Browsing by Author "Divya Khanna"

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A Hospital-Based Population Screening for Peripheral Arterial Diseases in a North-East University Hospital of India
(Springer, 2023) Ajay K. Khanna; Divya Khanna; Himanshu Verma; T.B. Singh; Satyendra K. Tiwary; Puneet Gupta
This study was carried out with an aim of screening the hospital-based population through ankle-brachial pressure index measurement to identify the asymptomatic patients of peripheral arterial disease. Further association of peripheral arterial disease with other risk factors was also studied. A total of 1000 patients of a surgical unit of a university hospital, Varanasi, India, were studied for a period of 2 years. Ankle-brachial pressure index in both lower limbs was measured. Patients aged less than 18 years and patients with blood pressure less than 90/60 mm Hg were excluded. History of claudication, smoking, hypertension, diabetes, coronary artery diseases, and family history of peripheral arterial disease were recorded. Patients with an ankle-brachial pressure index less than 0.9 were labeled as a case of peripheral arterial disease. Out of 1000 patients, 35 patients were symptomatic for peripheral arterial disease and all had ankle-brachial pressure index value < 0.9. Rest 965 patients were asymptomatic, out of which 155 (16.1%) had ankle-brachial pressure index less than 0.9. Elderly male smokers were the main victims. Hypertension was associated with an increased risk for peripheral arterial disease. Out of 15 patients with a history of coronary artery disease, 12 had peripheral arterial disease. The prevalence of peripheral arterial disease in an asymptomatic hospital-based population was 16.1%. Screening by measuring ankle-brachial pressure index can help in its early detection. Risk factors modification at this stage can prevent significant morbidity due to the disease. © 2021, Association of Surgeons of India.
Atypical leg ulceration
(Springer India, 2016) Ajay K. Khanna; Divya Khanna
[No abstract available]
Cancer pattern in Varanasi district from Uttar Pradesh state of India, a foundation for cancer control based on the first report of the population-based cancer registry
(Wolters Kluwer Medknow Publications, 2024) Atul M. Budukh; Satyajit Pradhan; Virendra B. Singh; Divya Khanna; Sonali S. Bagal; Priyal S. Chakravarti; Anand N. Sharma; Rajesh K. Vishwakarma; Shraddha S. Shinde; Naveen C. Khargekar; Pankaj Chaturvedi; Rajesh P. Dikshit; Vijay K. Shukla; Rajendra A. Badwe
Background: The cancer registry provides reliable data from the population. In this article, we provide cancer burden and its patterns from the Varanasi district. Methods: The method adopted by the Varanasi cancer registry is community interaction along with regular visits to more than 60 sources to collect data on cancer patients. The cancer registry was established by the Tata Memorial Centre, Mumbai, in 2017 covering 4 million population (57% rural and 43% urban population). Results: The registry has recorded 1,907 incidence cases (1,058 male and 849 female). The age-adjusted incidence rate per 100,000 population in male and female of Varanasi district is 59.2 and 52.1, respectively. One in 15 male and one in 17 female are at risk of developing the disease. Mouth and tongue cancers are the predominant cancers in male, whereas breast, cervix uteri, and gallbladder are the leading cancer sites among the female. In female, cervix uteri cancer is significantly higher (double) in rural areas when compared with urban areas (rate ratio [RR] 0.5, 95% confidence interval [CI; 0.36, 0.72]), whereas in male, mouth cancer is higher in urban areas when compared with rural areas (RR 1.4, 95% CI [1.11, 1.72]). More than 50% of cancer cases in male are due to tobacco consumption. There may be underreporting of the cases. Conclusion: The results of the registry warrant policies and activities related to early detection services for the mouth, cervix uteri, and breast cancers. The Varanasi cancer registry is the foundation for cancer control and will play an important role in the evaluation of the interventions. © 2024 Indian Journal of Cancer.
Clinical breast examination: A screening tool for lower- and middle-income countries
(John Wiley and Sons Inc, 2024) Divya Khanna; Priyanka Sharma; Atul Budukh; Ajay Kumar Khanna
Breast cancer (BC) remains a global health challenge, devastatingly impacting women's lives. Low-and-middle-income countries (LMIC), such as India, experience a concerning upward trend in BC incidence, necessitating the implementation of cost-effective screening methods. While mammography, ultrasonography, and magnetic resonance imaging are preferred screening modalities in resource-rich settings, limited resources in LMICs make clinical breast examination (CBE) the method of choice. This review explores the merits of CBE, its coverage, barriers, and facilitators in the Indian context for developing strategies in resource-constrained settings. CBE has shown significant down-staging and cost-effectiveness. Performed by trained health workers in minutes, CBE offers an opportunity for education about BC. Various individual and health system barriers, such as stigma, financial constraints, and the absence of opportunistic screening hinder CBE coverage. Promising facilitators include awareness programs, capacity building, and integrating CBE through universal health care. No healthcare provider must miss any screening opportunity through CBE. © 2024 The Author(s). Asia-Pacific Journal of Clinical Oncology published by John Wiley & Sons Australia, Ltd.
Determinants of uptake of cervical cancer screening in northern india
(Institute of Medico-Legal Publications, 2019) Divya Khanna; Sunita Vashist; Anuradha Khanna; Ajay K. Khanna
Background: The launch of operational framework for India’s first national cancer screening programme in 2016 was a landmark event in the background of poor screening coverage status. Our study aims to determine the factors deciding the uptake of cervical screening amongst women in rural India. Method: A cross-sectional, observational study was carried out amongst the women attending a secondary health centre of a district from Northern India. A total of 1250 women aged above 30 years who were never diagnosed or treated for cervical cancer were enrolled. After taking informed consent all women were interviewed about their bio-social profile and if they ever underwent screening of cervical cancer. Chi-square or Fisher’s exact test was applied to find out significant difference in distribution of bio-social variables (predictors) amongst the study population. The significant predictor variables were subjected to Binary and Multiple Logistic Regression. Unadjusted and Adjusted Prevalence Odds Ratio with 95% Confidence Interval were generated. Results: Religion, working status of the women, history of multiple sexual contacts were important factors influencing the utilization of screening. Conclusion: We conclude that cervical cancer screening is a cost-effective strategy in saving lives. We can tap its benefits only when we identify and remove the hurdles in the utilization of cervical cancer screening. © 2019, Indian Journal of Public Health Research and Development. All rights reserved.
Epidemiology of leg ulcer
(Springer India, 2016) Divya Khanna; Ajay Kumar Khanna
[No abstract available]
Epidemiology of Vascular Malformations
(Springer Singapore, 2021) Divya Khanna; Ajay K. Khanna
Vascular anomaly comprises a wide spectrum of lesions as an outcome of disorders in vascular development. They continue to be a challenge in both diagnosis and treatment and need individual and multispecialty treatment program. The key to proper treatment of these lesions relies on correct diagnosis and classifying the vascular lesion. The vascular anomaly can be described by two abnormal vascular conditions: the congenital vascular malformation (CVM) and the vascular tumor that represents neonatal or infantile hemangioma. Both conditions are different in their anatomical, histological, and pathophysiological findings and also in their clinical courses, which emphasizes the importance of a precise understanding of these two conditions. © Springer Nature Singapore Pte Ltd. 2021.
Extravasation Ulcers Following Chemotherapy
(Springer Nature, 2023) Ajay K. Khanna; Divya Khanna
Intravenous infusion is the principal modality of administration of anti-cancer drugs with numbers exceeding one million infusions each day worldwide [1]. Extravasation is one of the most dreaded complications when administering chemotherapy. It is defined either as the escape of a chemotherapeutic agent from a vessel into the surrounding tissues by leakage or as an involuntary injection of a drug into the tissues. The frequency of extravasation in adults is considered to be between 0.1% and 6% [2]. Extravasation ulcers following chemotherapy is unintended instillation or leakage of drugs into the perivascular space or into the subcutaneous tissue during injection or infusion of chemotherapy in various malignant diseases. The severity of tissue damage can be limited by quick detection of extravasations and swift treatment. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.
Implementation of Early Detection Services for Cancer in India During COVID-19 Pandemic
(SAGE Publications Ltd, 2020) Divya Khanna; Naveen Chandrahas Khargekar; Ajay Kumar Khanna
Early detection of cancer greatly increases the chances of better survival. The emergence of COVID-19 pandemic has disrupted several essential health services globally and early detection of cancer services is one of them. The routine cancer screenings have plummeted in many developed countries since the crisis. India has highest estimated lip and oral cavity cancer cases worldwide (119,992, 33.8%) and the secondhighest number of breast (162,468, 17.8%) and cervix uteri (96,922,30.7%) cancers in Asian sub-continent. Not only India has high burden of cancer, but the majority (75-80%) of patients have advanced disease at the time of diagnosis. Hence is it imperative that early detection services should be kept functional at out-patient settings so that at least the patients coming to hospitals with early signs and symptoms can be diagnosed as early as possible. Strategies need to be adopted to continue early detection services and ensure safety of patients and health care workers from COVID-19 transmission. © The Author(s) 2020.
Kaposi Sarcoma
(Springer Nature, 2023) Divya Khanna; Ajay K. Khanna
This chapter describes Kaposi sarcoma which has been a significant public health problem in sub-Saharan African nations. The epidemic variant of Kaposi sarcoma is regarded as an AIDS-defining illness. Kaposi sarcoma is causally linked to Human herpes virus-8 (HHV8) which is also called Kaposi sarcoma herpesvirus (KSHV) and presents with cutaneous and visceral manifestations. The chapter discusses the epidemiology of Kaposi sarcoma and its variants, clinical manifestations, staging, diagnosis (histology, immunohistochemistry and molecular testing), etiopathogenesis, and potential modes of transmission. In addition, it also describes the epidemiology and life cycle of HHV8/KSHV and how the virus strikes a delicate balance with the host’s immune system to create a long-lasting latent infection. Finally, the chapter describes the multi-modality management of Kaposi sarcoma for localised and disseminated disease, the prevention and early detection aspects of the disease and the quality of life of the patients with Kaposi sarcoma. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.
Prevalence and associated factors of mammography uptake among the women aged 45 years and above: policy implications from the longitudinal ageing study in India wave I survey
(BioMed Central Ltd, 2025) Priyanka Sharma; Dipak Das; Divya Khanna; Atul Madhukar Budukh; Anita K. Khokhar; Satyajit Pradhan; Ajay Kumar Khanna; Pankaj P. Chaturvedi; Rajendra Achyut Badwe
Background: Breast cancer emerged as number one cancer among women worldwide in terms of incidence and mortality. Majority of breast cancers diagnosed in India are among women aged 45 years and above. A low proportion of Indian female population in reproductive age group (30–49 years) underwent breast cancer screening. The national operational framework includes mammography as one of the investigation modalities under the algorithm for early detection and management of breast cancer. This study describes prevalence and associated factors of mammography uptake in women aged 45 years and above. Methods: We utilized data from 35,083 women aged ≥ 45 years in the Longitudinal Aging Study of India, a nationwide representative survey of the Indian population. The outcome variable was self-reported history of undergoing mammography in past two years before the survey as a representation of early detection of breast cancer. Demographic, behavioural, and clinical characteristics were taken as independent variables. Univariable and multivariable models were applied for the following age groups: 45–59 years and ≥ 60 years, and unadjusted and adjusted odds ratios were calculated. Results: The prevalence of mammography was 1.3% among Indian women aged 45 years and above, 1.7% among 45–59 years and 0.9% among women ≥ 60 years. The highest prevalence was reported in Kerala and the lowest was in Nagaland. Among women in 45–59 years age group, secondary or higher education, being currently in union, having diabetes, neurological illness, hearing problems, and reproductive health problems, better cognition level, and self-history of cancer were found to be associated with increased mammography uptake. Urban residence, being currently in union, having bone/joint disease, hearing problem, and one or multi-morbidity, better cognition level and self and family history of cancer were associated with higher mammography uptake among elderly women. Conclusions: Low rates of mammography among women across the country, along with inter-state disparities, highlight inadequate coverage of early detection of breast cancer under National program. Increasing burden of breast cancer in all states underscores need to implement early detection program proactively. Disparities in mammography uptake by age, residence and co-morbidities reflect the need for special focus and context-specific research for pragmatic interventions. © The Author(s) 2025.
Research Gap in Health Literacy: Are We Overlooking a Possible Solution to Inadequate Cancer Screening in India?
(Asian Pacific Organization for Cancer Prevention, 2023) Divya Khanna; Ajay Kumar Khanna
India has one of the highest oral cancer burdens and accounts for one out of every five cervical cancer incidences worldwide. Majority of these preventable cancers are diagnosed in advanced stages with poor prognosis and survival. World Health Organization supports health literacy as a measure for accomplishing sustainable development goals. Community trials have reported that health literacy-focused interventions improve cancer screening participation and adherence. In India health literacy research is unutilized for cancer screening. Majority of the research utilized proxy information using disease-specific knowledge, attitude, and socio-demographic characteristics for screening participation. Through this correspondence, we discuss the poor cancer screening coverage in India and the research gap in health literacy in Indian context. Without an understanding of the distribution of the components of health literacy and the development of context-specific interventions for improvement, it will be difficult for any technology or innovation to penetrate the community and increase screening coverage. © (2023), (Asian Pacific Organization for Cancer Prevention). All Rights Reserved.
Venous Thromboembolism and COVID-19—an Epidemiological Perspective
(Springer, 2023) Ajay Kumar Khanna; Divya Khanna
The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared as pandemic by World Health Organization (WHO) in March 2020. The outbreak has caused 5,232,562 deaths worldwide until December 3rd, 2021. Though primarily affecting the respiratory system, involvement of other organ systems have been reported in severe disease. Venous thromboembolism (VTE) has been recognized as an important complication. Previous studies have reported the prevalence of VTE in intensive care unit (ICU) patients between 7 and 85% and in non-ICU patients between 0 and 19%. COVID-19 patients that are at high risk for VTE are also at increased risk for bleeding. In such cases, anticoagulation may potentially be harmful. Thereby, it is important to understand the risk factors for VTE predisposition in the COVID-19 patients, timing of VTE, and the rate of occurrence of VTE in hospitalized patients post-discharge. Comparison of the rate of occurrence of VTE in COVID-19 patients with the non-COVID-19 patients with similar disease severity is required to truly interpret the reportedly high rates of VTE in COVID-19 patients. Several pathophysiological mechanisms have been reported for the development of VTE in COVID-19. Autopsy-based studies have contributed to the existing knowledge. d-dimer, presently, seems to be the most suitable investigation for risk-identification of VTE supported by Doppler studies and overall clinical context. Further, prospective studies and clinical trials are essentially required to fill the gaps in evidence for occurrence, risk prediction and management of VTE in COVID-19 patients. © 2022, Association of Surgeons of India.