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An epidemiological study on delay in treatment initiation of cancer patients

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Health 2012年第2期4卷 66-79页

作者： alok kumar Dwivedi Sada Nand Dwivedi Suryanarayana Deo Rakesh Shukla Arvind Pandey Durgesh kumar Dwivedi Center for Biostatistical Services Division of Biostatistics and Epidemiology Department of Environmental Health College of Medicine University of Cincinnati Cincinnati USA Department of Biostatistics All India Institute of Medical Sciences New Delhi India Department of NMR & MRI Facility All India Institute of Medical Sciences New Delhi India Department of Surgical Oncology All India Institute of Medical Sciences New Delhi India National Institute of Medical Statistics Indian Council of Medical Research New Delhi India

Early diagnosis and timely initiation of treatment of cancer patients may improve survival and quality of life. Various measures of delay can be made during diagnosis and treatment initiation. Most of the studies were based on single type of cancer with different definitions and measurements of delay in diagnosis and treatment. Thus, it has been difficult to synthesize results and generalize to other types of cancer. The study proposes to measure total duration between onsets of symptom to start of treatment into three components, namely primary, secondary and tertiary delays. Primary delay is defined as onset of symptoms to contacting the first medical person, secondary delay is from first medical contact to confirmed diagnosis, and tertiary delay is from confirmed diagnosis to treatment initiation. The aim of this study is to determine factors associated with primary, secondary and tertiary delays in cancer patients. This study was planned as a cross-sectional study. Data was collected from patients admitted to the surgical wards of Department of Surgical Oncology, Institute Rotary Cancer Hospital, New Delhi during 2006-2007. Gamma regression and quantile regressions at 25th, 50th and 75th percentile of each of the delays were used to determine related factors. A total of 403 patients were included in the analysis. The median tertiary delay was found almost two folds (59;Interquartile range: 26 - 101 days) than the primary and secondary delays. Extremity cancer patients had longest primary, secondary and tertiary delays. Shortest primary, secondary and tertiary delays were observed for gastrointestinal cancer, breast and genitourinary cancer respectively. There is an urgent need and scope to reduce delay at each level primary, secondary and tertiary delay. Intervention studies are needed through information, education and communication/screening programs to reduce the diagnostic and treatment delays in cancer patients.

关键词： Delay Cancer Log Gamma Regression Quantile Regression

Clinical outcome of orbital apex syndrome in COVID associated mucormycosis patients in a tertiary care hospital

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International Journal of Ophthalmology(English edition) 2022年第4期15卷 527-532页

作者： Smiti Rani Srivastava Purban Ganguly Debasis Barman Sudip Das Manimoy Bandyopadhyay Asim kumar Ghosh Subhra Sarkar Amitabha Sengupta Sarbari Swaika Pritam Chatterjee Amit kumar Gupta alok Ranjan Mondal Soumyajit Guha Sinjita Dutta Souvik Adhikari Aditi Kaushik Partha Sundar Biswas Asif Ayub Department of Ophthalmology Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial HospitalKolkata 999008India

AIM: To share clinical pattern of presentation, the modalities of surgical intervention and the one month postsurgical outcome of rhino-orbito-mucormycosis(ROCM) ***: All COVID associated mucormycosis(CAM) patients underwent comprehensive multidisciplinar y examination by ophthalmologist, otorhinolaryngologist and physician. Patients with clinical and radiological evidence of orbital apex involvement were included in the study. Appropriate medical and surgical intervention were done to each patient. Patients were followed up one-month post intervention. RESULTS: Out of 89 CAM patients, 31(34.8%) had orbital apex syndrome. Sixty-six(74.2%) of such patients had pre-existing diabetes mellitus, 18(58%) patients had prior documented use of steroid use, and 55(61.8%) had no light perception(LP) presenting vision. Blepharoptosis, proptosis, complete ophthalmoplegia were common clinical findings. Seventeen(19.1%) of such patients had variable amount of cavernous sinus involvement. Endoscopic debridement of paranasal sinuses and orbit with or without eyelid sparing limited orbital exenteration was done in most cases, 34(38.2%) patients could retain vision in the affected eye. CONCLUSION: Orbital apex involvement in CAM patients occur very fast. It not only leads to loss of vision but also sacrifice of the eyeball, orbital contents and eyelids. Early diagnosis and prompt intervention can preserve life, vision and spare mutilating surgeries.

关键词： rhino-orbito-cerebral mucormycosis COVID associated mucormycosis orbital exenteration endoscopic paranasal sinus debridement orbital apex syndrome

Acute onset of massive epistaxis due to post-traumatic cavernous internal carotid artery pseudoaneurysm: A case report

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Journal of Acute Disease 2021年第1期10卷 39-41页

作者： Santosh kumar Swain alok Das Satyabrata Acharya Nibi Shajahan Rohit Agrawala Department of Otorhinolaryngology IMS and SUM HospitalSiksha"O"Anusandhan University(Deemed to be)K8Kalinga NagarBhubaneswar-751003OdishaIndia

Rationale:Cavernous internal carotid artery(ICA)pseudoaneurysm caused by non-penetrating head trauma is a rare cause of massive *** sudden onset of epistaxis due to such a fatal aneurysm protruding into the sphenoid sinus is extremely rare in clinical *** management is often challenging because of anatomical inaccessibility of the bleeding ***'s concern:A 42-year-old man with a history of head trauma showing an ICA aneurysm eroding the sphenoid sinus followed by massive ***:A computerized tomography(CT)scan showed a fracture in the sphenoid *** angiogram revealed cavernous ICA ***:Endovascular coil ***:The patient recovered well and was discharged without any neurological deficits Lessons:Cavernous ICA pseudoaneurysm may lead to a life-threatening *** a patient has a history of head trauma,post-traumatic cavernous ICA pseudoaneurysm should be considered a differential diagnosis of massive epistaxis.

关键词： Massive epistaxis Pseudoaneurysm Internal carotid artery Coil embolization

Primary Extra-Gastrointestinal Stromal Tumor (GIST) arising from mesentery of small bowel and presenting as abdominal mass: A rare entity

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Open Journal of Gastroenterology 2013年第5期3卷 267-271页

作者： alok kumar Tiwari Anil kumar Choudhary Hemant Khowal Poras Chaudhary Mohinder P. Arora Department of Surgery Dr R.M.L Hospital New Delhi India Department of Surgery Lady Hardinge Medical College New Delhi India

Introduction: Majority of mesenchymal tumors of gastrointestinal tract are Gastrointestinal Stromal Tumor (GIST). It is, however, a rare tumor, accounting for less than 1% of primary gastrointestinal (GI) neoplasms. Though, these tumors are refractory to conventional chemotherapy or radiotherapy but show a good response to targeted adjuvant chemotherapy with tyrosine kinase inhibitors following surgical resection. Case Report: we report here a case of primary Extra-GIST tumor arising from mesentry of small bowel near duodeno-jejunal junction in a 69 years old male patient. The patient presented with a palpable mass in upper abdomen for past 15 days. On examination, a non-tender mobile lump of size around 17 × 10 cm, with bosselated surface and firm in consistency was palpable involving epigastric, left hypochondrium and umbilical region. Contrast enhanced computed tomography of abdomen revealed a heterogenous mesentric mass. On surgical intervention a mass was found involving mesentery near dudenojejunal junction without involvement of gastrointestinal tract. Complete surgical resection of the tumor was done and adjuvant chemotherapy with Imatinib mesylate was started as HPE revealing GIST with mitotic index of >10/50 HPF and 17 × 10 cm size placed the patient in high risk category. Patient was discharged on 12th of post-operative day with advice of regular follow-up. Conclusion: GIST occurrence is not restricted to bowel but can involve unusual sites also. The mainstay of treatment remains surgical resection with adequate margin. In cases where tumour has malignant potential (high mitotic figures on histopathology) adjuvent treatment with tyrosine kinase may prevent or delay relapse.

关键词： Extra-Gastrointestinal Stromal Tumors GIST Mesentric Tumors Imatinib Mesylate Abdominal Mass

Bacteriocins as antimicrobial and preservative agents in food:Biosynthesis,separation and application

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Food Bioscience 2022年第2期46卷 749-771页

作者： Deepak kumar Verma Mamta Thakur Smita Singh Soubhagya Tripathy alok kumar Gupta Deepika Baranwal Ami R.Patel Nihir Shah Gemilang Lara Utama Alaa Kareem Niamah M´onica L.Ch´avez-Gonz´alez Carolina Flores Gallegos Cristobal Noe Aguilar Prem Prakash Srivastav Agricultural and Food Engineering Department Indian Institute of Technology KharagpurKharagpur721302West BengalIndia Department of Food Technology School of SciencesITM UniversityGwalior474001Madhya PradeshIndia Department of Nutrition and Dietetics University Institute of Applied Health SciencesChandigarh UniversityChandigarh140413PunjabIndia Division of Post-harvest Management ICAR-Central Institute for Subtropical Horticulture(Ministry of Agriculture and Farmers WelfareGovernment.of India)Lucknow(UP)226101India Department of Home Science Arya Mahila PG CollegeBanaras Hindu UniversityVaranasiUttar Pradesh221005India Division of Dairy Microbiology Mansinhbhai Institute of Dairy and Food Technology-MIDFTDudhsagar Dairy CampusMehsana384002GujaratIndia Faculty of Agro-Industrial Technology Universitas PadjadjaranSumedang45363Indonesia Center for Environment and Sustainability Science Universitas PadjadjaranBandung40132Indonesia Department of Food Science College of AgricultureUniversity of BasrahBasra CityIraq Bioprocesses and Bioproducts Research Group and Nanobioscience Group.Food Research Department School of Chemistry.Autonomous University of CoahuilaSaltillo Campus25280CoahuilaMexico

Emerging evidence shows the trend of using safe and natural preservatives like bacteriocins in food *** increasing demand by the food industry to extend keeping quality and prevent spoilage of various food products has appealed for new preservatives and new methods of ***,to discover the novel spectrum of antimicrobial compounds that could effectively battle food-borne pathogens,bacteriocins have been intensively studied in the last few ***,great attention has been paid to the application of lactic acid-bacterial bacteriocins targeting food spoilage-causing or pathogenic microorganisms with no significant side *** mechanisms of action like pore-formation,retarding cell-wall/nucleic acid/protein synthesis have been proposed and described for diverse ***,the syntheses,purification of bacteriocins in addition to their applications as antimicrobial and preservative agents in food processing are reviewed in *** review will also discuss the preservative effect of bacteriocins and their combinations having multiple modes of action(hurdle approach)to reduce the microbial load as well as antimicrobial resistance.

关键词： Lactic acid bacteria Bacteriocins Preservative Food-borne pathogens Food processing

Sustainable ifngerling production technique of endangeredLabeo calbasu (Hamilton, 1822) based on different protein levels in ponds

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Journal of Coastal Life Medicine 2017年第2期5卷 51-58页

作者： Md.Abdus Samad Shamol Chandra Barman Sujit kumar Chatterjee Md.Mustafizur Rahman alok kumar Paul Department of Fisheries University of RajshahiRajshahi-6205Bangladesh Fish Inspection and Quality Control Department of FisheriesDhakaBangladesh

Objective:To conduct on sustainable fingerling production technique of endangered Labeo calbasu (Hamilton, 1822) (L. calbasu) based on different protein levels in ponds. Methods: The experiment was carried out under rearing pond in fish hatchery complex with three treatments group each having three replicates under department of fisheries, University of Rajshahi.L. calbasu were stocked at 41990/ha in T1, T2 and T3, respectively. The initial length ofL. calbasu in three treatments were (4.60 ± 0.10) cm and initial weights were (3.48 ± 0.01) g. Fishes were fed with 28%, 30%, 32% protein supplement for T1, T2, T3, respectively. The fishes were initially fed at 10% of body weight on 1st and 2nd fortnight. Then it was decreased at 8% of body weight on 3rd and 4th fortnight. Finally in 5th fortnight they were fed 5% of body weight. The physico-chemical characteristics of pond water were measured fortnightly. Results: The mean final weight gain was found highest in T3 (40.87 ± 0.01) g which was significant compared to T1 and T2. SGR (% bwd–1) was found 2.83 ± 0.02 (T1), 3.04 ± 0.01 (T2) and 3.39 ± 0.01 (T3). The highest survival rate ofL. calbasu was found in T3 (90.00 ± 1.00) and the lowest was found in T1 (87.00 ± 1.00). The best FCR (1.54 ± 0.01) was observed in T3 fed with 32% protein supplement. The highest production was observed in T3 (1672.20 ± 16.96 kg/ha/75 days) and lowest was observed in T1(1055.50 ± 29.04 kg/ha/75 days). The highest net benefit was calculated in T3 (260663.00 ± 4326.88 tk.) and lowest was found in T1 (112831.00 ± 7383.66 tk.). The CBR was found 0.60 ± 0.04, 0.80 ± 0.02 and 1.16 ± 0.02 in T1, T2 and T3, respectively. There were significant differences in CBR values among the three treatments. Conclutions:In this study, growth parametersi.e., weight gain, SGR (% bwd–1), length gain, total yield were significantly (P < 0.05) improved in T3 treatment fed with 32% protein supplemented diets.

关键词： Fingerling Production Endangered Labeo calbasu Protein levels

Pathogenic mechanisms of pancreatitis

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第1期8卷 10-25页

作者： Murli Manohar alok kumar Verma Sathisha Upparahalli Venkateshaiah Nathan L Sanders Anil Mishra Department of Medicine Section of Pulmonary DiseasesTulane Eosinophilic Disorders CenterTulane University School of MedicineNew OrleansLA 70112United States

Pancreatitis is inflammation of pancreas and caused by a number of factors including pancreatic duct obstruction, alcoholism, and mutation in the cationic trypsinogen gene. Pancreatitis is represented as acute pancreatitis with acute inflammatory responses and; chronic pan-creatitis characterized by marked stroma formation with a high number of infiltrating granulocytes(such as neutrophils, eosinophils), monocytes, macrophages and pancreatic stellate cells(PSCs). These inflammatory cells are known to play a central role in initiating and promoting inflammation including pancreatic fibrosis, i.e., a major risk factor for pancreatic cancer. A number of inflammatory cytokines are known to involve in pro-moting pancreatic pathogenesis that lead pancreatic fibrosis. Pancreatic fibrosis is a dynamic phenomenon that requires an intricate network of several autocrine and paracrine signaling pathways. In this review, we have provided the details of various cytokines and molecular mechanistic pathways(i.e., Transforming growth factor-β/SMAD, mitogen--activated protein kinases, Rho kinase, Janus kinase/signal transducers and activators, and phosphatidylinositol 3 kinase) that have a critical role in the activation of PSCs to promote chronic pancreatitis and trigger the phenomenon of pancreatic fibrogenesis. In this review of literature, we discuss the involvement of several pro-inflammatory and anti-inflammatory cytokines, such as in interleukin(IL)-1, IL-1β, IL-6, IL--8 IL-10, IL-18, IL--33 and tumor necrosis factor-α, in the pathogenesis of disease. Our review also highlights the significance of several experimental animal models that have an important role in dissecting the mechanistic pathways operating in the development of chronic pancreatitis, including pancreatic fibrosis. Additionally, we provided several intermediary molecules that are involved in major signaling pathways that might provide target molecules for future therapeutic treatment strategies for pancreatic p

关键词： Pancreatitis Pancreatic stellate cells Transforming growth factor-β/SMAD Janus kinase/signal transducers and activators Mitogen-activated protein kinases

The Journey of SRS: An Initial Experience of Starting Sterotactic Radiosurgery Facility at Purbanchal Cancer Hospital—First in Nepal

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2023年第2期12卷 37-50页

作者： Birendra kumar Yadav Karthik Nagamuthu alok Thakur Kushal Rizal Umesh kumar Sharma Ujwal Rai Dinesh Thapa Shishir Thapa kumar Chinnappan Amit kumar Dubey Suraj Gurung Aman Yadav Utpalkant kumar Ranjay kumar Department of Radiation Oncology Purbanchal Cancer Hospital Jhapa Nepal Department of Radiology Purbanchal Cancer Hospital Jhapa Nepal Deapartment of Pathology Purbanchal Cancer Hospital Jhapa Nepal Department of Neurosurgery Purbanchal Cancer Hospital Jhapa Nepal

Introduction: Radiotherapy (RT) is a vital cancer treatment modality for both curative and palliative purposes. Nepal is a developing country with a population of around 30 million people. Cancer affects 100 - 120 people out of every 100,000, and the figure is increasing. The number of radiation facility machines in the country is still countable in fingers. Purbanchal Cancer Hospital, Nepal is the first comprehensive cancer facility capable of performing stereotactic radiosurgery (SRS). Our facility has cutting-edge Varian Truebeam Linear Accelerators with millennium MLC, which makes SRS and SRT’S for intracranial lesions such as small benign and malignant tumors much easier. In addition to SRS, we are the pioneers of SBRT for lung using 4DCT, interstitial & intraluminal brachytherapy, RPM Gated & DIBH modalities in Nepal. Methods & Materials: The purpose of this study is to share our experience in establishing an SRS facility in the country, which includes training the RT team on the importance of process accuracy, patient selection, patient assessment, mould preparation, and describing image data acquisition, target, and organ at risk delineation on CT and MRI images, treatment planning process, and quality assurance. Results & Discussion: The plans for all SRS and SRT cases are based on target coverage, OAR sparing, hotspot inside the target, conformity index, heterogeneity index, and dose fall off. To select the final plan, we used strict passing criteria such as a conformity index Paddick (CIPaddick) more than 0.85, a falloff between 100% and 50% of less than 5.5 mm (maximum 6 mm in irregular targets), and a hotspot inside the target between 115 to 140 percent, as per clinical standards. In addition, we determined the CILomax and CIRTOG for each case. Passing criteria for verification plans are set as minimum of 95% for a 2% percentage dose difference (% DD) and a 2-mm distance to an agreement (DTA). We also gathered demographic data from patients treated in t

关键词： Conformity Index Double Shell Positioning System Electronic Portal Imaging Device Linear Accelerator Millennium MLC Octavius Detector 1500 Setup Field

Moderate and Severe Blood Pressure Elevation Associated with Stroke in the Mexican Hispanic Population

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Health 2017年第6期9卷 951-963页

作者： Derek Senior Michael F. Osborn Katherene Tajnert Ahmed Badr alok kumar Dwivedi Jun Zhang Department of Biomedical Sciences Texas Tech University Health Sciences Center El Paso USA

Background: Stroke is the fourth leading cause of death in US. Amongst other factors such as age, sex, race, genetics, obesity, diabetes etc., hypertension continues to be the leading contributing factor towards stroke. Studies regarding stroke in Hispanics are sparse and inconclusive. Objectives: The objective of the present study is to investigate the potential association between blood pressure elevation and risk of ischemic stroke among the Mexican Hispanic population. Methods: A retrospective data analysis was carried out for a planned case-control study with case-control ratios of 1:2. Mexican Hispanic cases were from the ElPasoStroke database with diagnosed hypertension that had sustained an ischemic stroke (n = 505) and Mexican Hispanics diagnosed with hypertension who were stroke-free as controls from the 2005-2010 NHANES databases (n = 1010). In this analysis, we included subjects who had data on systolic, diastolic or mean arterial blood pressures for cases (327) and controls (772). In cases, blood pressure was determined by the initial admission measurement, and in controls, the first measured blood pressure was used. The unadjusted and adjusted effects of continuous measurements of systolic, diastolic and mean arterial blood pressure on stroke were determined using logistic regression analyses. Subjects were further classified into groups based on prehypertension and hypertension ranges, as established by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). Unadjusted and adjusted logistic regression models were also used to determine the effect of categorized blood pressures. Results: Our data indicate that per unit increase in systolic, diastolic or mean arterial blood pressure elevates the odds of stroke among the Mexican Hispanic population. Adjusted analysis of categorized blood pressures showed that mild or moderate/severe high blood pressure significantly associated with odds of stroke. M

关键词： Blood Pressure Risk Factors Ischemic Stroke Mexican Hispanic Epidemiology