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World Journal of Diabetes 2018年第5期9卷 72-79页

作者： Saurav Basu Suneela garg Nandini Sharma M Meghachandra Singh sandeep garg Department of Community Medicine Maulana Azad Medical College Department of Medicine Maulana Azad Medical College

AIM To assess the adherence to self-care practices,glycemic status and influencing factors in diabetes patients.METHODS This was a cross-sectional observational analysis of baseline data from a quasi-experimental study conducted among 375 diabetic patients aged between 18 to 65years at a major public tertiary care centre in New Delhi,India during February-September’2016.The Summary of Diabetes Self-care activities measure was used to assess medical adherence in diabetic patients.Open ended questions were used to identify facilitators and inhibitors of medical adherence.RESULTS Mean age of the study subjects was 49.7±10.2 years.A total of 201 men and 174 women were enrolled in the study.Three hundred nine(82.4%)subjects were adherent to their intake of anti-diabetic medication.On binary logistic regression,education level below primary school completion and absence of hypertensioncomorbidity were found to be independent predictors of medication non-adherence.Sociocultural resistance was an important factor impeding outdoor exercise among younger women.Knowledge of diabetes in the study subjects was low with mean score of 3.1±2(maximum score=10).Suboptimal glycemic control was found in259(69%)subjects which was significantly more likely in patients on Insulin therapy compared to those on Oral Hypoglycemic agents alone(P<0.006).DISCUSSION Our study found a large gap existed between selfreported medication adherence and glycemic control.This suggests the need for enhanced physician focus for diabetic patient management.

关键词： Diabetes Adherence Glycemic control Insulin India

Comparative prospective study between medial and lateral distal tibial locking compression plates for distal third tibial fractures

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Chinese Journal of Traumatology 2017年第3期20卷 151-154页

作者： sandeep garg Vikram Khanna Mahaveer Prashad Goyal Narendra Joshi Amrut Borade Ishan Ghuse Department of Orthopaedics Sawai Mansingh Medical College & Affiliated Hospital Jaipur India Department of Orthopaedics National Institute of Medical Sdences Jaipur India

OBJECTIVE:Tibial fracture is the most common long bone fracture. Distal third tibial fractures are challenging though open reduction and plating can result in anatomical reduction and rigid fixation. This paper aimed to evaluate and compare the results of medial and lateral locking compression plates for distal third tibial fractures.;METHODS:This prospective clinical study involved 36 patients with distal tibial fractures admitted in Department of Orthopaedics, Sawai Mansingh Medical College & Affiliated Hospital, Jaipur, India, from June 2011 to May 2012, including 29 closed fractures and 7 open fractures at the mean age of 38.9 years. Thirty-six patients were divided equally into two groups based on treatment method, including medial plating group (18 patients) and lateral plating group (18 patients). They were followed up for at least 5 months after discharge. The functional outcomes were evaluated using Tenny and Wiss clinical assessment criteria.;RESULTS:Malunion was found in 3 cases of medial plating group and in 1 case of lateral plating group. In the medial plating group, there were 5 cases of superficial infections, 1 deep infection, 1 nonunion and 3 wound dehiscence. In the lateral plating group, there was 1 case of superficial infections, 1 deep infection and 1 nonunion. In the lateral plating group, 4 patients reported feeling the plates and screws but none of them asked to remove the hardware. In the medial plating group, 9 patients reported symptomatic hardware problems and 7 asked to remove the hardware. The number of cases graded as excellent/good/fair was 1/8/7 in the medial plating group and 3/7/7 in the lateral plating group respectively. In the medial plating group, the final range of motion was 17.2° in ankle dorsiflexion and 30.7° in ankle plantar flexion. In the lateral plating group, the final range of motion was 19° in ankle dorsiflexion and 34.2° in ankle plantar flexion.;CONCLUSIONS:Lateral plating of distal tibia is safe and feasible, which can provide biological fixation and prevent

关键词：钢板胫骨远端加压锁定长骨骨折标准评价运动范围

Unusual presentation of extramedullary blast crisis in chronic myeloid leukemia:A case report

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World Journal of Hematology 2023年第4期10卷 42-47页

作者： Rashmi Mishra sandeep garg Praveen Bharti Deepak Ranjan Malla Ishan Rohatgi Sachin Gautam Department of General Medicine Maulana Azad Medical CollegeNew Delhi 110002DelhiIndia Department of Internal Medicine Maulana Azad Medical CollegeNew Delhi 110002DelhiIndia

BACKGROUND Extramedullary blast crisis in chronic myeloid leukemia(CML)is an uncommon occurrence of leukemic blast infiltration in regions other than the bone marrow.Malignant infiltration of the serosal membranes should be considered in cases where CML presents with ascites or pleural effusion.CASE SUMMARY A 23-year-old female with CML presented with progressively worsening ascites and pleural effusion despite first-line tyrosine kinase inhibitor treatment.Her blood work indicated leukocytosis with myelocyte bulge and 2%blasts.Analysis of the patient’s bone marrow confirmed the chronic phase of CML.Abdominal ultrasound revealed hepatosplenomegaly with ascites.The fluid investigation of both ascites and pleural effusion revealed a predominance of neutrophils with exudate.However,no acid-fast bacilli or growth was observed after culturing.Although hydroxyurea reduced cell counts,there was no observed effect on ascites or pleural effusion.Repeat investigation of the ascitic and pleural fluid revealed a polymorphous myeloid cell population consisting of myelocytes,metamyelocytes,band forms,neutrophils and a few myeloblasts.Extramedullary blast crisis was suspected,and mutation analysis was performed.We switched the patient to dasatinib.The patient’s symptoms were relieved,and ascites and pleural effusion diminished.CONCLUSION Serosal membrane involvement in CML is extremely rare.In this case,the patient responded well to dasatinib treatment.

关键词： Chronic myeloid leukemia Extramedullary blast crisis Serosal infiltration Ascites Pleural effusion Case report

Immunophenotypic signature of primary glioblastoma multiforme: A case of extended progression free survival

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World Journal of Clinical Cases 2017年第6期5卷 247-253页

作者： Puneet Gandhi Richa Khare Nitin garg sandeep Sorte Department of Research Bhopal Memorial Hospital and Research Centre Department of Neurosurgery Bhopal Memorial Hospital and Research Centre Bansal Hospital

Glioblastoma-multiforme(GBM), the most aggressive glial tumor, has a worldwide age-adjusted incidence ranging from 0.59-3.69/100000 persons. Despite current multimodal-treatment approach, median-survival time and progression-free survival(PFS) remains short. Glioblastomas display a variety of molecular alterations, which necessitates determining which of these have a prognostic significance. This is a case of a 45-yearold patient who presented with progressive slurring of speech and features of raised intracranial pressure. Computed tomography(CT) scan revealed a large heterogeneously enhancing lesion in the left front-temporalperisylvian region with solid, cystic areas, suggestive of malignant glioma. Partial tumor-excision was followed by concurrent chemo-radiotherapy. Histopathologically, the tumor was astrocytoma grade-IV. Patient had an extended PFS of 12 mo, with an overall survival of 26 mo. Primary-GBM was confirmed using molecular markers and the immunophenotypic signature was defined by evaluating systemic expression of human telomerase reverse transcriptase, interleukin-6, neutrophil-lymphocyte ratio, tissue inhibitor of metalloproteinases-1, human chitinase-3-like-protein-1(YKL-40) and high mobility group-A1. Current findings suggest that this signature can identify worst outcomes, independent of clinical criteria.

关键词： Glioblastoma multiforme Immunophenotypic signature Progression free survival Molecular markers Human telomerase reverse transcriptase Interleukin-6 Tissue inhibitor of metalloproteinases-1 YKL-40 High mobility group-A1

Unique case of oligoastrocytoma with recurrence and grade progression:Exhibiting differential expression of high mobility group-A1 and human telomerase reverse transcriptase

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World Journal of Clinical Cases 2016年第9期4卷 296-301页

作者： Puneet Gandhi Richa Khare Kavita Niraj Nitin garg sandeep K Sorte Hanni Gulwani Department of Research Bhopal Memorial Hospital and Research Centre Department of Neurosurgery Bhopal Memorial Hospital and Research Centre and Bansal Hospital Department of Pathology Bhopal Memorial Hospital and Research Centre

Mixed gliomas, primarily oligoastrocytomas, account for about 5%-10% of all gliomas. Distinguishing oligoastrocytoma based on histological features alone has limitations in predicting the exact biological behavior, necessitating ancillary markers for greater specificity. In this case report, human telomerase reverse transcriptase(hT ERT) and high mobility group-A1(HMGA1); markers of proliferation and stemness, have been quantitatively analyzed in formalin-fixed paraffin-embedded tissue samples of a 34 years old patient with oligoastrocytoma. Customized florescence-based immunohistochemistry protocol with enhanced sensitivity and specificity is used in the study. The patient presented with a history of generalized seizures and his magnetic resonance imaging scans revealed infiltrative ill-defined mass lesion with calcified foci within the left frontal white matter, suggestive of glioma. He was surgically treated at our center for four consecutive clinical events. Histopathologically, the tumor was identified as oligoastrocytoma-grade Ⅱ followed by two recurrence events and final progression to grade Ⅲ. Overall survival of the patient without adjuvant therapy was more than 9 years. Glial fibrillary acidic protein, p53, Ki-67, nuclear atypia index, pre-operative neutrophillymphocyte ratio, are the other parameters assessed. Findings suggest that hT ERT and HMGA1 are linked to tumor recurrence and progression. Established markers can assist in defining precise histopathological grade in conjuction with conventional markers in clinical setup.

关键词： Human telomerase reverse transcriptase High mobility group-A1 Oligoastrocytoma Recurrence Tumor grade

Novel molecular panel for evaluating systemic inflammation and survival in therapy naïve glioma patients

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World Journal of Clinical Oncology 2021年第10期12卷 947-959页

作者： Puneet Gandhi Richa Shrivastava Nitin garg sandeep K Sorte Department of Research Bhopal Memorial Hospital and Research CentreBhopal 462038Madhya PradeshIndia Department of Neurosurgery Bhopal Memorial Hospital and Research CentreBhopal 462038Madhya PradeshIndia

BACKGROUND Inflammation is crucial to tumor progression.A traumatic event at a specific site in the brain activates the signaling molecules,which triggers inflammation as the initial response within the tumor and its surroundings.The educated immune cells and secreted proteins then initiate the inflammatory cascade leading to persistent chronic inflammation.Therefore,estimation of the circulating inflammatory indicators kynurenine(KYN),interleukin-6(IL-6),tissue-inhibitor of matrix-metalloproteinase-1 and human telomerase reverse transcriptase(hTERT)along with neutrophil-lymphocyte ratio(NLR)has prognostic value.AIM To assess the utility of chosen inflammatory marker panel in estimating systemic inflammation.METHODS The chosen markers were quantitatively evaluated in 90 naive,molecularly subtyped plasma samples of glioma.A correlation between the markers and confounders was assessed to establish their prognostication power.Follow-up on the levels of the indicators was done 3-mo post-surgery.To establish the validity of circulating KYN,it was also screened qualitatively by dot-immune-assay and by immunofluorescence-immunohistochemistry in tumor tissues.RESULTS Median values of circulating KYN,IL-6,hTERT,tissue-inhibitor of matrixmetalloproteinase-1 and NLR in isocitrate-dehydrogenase-mutant/wildtype and within the astrocytic sub-groups were estimated,which differed from controls,reaching statistical significance(P90%)than standalone markers,to define survival.The inflammatory panel could discriminate between WHO grades,and isocitrate-dehydrogenase-mutant/wildtype and define differential survival between astrocytic isocitrate-dehydrogenase-mutant/wildtype.Therefore,its assessment for precise disease prognosis is indicated.Association of KYN with NLR,IL-6 and hTERT was significant.Cox-regression described KYN,IL-6,NLR,and hTERT as good pr

关键词： Circulating Glioma Inflammatory marker Kynurenine Non-invasive Prognostic

Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study

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World Journal of Gastrointestinal Endoscopy 2017年第4期9卷 162-170页

作者： Harshit garg Pratyusha Priyadarshini sandeep Aggarwal Samagra Agarwal Rachna Chaudhary Department of Surgical Disciplines All India Institute of Medical Sciences Department of Medicine All India Institute of Medical Sciences

AIM To compare the impact of laparoscopic Roux-en-Y gastric bypass(LRYGB) and laparoscopic sleeve gastrectomy(LSG) on weight loss and obesity related comorbidities over two year follow-up via case control study design.METHODS Forty patients undergoing LRYGB, who completed their two year follow-up were matched with 40 patients undergoing LSG for age, gender, body mass index and presence of type 2 diabetes mellitus(T2DM). Data of these patients was retrospectively reviewed to compare the outcome in terms of weight loss and improvement in comorbidities, i.e., T2 DM, hypertension(HTN), obstructive sleep apnea syndrome(OSAS), hypothyroidism and gastroesophageal reflux disease(GERD).RESULTS Percentage excess weight loss(EWL%) was similar in LRYGB and LSG groups at one year follow-up(70.5% vs 66.5%, P = 0.36) while it was significantly greater for LRYGB group after two years as compared to LSG group(76.5% vs 67.9%, P = 0.04). The complication rate after LRYGB and LSG was similar(10% vs 7.5%,P = 0.99). The median duration of T2 DM and mean number of oral hypoglycemic agents were higher in LRYGB group than LSG group(7 years vs 5 years and 2.2 vs 1.8 respectively, P < 0.05). Both LRYGB and LSG had significant but similar improvement in T2 DM, HTN, OSAS and hypothyroidism. However, GERD resolved in all patients undergoing LRYGB while it resolved in only 50% cases with LSG. Eight point three percent patients developed new-onset GERD after LSG.CONCLUSION LRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2 DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG.

关键词： Bariatric 外科 Laparoscopic 袖子 gastrectomy Laparoscopic Roux-en-Y 胃绕过重量损失 Comorbidities

Low dose oral curcumin is not effective in induction of remission in mild to moderate ulcerative colitis: Results from a randomized double blind placebo controlled trial

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第2期8卷 147-154页

作者： Saurabh Kedia Vikram Bhatia sandeep Thareja Sushil garg Venigalla Pratap Mouli Sawan Bopanna Veena Tiwari Govind Makharia Vineet Ahuja Department of Gastroenterology All India Institute of Medical Sciences Department of Gastroenterology Institute of Liver and Biliary Sciences Department of Gastroenterology Army Hospital - Research and Referral

AIM To evaluate the role of oral curcumin in inducing clinical remission in patients with mild to moderate ulcerative colitis(UC).METHODS A prospective randomized double-blind placebo-controlled trial comparing the remission inducing effect of oral curcumin and mesalamine 2.4 g with placebo and mesalamine 2.4 g in patients of ulcerative colitis with mild to moderate severity was conducted from January 2003 to March 2005. The included patients received 1 capsule thrice a day of placebo or curcumin(150 mg) for 8 wk. Patients were evaluated clinically and endoscopically at 0,4 and 8 wk. The primary outcome was clinical remission at 8 wk and secondary outcomes were clinical response, mucosal healing and treatment failure at 8 wk. The primary analysis was intention to treat worst case scenario(ITT-WCS).RESULTS Of 300 patients with UC, 62 patients(curcumin: 29, placebo: 33) fulfilled the inclusion criteria and were randomized at baseline. Of these, 21 patients did not complete the trial, 41 patients(curcumin: 16, placebo: 25) finally completed 8 wk. There was no significant difference in rates of clinical remission(31.3% vs 27.3%, P = 0.75), clinical response(20.7% vs 36.4%, P = 0.18), mucosal healing(34.5% vs 30.3%, P = 0.72), and treatment failure(25% vs 18.5%, P = 0.59) between curcumin and placebo at 8 wk.CONCLUSION Low dose oral curcumin at a dose of 450 mg/d was ineffective in inducing remission in mild to moderate cases of UC.

关键词： Curcumin Mesalamine Ulcerative colitis Ulcerative colitis disease activity index Mucosal healing