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garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference?

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World Journal of Gastroenterology 2024年第3期30卷 204-210页

作者： Petr Tsarkov Inna Tulina Parvez Sheikh Darya D Shlyk pankaj garg Department of Colorectal Surgery Sechenov First Moscow State Medical UniversityMoscow 119991Russia Department of Oncologic Colorectal Surgery Sechenov First Moscow State Medical UniversityMoscow 119991Russia Department of Colorectal Surgery Saifee HospitalMumbai 400004MaharashtraIndia Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia

The main aim of this opinion review is to comment on the recent article published by garg et al in the World Journal of Gastroenterology 2023;29:4593–4603.The authors in the published article developed a new scoring system,garg incon-tinence scores(GIS),for fecal incontinence(FI).FI is a chronic debilitating disease that has a severe negative impact on the quality of life of the patients.Rome IV criteria define FI as multiple episodes of solid or liquid stool passed into the clothes at least twice a month.The associated social stigmatization often leads to significant under-reporting of the condition,which further impairs management.An important point is that the complexity and vagueness of the disease make it difficult for the patients to properly define and report the magnitude of the problem to their physicians.Due to this,the management becomes even more difficult.This issue is resolved up to a considerable extent by a scoring ques-tionnaire.There were several scoring systems in use for the last three decades.The prominent of them were the Cleveland Clinic scoring system or the Wexner scoring system,St.Marks Hospital or Vaizey’s scores,and the FI severity index.However,there were several shortcomings in these scoring systems.In the opinion review,we tried to analyze the strength of GIS and compare it to the existing scoring systems.The main pitfalls in the existing scoring systems were that most of them gave equal weightage to different types of FI(solid,liquid,flatus,etc.),were not comprehensive,and took only the surgeon’s perception of FI into view.In GIS,almost all shortcomings of previous scoring systems had been addressed:different weights were assigned to different types of FI by a robust statistical methodology;the scoring system was made comprehensive by including all types of FI that were previously omitted(urge,stress and mucus FI)and gave priority to patients’rather than the physicians’perceptions while developing the scoring system.Due to this,GIS indeed looked like a paradigm shift in the evaluat

关键词： Fecal incontinence Scoring system Urge Stress Flatus

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Appraisal of pollution and health risks associated with coal mine contaminated soil using multimodal statistical and Fuzzy-TOPSIS approaches

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Frontiers of Environmental Science & Engineering 2024年第5期18卷 101-115页

作者： Sumit kumar Sonali Banerjee Saibal Ghosh Santanu Majumder Jajati Mandal pankaj kumar Roy Pradip Bhattacharyya Agricultural and Ecological Research Unit Indian Statistical InstituteGiridih815301India Department of Life and Environmental Sciences Bournemouth University(Talbot Campus)Fern BarrowPooleBH12 5BBUK School of Sciences Engineering & EnvironmentUniversity of SalfordSalfordM5 4QJUK School of Water Resource Engineering Jadavpur UniversityKolkata700032India School of Environmental Studies Jadavpur UniversityKolkata700032India

The present study assesses the concentration,probabilistic risk,source classification,and dietary risk arising from heavy metal(HMs)pollution in agricultural soils affected by coal mining in eastern part of India.Analyses of soil and rice plant indicated significantly elevated levels of HMs beyond the permissible limit in the contaminated zones(zone 1:PbSoil:108.24±72.97,CuSoil:57.26±23.91,CdSoil:8.44±2.76,CrSoil:180.05±46.90,NiSoil:70.79±25.06 mg/kg;PbGrain:0.96±0.8,CuGrain:8.6±5.1,CdGrain:0.65±0.42,CrGrain:4.78±1.89,NiGrain:11.74±4.38 mg/kg.zone 2:PbSoil:139.56±69.46,CuSoil:69.89±19.86,CdSoil:8.95±2.57,CrSoil:245.46±70.66,NiSoil:95.46±22.89 mg/kg;PbGrain:1.27±0.84,CuGrain:7.9±4.57,CdGrain:0.76±0.43,CrGrain:8.6±1.58,NiGrain:11.50±2.46 mg/kg)compared to the uncontaminated zone(zone 3).Carcinogenic and non-carcinogenic health risks were computed based on the HMs concentration in the soil and rice grain,with Pb,Cr,and Ni identified as posing a high risk to human health.Monte Carlo simulation,the solubility-free ion activity model(FIAM),and severity adjusted margin of exposure(SAMOE)were employed to predict health risk.FIAM hazard quotient(HQ)values for Ni,Cr,Cd,and Pb were>1,indicating a significant non-carcinogenic risk.SAMOE(risk thermometer)results for contaminated zones ranged from low to moderate risk(CrSAMOE:0.05,and NiSAMOE:0.03).Fuzzy-TOPSIS and variable importance plots(from random forest)showed that Ni and Cr were mostly responsible for the toxicity in the rice plant,respectively.A self-organizing map for source classification revealed common origin for the studied HMs with zone 2 exhibiting the highest contamination.The positive matrix factorization model for the source apportionment identified coal mining and transportation as the predominant sources of HMs.Spatial distribution analysis indicated higher contamination near mining sites as compared to distant sampling sites.Consequently,this study will aid environmental scientists and policymakers controlling HM pollution in agricultural soils near coal m

关键词： Coal mine Free ion activity model Monto Carlo Simulation Pollution and Health risk Fuzzy-TOPSIS

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Subcutaneous and breast metastasis from asymptomatic gallbladder carcinoma

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Hepatobiliary & Pancreatic Diseases International 2009年第2期8卷 209-211页

作者： pankaj kumar garg Nita Khurana Niladhar S Hadke Department of Surgery Maulana Azad Medical College and Lok Nayak Hospital Department of Pathology Maulana Azad Medical College and Lok Nayak Hospital

BACKGROUND:Though gallbladder carcinoma is asso- ciated with early lymphatic and hematogenous spread, the only common extra-abdominal site of metastasis is lung.Gallbladder carcinoma metastasizing to breast and subcutaneous tissue is not known. METHOD:This report describes an interesting and unusual case of asymptomatic gallbladder carcinoma presenting with subcutaneous and breast metastasis. RESULTS:A 42-year-old woman presented with multiple subcutaneous nodules over the abdominal wall,anterior chest wall,back and in bilateral breasts.Fine needle aspiration cytology(FNAC)of these nodules revealed metastatic adenocarcinoma.The patient was investigated for a primary neoplasm.An ultrasound of the abdomen followed by a contrast-enhanced CT scan showed a growth in gallbladder,infiltrating the liver with multiple hepatic metastases.CT-guided FNAC from the growth in the gallbladder revealed adenocarcinoma.She was diagnosed as a case of metastatic adenocarcinoma of the gallbladder and palliative combination chemotherapy with gemcitabine and carboplatin was given.But she developed jaundice and deteriorated dramatically in a short span of time.No specific therapy could be started and she was given supportive treatment.She died within three weeks of diagnosis due to hepatic encephalopathy. CONCLUSIONS:This report highlights an unusual metastasis of gallbladder carcinoma to the breast and subcutaneous tissue presenting as multiple lesions,which has never been reported in the English literature.These were unknown sites of metastasis for carcinoma of the gallbladder.Moreover,bilateral multiple metastatic lesions to breast are also very rare.

关键词： gallbladder carcinoma breast metastasis subcutaneous metastasis

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Preoperative therapy in locally advanced esophageal cancer

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World Journal of Gastroenterology 2016年第39期22卷 8750-8759页

作者： pankaj kumar garg Jyoti Sharma Ashish Jakhetiya Aakanksha Goel Manish kumar Gaur Department of Surgery University College of Medical Sciences and Guru Teg Bahadur Hospital University of Delhi Department of Surgical Oncology Sawai Man Singh Medical College Department of Surgical Oncology Dr BRA Institute Rotary Cancer Hospital All India Institute of Medical Sciences

Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer(T2 or greater or node positive); however, a high rate of disease recurrence(systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment(preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy(radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.

关键词：食道的癌症外科手术前的治疗 Multimodality 治疗化疗放射疗法 Chemoradiotherapy

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Giant exophytic renal angiomyolipoma masquerading as a retroperitoneal liposarcoma: A case report and review of literature

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World Journal of Clinical Oncology 2018年第7期9卷 162-166页

作者： Gopal Sharma Ayush Jain Prerit Sharma Sonal Sharma Vinita Rathi pankaj kumar garg Department of Surgery University College of Medical Sciences and Guru Teg Bahadur Hospital University of Delhi Department of Pathology University College of Medical Sciences and Guru Teg Bahadur Hospital University of Delhi Department of Radiology University College of Medical Sciences and Guru Teg Bahadur Hospital University of Delhi

A 42-years-old lady, presented with a large retroperitoneal mass which was preoperatively diagnosed as a retroperitoneal liposarcoma following an image guided core biopsy. She underwent a margin-negative resection of the retroperitoneal mass(multi visceral resection-enbloc excision of the retroperitoneal mass with a left nephrectomy and a segmental descending colectomy). The final histopathological examination of the resected specimen confirmed an exophytic renal angiomyolipoma(AML) which was extending into the retroperitoneum. AML is a rare benign tumor arising most commonly from the kidney. It can sometimes present as a diagnostic challenge as it mimics a retroperitoneal liposarcoma or a fat-containing renal cell carcinomas closely. We present this case to share our experience of managing a case of giant exophytic AML which resembled retroperitoneal liposarcoma closely and resulted into an aggressive surgery.

关键词： Angiomyolipoma Retroperitoneum Liposarcoma Diagnosis Biopsy

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In-hospital outcomes in COVID-19 patients with non-alcoholic fatty liver disease by severity of obesity:Insights from national inpatient sample 2020

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World Journal of Hepatology 2024年第6期16卷 912-919页

作者： Sashwath Srikanth Vibhor garg Lakshmi Subramanian Jyoti Verma Hansika Sharma Harroop Singh Klair Shrenil A Kavathia Jithin Kolli Teja Nikhil Sai Vasireddy kumar Anmol Dhanush Kolli Shruti Sanjay Bodhankar Sobya Hashmi Shaylika Chauhan Rupak Desai Department of Medicine ECU Health Medical CenterGreenvilleNC 27834United States Department of Medicine Jacobi Medical Center/Albert Einstein College of MedicineBronxNY 10461United States Department of Medicine North Alabama Medical CentreFlorenceAL 35630United States Department of General Medicine Gandhi Medical CollegeSecunderabad 500003TelanganaIndia Department of Medicine Government Medical CollegePatiala 147001PunjabIndia Department of Medicine B.J.Medical CollegeAhmedabad 380016GujaratIndia Department of Medicine JSS Medical CollegeMysore 570015KarnatakaIndia Department of Internal Medicine Gandhi Medical CollegeSecunderabad 500003TelanganaIndia Department of Medicine Kasturba Medical CollegeManipal 575001KarnatakaIndia Clinical Extern Department of Internal MedicineBeaumont HospitalDearbornMI 48124United States Department of Internal Medicine Geisinger Health SystemWilkes-BarrePA 18702United States Independent Researcher AtlantaGA 30079United States

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular diseases independently of other risk factors.However,data on its effect on cardiovascular outcomes in coronavirus disease 2019(COVID-19)hospitalizations with varied obesity levels is scarce.Clinical management and patient care depend on understanding COVID-19 admission results in NAFLD patients with varying obesity levels.AIM To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of obesity.METHODS COVID-19 hospitalizations with NAFLD were identified using International Classification of Disease-10 CM codes in the 2020 National Inpatient Sample database.Overweight and Obesity Classes Ⅰ,Ⅱ,and Ⅲ(body mass index 30-40)were compared.Major adverse cardiac and cerebrovascular events(MACCE)(all-cause mortality,acute myocardial infarction,cardiac arrest,and stroke)were compared between groups.Multivariable regression analyses adjusted for sociodemographic,hospitalization features,and comorbidities.RESULTS Our analysis comprised 13260 hospitalizations,7.3% of which were overweight,24.3% Class Ⅰ,24.1% Class Ⅱ,and 44.3% Class Ⅲ.Class Ⅲ obesity includes younger patients,blacks,females,diabetics,and hypertensive patients.On multivariable logistic analysis,Class Ⅲ obese patients had higher risks of MACCE,inpatient mortality,and respiratory failure than Class Ⅰ obese patients.Class Ⅱ obesity showed increased risks of MACCE,inpatient mortality,and respiratory failure than Class I,but not significantly.All obesity classes had non-significant risks of MACCE,inpatient mortality,and respiratory failure compared to the overweight group.CONCLUSION Class Ⅲ obese NAFLD COVID-19 patients had a greater risk of adverse outcomes than class Ⅰ.Using the overweight group as the reference,unfavorable outcomes were not significantly different.Morbid obesity had a greater risk of MACCE regardless of the referent group(overweight or Class Ⅰ obese)compared to overweight NAFLD patients admitted with COVID-19.

关键词： Non-alcoholic fatty liver disease Obesity Obese Body mass index Major adverse cardiac and cerebrovascular events Mortality Acute myocardial infarction Cardiac arrest Stroke

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Mixed Saddle Point and Its Equivalence with an Efficient Solution under Generalized (V, <i>p</i>)-Invexity

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Applied Mathematics 2015年第9期6卷 1630-1637页

作者： Arvind kumar pankaj kumar garg Department of Mathematics University of Delhi Delhi India Department of Mathematics Rajdhani College University of Delhi Delhi India

The purpose of this paper is to define the concept of mixed saddle point for a vector-valued Lagrangian of the non-smooth multiobjective vector-valued constrained optimization problem and establish the equivalence of ... 详细信息

关键词： Nonsmooth Multiobjective Programs (V p)-Invexity Mixed Saddle Point Vector-Valued Mixed Lagrangian Function

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Lymphadenectomy in gastric cancer: Contentious issues

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World Journal of Gastrointestinal Surgery 2016年第4期8卷 294-300页

作者： pankaj kumar garg Ashish Jakhetiya Jyoti Sharma Mukur Dipi Ray Durgatosh Pandey Department of Surgical Oncology Dr BRA Institute Rotary Cancer Hospital All India Institute of Medical Sciences Department of Surgery University College of Medical Sciences and Guru Teg Bahadur Hospital

The stomach is the sixth most common cause of cancer worldwide. Surgery is an important component of the multi-modality treatment of the gastric cancer. The extent of lymphadenectomy has been a controversial issue in the surgical management of gastric cancer. The East-Asian surgeons believe that quality-controlled extended lymphadenectomy resulting in better locoregional control leads to survival benefit in the gastric cancer; contrary to that, many western surgeons believe that extended lymphadenectomy adds to only postoperative morbidity and mortality without significantly enhancing the overall survival. We present a comprehensive review of the lymphadenectomy in the gastric cancer based on the previously published randomized controlled trials.

关键词： Gastric neoplasms Lymphadenectomy Gastrectomy Survival Disease recurrence

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Comparison between recent sphincter-sparing procedures for complex anal fistulas-ligation of intersphincteric tract vs transanal opening of intersphincteric space

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World Journal of Gastrointestinal Surgery 2022年第5期14卷 374-382页

作者： pankaj garg Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113India Department of Colorectal Surgery Indus International HospitalMohali 140507India

Complex anal fistulas are difficult to treat.The main reasons for this are a higher recurrence rate and the risk of disrupting the continence mechanism because of sphincter involvement.Due to this,several sphincter-sparing procedures have been developed in the last two decades.Though moderately successful in simple fistulas(50%-75%healing rate),the healing rates in complex fistulas for most of these procedures has been dismal.Only two procedures,ligation of intersphincteric fistula tract and transanal opening of intersphincteric space have been shown to have good success rates in complex fistulas(60%-95%).Both of these procedures preserve continence while achieving high success rates.In this opinion review,I shall outline the history,compare the pros and cons,indications and contraindications and future application of both these procedures for the management of complex anal fistulas.

关键词： Anal fistula Fistulotomy Incontinence Ligation of intersphincteric fistula tract Transanal opening of intersphincteric space Recurrence

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Spontaneous rupture of the renal pelvis presenting as an urinoma in locally advanced rectal cancer

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World Journal of Clinical Cases 2014年第4期2卷 108-110页

作者： pankaj kumar garg Debajyoti Mohanty Vinita Rathi Bhupendra kumar Jain Department of Surgery University College of Medical Sciences and Guru Teg Bahadur Hospital Department of Surgical Oncology All India Institute of Medical Sciences Department of Radiology University College of Medical Sciences and Guru Teg Bahadur Hospital

A 29-year-old gentleman underwent a transverse colostomy for intestinal obstruction caused by advanced rectal carcinoma. On the 5th postoperative day, the patient developed a painful swelling on the right side of the abdomen. The contrast enhanced computed tomography of the abdomen revealed a right sided hydronephrosis, a large rent in the renal pelvis, and a large retroperitoneal fluid collection on the right side. Percutaneous nephrostomy and pigtail catheter drainage of the urinoma led to resolution of abdominal swelling. Development of a urinoma as a consequence of rectal carcinoma is highly unusual. Prompt imaging for confirmation of diagnosis, decompression of the renal pelvicalyceal system, and drainage of the urinoma limits morbidity.

关键词： Colorectal cancer Urinoma Spontaneous rupture of the renal pelvis Percutaneous nephrostomy Pigtail catheter drainage

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