDS-training sessions at regular intervals from the very inception of nursing programme to impart complete and correct knowledge of these future Florence Nightingales regarding various aspects of HIV/AIDS and for removal of misconceptions.
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Affiliation(s)
- A Kumar
- Department of Preventive and Social Medicine, Maulana Azad Medical College, New Delhi
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Walia M, Mahajan M, Singh K. Serum adenosine deaminase, 5'-nucleotidase & alkaline phosphatase in breast cancer patients. Indian J Med Res 1995; 101:247-9. [PMID: 7672835] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Serum levels of adenosine deaminase (ADA), 5-nucleotidase (5'-NT) and alkaline phosphatase (ALP) were studied in 25 patients of carcinoma breast and 25 normal subjects. Adenosine deaminase was found to be the better probable parameter for the detection of cancer and to assess the development of various stages of cancer whereas 5'-nucleotidase had only diagnostic significance. Serum alkaline phosphatase levels were important for assessing the spread of cancer at secondary sites. After mastectomy a significant decrease was found in the levels of serum ADA and 5'-NT whereas no variations were found in case of serum ALP.
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Affiliation(s)
- M Walia
- Department of Biochemistry, Government Medical College, Amritsar
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Kissoon N, Dreyer J, Walia M. Pediatric trauma: differences in pathophysiology, injury patterns and treatment compared with adult trauma. CMAJ 1990; 142:27-34. [PMID: 2403481 PMCID: PMC1451562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although multiple trauma remains the leading cause of death among children, fewer resources and less attention have been directed to treatment of the injured child than to treatment of the injured adult. Insufficient training of medical personnel and hence lack of expertise in the management of injured children are factors contributing to disability and death in such children. Although the principles of resuscitation of injured children are similar to those for adults, appreciation of the differences in cardiorespiratory variables, airway anatomy, response to blood loss, thermoregulation and equipment required is essential for successful initial resuscitation. Cerebral, abdominal and thoracic injuries account for most of the disability and death among injured children. Cerebral damage may be due to secondary injuries to the brain and is potentially preventable. The need to preserve the spleen in children complicates the management of abdominal trauma. Although children usually have large cardiorespiratory reserves, they are likely to need airway control and ventilation with thoracic injuries. The psychologic effect of trauma may pose long-term problems and needs close follow-up.
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