Browsing by Author "Nimisha Verma"

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A Randomized Controlled Trial Comparing the Effect of Two-Time Durations of Balloon Compression During Percutaneous Balloon Compression in Resistant Trigeminal Neuralgia
(American Society of Interventional Pain Physicians, 2024) M. Madivanan; Nimisha Verma; Anil K. Paswan; Shashi Prakash; Arvind Bhaleka
Background: Percutaneous balloon compression of the trigeminal nerve’s gasserian ganglion for the treatment of trigeminal neuralgia is an interventional pain procedure with results comparable to microvascular decompression surgery. The procedure is safe in experienced hands and has less morbidity associated with it. However, there is a lack of clear-cut guidelines about the details of the technique like balloon shape, inflation pressure, and duration of inflation. So, keeping the inflation pressure and shape of the balloon constant, we studied the effect of the duration of inflation of the balloon and its effect on pain relief in refractory trigeminal neuralgia cases. Objectives: To study the outcome with 2 different durations of balloon inflation times in terms of pain relief and complications after percutaneous balloon compression. Study Design: Prospective parallel design randomized, controlled trial. Setting: The study was conducted in a tertiary care hospital in North Eastern India after obtaining approval from the Institutes’ ethics committee (Dean/2018/EC/449). The study was also registered with the Clinical Trials Registry of India (CTRI no. CTRI/2019/03/018166). All patients referred to a pain clinic for unilateral facial pain were screened for the study over 2 years from April 2019 to March 2021. Methods: Forty patients who met the diagnosis of trigeminal neuralgia and who did not respond satisfactorily to medications were included in the study. They underwent routine blood investigations and a magnetic resonance image of the brain to rule out any medical or surgical conditions. Percutaneous balloon compression was conducted under C-arm guidance using a 12 gauge cannula and a 4 Fr Fogarty balloon was used for compressing the gasserian rootlets. Results: Patients who underwent 90 seconds as well as 120 seconds showed good pain relief. The 2 groups did not show any significant difference in pain relief based on the duration of compression. Visual analog scale scores were reduced from 7-8 to 0-3. Masseter muscle weakness was present in 47.5% of patients post-procedure and recovered in all except one patient. Limitations: We have followed up with our patients for a short period of 6 months only. We could not measure the intra-luminal compression pressure of the balloon. Conclusion: There is no difference in the pain relief obtained by the 2 different durations of compressions. A longer duration of compression, however, has more incidence of side effects. © 2024, American Society of Interventional Pain Physicians. All rights reserved.
Building Palliative Care Capacity - A Rapid Evaluation of Services in Eleven Hospitals in Northern India
(2025) Komal Kashyap; Anjum Khan Joad; Brajesh Kumar Ratre; Suraj Pal Singh; Varun Shekhar; Surabhi Shekhar; Anshika Arora; Sweety Gupta; Kunal Jain; Rohit Lahori; Vanita Ahuja; Sukanya Mitra; Arshi Taj; Manoj Kamal; Nimisha Verma; Lalit Kumar Raiger; Seema Partani; Naveen Patidar; Anuja Pandit; Saurabh Vig; H. K.R. Sagiraju; Raghav Gupta; Prashant Sirohiya; S. P.V. Kumar; Neetu S. Mahajan; Sushma Bhatnagar
AIMS AND OBJECTIVES: This study aimed to evaluate palliative care capacity across eleven northern Indian hospitals whose physicians and nurses had undergone training as part of the Cancer Treatment Centers (CTC) program. An online rapid evaluation using The "Standards audit tool for Indian palliative care programs" developed by the Indian Association of Palliative Care (IAPC) was done to audit specific aspects of palliative care delivery including staff training, recordkeeping, availability of morphine, and continuing professional development programs. A descriptive analysis of the data was conducted. Additional information was obtained through surveys, site visits, document reviews, and interviews with program leaders. For each site, the researchers determined to what extent the program met the set IAPC of the Standards Audit Tool. The eleven centers satisfied most of the essential criteria and some of the desirable criteria. One center did not have an in-house access to oral morphine. Some of the lacunae were inadequate provision of home care, unavailability of care after business hours, place of multidisciplinary collaboration, and involvement of community and volunteers. There was evidence of teaching, training, team health, audit, and administrative support. These hospitals were delivering good quality palliative care as per IAPC standards in parts of northern India that are underserved. There is scope for improvement in the outreach to the community, and a more multidisciplinary approach is required. © © 2025 WHO South-East Asia Journal of Public Health.
Building Palliative Care Capacity in North India: A Multicenter Approach
(Elsevier Inc., 2025) Komal Kashyap; Brajesh Kumar Ratre; Vishwajeet Singh; Suraj Pal Singh; Varun Shekhar; Surabhi Shekhar; Priya Ramakrishnan; Abhishek Kandwal; Sweety Gupta; Kunal Jain; Rohit Lahori; Vanita Ahuja; Sukanya Mitra; Arshi Taj; Manoj Kamal; Nimisha Verma; Lalit Kumar Raiger; Seema Partani; Naveen Patidar; Anuja Pandit; Saurabh Vig; H. K.R. Sagiraju; Raghav Gupta; Prashant Sirohiya; Sanjeev Kumar; Neetu S. Mahajan; Sushma Bhatnagar
Context: In low-resource settings like Northern India, palliative care providers often lack adequate training, institutional support, and interdisciplinary collaboration that are indispensable for effective implementation. Objectives: This article highlights strategies to build palliative care capacity through education, interdisciplinary collaboration, and system-level interventions in Northern India. The article describes a palliative care capacity-building project executed from 2023 through 2025. It presents scalable approaches to overcome barriers to palliative care, enhance palliative care competencies, and expand palliative care infrastructure. Material and Method: The project proceeded in three phases and began with the selection and development of nine centers of excellence (Phase I), followed by associating each center with ten district hospitals to embed palliative care within the region (Phase II). Phase III focused on palliative care training for providers in 90 district hospitals. The project assessed capacity and quality improvements at the centers and evaluated providers' palliative care knowledge post-training in the district hospitals. Results: The centers of excellence reported substantial capacity and continued improvements in palliative care delivery throughout the project. Physicians and nurses affiliated with the district hospital showed significant and lasting knowledge gains after palliative care training. Conclusion: These results demonstrate significant progress in palliative care capacity with the region, but they, also, underscore the need for ongoing efforts in training, research, and systematic record-keeping. The project’s success in its three phased approach illustrates the potential for education, collaboration, and system-level support to strengthen palliative care capacity. © 2025 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Cancer surgery during COVID increased the patient mortality and the transmission risk to healthcare workers: results from a retrospective cohort study (NCT05240378)
(BioMed Central Ltd, 2022) Kishan Soni; J.F. Neville; Roli Purwar; Tarun Kumar; Ghanshyam Yadav; Nimisha Verma; Manoj Pandey
Background: India encountered two waves of COVID-19 pandemic with variability in its characteristics and severity. Concerns were raised over the safety of treatment, and higher morbidity was predicted for oncological surgery. The present study was conducted to evaluate and compare the rate of morbidity and mortality in patients undergoing curative surgery for cancer before and during the COVID-19 pandemic. Method: The prospectively obtained clinical data of 1576 patients treated between April 2019 and May 2021 was reviewed; of these, 959 patients were operated before COVID-19 and 617 during the pandemic. The data on complications, deaths, confirmed or suspected COVID-19 cases, and COVID-19 infection among health workers (HCW) was extracted. Results: A 35% fall in number of surgeries was seen during the COVID period; significant fall was seen in genital and esophageal cancer. There was no difference in postoperative complication; however, the postoperative mortality was significantly higher. A total of 71 patients had COVID-19, of which 62 were preoperative and 9 postoperative, while 30/38 healthcare workers contracted COVID-19, of which 7 had the infection twice and 3 were infected after two doses of vaccination; there was no mortality in healthcare workers. Conclusion: The present study demonstrates higher mortality rates after surgery in cancer patients, with no significant change in morbidity rates. A substantial proportion of HCWs were also infected though there was no mortality among this group. The results suggest higher mortality in cancer patients despite following the guidelines and protocols. © 2022, The Author(s).
Comparative Evaluation Of Efficacy Of Percutaneous Intradiscal Radiofrequency Ablation And Platelet Rich Plasma Injection For Discogenic Low Back Pain: A Prospective Randomized Trial
(World Scientific, 2022) Titiksha Goyal; Anil Kumar Paswan; Dhruv Jain; Nimisha Verma; Rajeev Kumar Dubey
Background: Discogenic pain is a common, yet underdiagnosed cause of low backache, for which a wide array of radiofrequency (RF) ablative techniques and regenerative therapies have been tried with variable results. The objective of the study was to compare pain relief and improvement in function between percutaneous intradiscal RF ablation and platelet-rich plasma (PRP) injection for the treatment of discogenic low backache. Methods: This double-blind, randomized, parallel-group interventional study was carried out in patients with chronic lumbar discogenic pain. Twenty-four patients each in percutaneous intradiscal radiofrequency (PIRF) ablation (Group R) and PRP injection (Group P) groups were analyzed. Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were calculated before the procedure, and at 3 and 6 months after the procedure. Results: At 3 months, NRS score was significantly less in group R compared to group P (P=0.001). However at 6 months, there was no statistically significant difference between NRS and ODI of both groups (P=0.616 and 0.369, respectively). Both NRS and ODI decreased significantly over 6 months within each group. Conclusion: No significant difference in efficacy of PIRF ablation and intradiscal PRP injection was observed at 6 months follow-up, although there was a significant improvement in pain and disability with both the procedures. © 2022 World Scientific Publishing Company.
Diagnosis, Preoperative Evaluation, and Assessment of Resectability of Pancreatic and Periampullary Cancer
(Springer, 2015) Ashish Verma; Sunit Shukla; Nimisha Verma
Periampullary region encircles a radius of 2 cm around the ampulla of Vater; accordingly, four distinct neoplasias with overlapping imaging features originate in the region. Each of these lesions has a different long-term prognosis; hence, imaging evaluation to characterize the lesion is important. Further certain specific features pertaining to the vascular invasion and systemic spread may decide about the treatment as well as surgical approach. An understanding of the advances in imaging and image processing technology as well as in the methods of image acquisition, for the purpose, is quite relevant towards etching out a rational pre-treatment evaluation protocol. Further, an evidence-based decision as to the choice of optimum modality for answering specific clinical question is of prime importance in achieving a reasonable post-treatment outcome. Pancreatic adenocarcinoma is the fourth most common cancer and a malignancy with one of the least 5-year survival rates (ranging from 6.8 to 15 % depending on peripancreatic extensions, dropping to 1.8 % for metastatic disease). A survival rate of 15–27 % can be achieved if the lesion is resectable but unfortunately, only 10–15 % of patients are eligible for resection. Cystic tumors of pancreas are a rarer variety of pancreatic neoplasia (5–15 % of pancreatic cysts and 1 % of all pancreatic cancers) which have a much better outcome and chances of resection. Being mostly incidentalomas, a timely differentiation of this lesion from the much more common pseudocyst (which would mandate a medical management and a different surgical protocol) is the key for curability. Lastly, the neuroendocrine tumors of pancreas are equally rare (1 % of all pancreatic tumors), but importantly due to associated clinical syndromes and their capability to metastasize early in the course of disease, a timely detection may hence be the key for successful treatment of these lesions. Imaging plays a vital role in the initial detection and characterization as well as in determination of resectability of each of these pancreatic neoplasias. Further, the differentiation of pancreatic head tumors from other periampullary neoplasias is important; the fact that most recurrences are as a result of surgical intervention in an otherwise inoperable disease while most treatment failures are due to improper characterization of the lesion is notable. © 2015, Association of Surgeons of India.
Feasibility of Enhanced Recovery After Surgery Protocol in Gallbladder Cancer
(Springer, 2025) Nisha Rateria; Mallika Tewari; Vinod Kumar Dixit; Nimisha Verma; Hari Shankar Shukla
Enhanced recovery after surgery (ERAS) protocol is a multimodal, multidisciplinary, and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the compliance with ERAS protocol and its effect on postoperative outcomes in Gallbladder Cancer (GBC) patients. A total of 45 patients with suspected or proven GBC who underwent curative intent surgery (radical cholecystectomy- RC ± additional procedures) between January 2021 and January 2023 were included in the study. As per the institute ERAS protocol, nasogastric tube (NGT) was removed on postoperative day (POD) 0/1 if output was less than 100 mL and clear liquids were allowed; ambulation at least 3 times out of bed on POD1; semisolid diet by POD3; urinary catheter and epidural catheter were removed by POD3; normal diet was allowed on POD5. Early removal of abdominal drain was encouraged as per the discretion of the surgeon. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free, and full ambulatory. NGT was removed on POD 0/1 in 31(72.1%) patients, abdominal drain removed by POD3 in 8 (18.2%), and 32 (71.1%) patients were discharged by POD6. There was no 30-day postoperative mortality. Complications were seen in 12 (26.7%) patients, of whom 2 (4.4%) were major and rest minor; all were conservatively managed. Three (6.67%) patients were readmitted. A compliance score of > 66.67 was identified as a significant predictor of the absence of complications. A significant inverse association was found between diabetes mellitus (p = 0.009), additional procedures (p = 0.023), and operative time (p = 0.039) with compliance. The length of hospital stay (LOS) was significantly less in patients with good compliance (p < 0.0001). ERAS protocol can be safely followed in the perioperative care of patients with GBC. ERAS decreases LOS and postoperative complications. © The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2025.
Intradiscal platelet-rich plasma injection for discogenic low back pain and correlation with platelet concentration: A prospective clinical trial
(Oxford University Press, 2020) Dhruv Jain; Titiksha Goyal; Nimisha Verma; Anil Kumar Paswan; Rajeev Kumar Dubey
Objective. Discogenic pain is common cause of low back ache and may result in significant morbidity. Platelet-rich plasma (PRP) is an upcoming regenerative therapy that has treatment potential for this condition. The objective of this study was to correlate platelet concentration in intradiscal PRP injection with improvement in low back pain and functional status at three and six months. Design. Prospective single-arm interventional study. Setting. Outpatient pain clinic and operation theater. Subjects. Twenty-five patients with discogenic pain diagnosed by clinical means and imaging with confirmation by provocative discography were recruited. Methods. The patients received PRP injection at a single or multiple disc levels. Preprocedure numerical rating scale (NRS) pain scores and Oswestry Disability Index (ODI) scores were calculated. Platelet counts of patients and PRP samples were measured. At three and six months postprocedure, NRS and ODI scores were measured, and improvement in these scores was correlated with platelet concentrations in the PRP sample. Results. Twenty patients completed the study. The improvement in NRS and ODI scores positively correlated with platelet concentrations in the PRP sample. We determined the correlation coefficient (r) of platelet concentrations with a reduction in NRS at three months (r=0.65) and six months (r=0.73) and in ODI score at three months (r=0.72) and six months (r=0.7). Conclusions. This study supports the use of intradiscal PRP for treatment of discogenic pain with preferably higher platelet counts to elicit a favorable response. © 2020 Oxford University Press. All rights reserved.
Magnetic resonance spectroscopy - Revisiting the biochemical and molecular milieu of brain tumors
(Elsevier B.V., 2016) Ashish Verma; Ishan Kumar; Nimisha Verma; Priyanka Aggarwal; Ritu Ojha
Background: Magnetic resonance spectroscopy (MRS) is an established tool for in-vivo evaluation of the biochemical basis of human diseases. On one hand, such lucid depiction of 'live biochemistry' helps one to decipher the true nature of the pathology while on the other hand one can track the response to therapy at sub-cellular level. Brain tumors have been an area of continuous interrogation and instigation for mankind. Evaluation of these lesions by MRS plays a crucial role in the two aspects of disease management described above. Scope of review: Presented is an overview of the window provided by MRS into the biochemical aspects of brain tumors. We systematically visit each metabolite deciphered by MRS and discuss the role of deconvoluting the biochemical aspects of pathologies (here in context of brain tumors) in the disease management cycle. We further try to unify a radiologist's perspective of disease with that of a biochemist to prove the point that preclinical work is the mother of the treatment we provide at bedside as clinicians. Furthermore, an integrated approach by various scientific experts help resolve a query encountered in everyday practice. Major conclusions: MR spectroscopy is an integral tool for evaluation and systematic follow-up of brain tumors. A deeper understanding of this technology by a biochemist would help in a swift and more logical development of the technique while a close collaboration with radiologist would enable definitive application of the same. General significance: The review aims at inciting closer ties between the two specialists enabling a deeper understanding of this valuable technology. © 2016 The Authors.
Sequential supraclavicular brachial plexus and stellate ganglion neurolysis for upper limb pain in metastatic breast cancer
(Wolters Kluwer Medknow Publications, 2021) Dhruv Jain; Titiksha Goyal; Anil Paswan; Nimisha Verma
Neuropathic pain in cancer can result in severe debilitation to a patient with limited treatment options. Interventional modalities like nerve destruction can provide relief but at the expense of motor paralysis. Sympathetic pain is often an undiagnosed and undertreated condition that may accompany cases of chronic pain. We describe a case of severe neuropathic pain in brachial plexopathy in a middle-aged woman caused by metastatic breast cancer that was managed by chemical neurolysis of brachial plexus. Residual pain was treated by neurolysis of stellate ganglion due to the presence of sympathetic pain. This case report highlights the importance of the dual nature of pain and its management by chemical neurolysis in severe refractory neuropathic and sympathetic mediated pain. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
Triple A to triple S: From diagnosis, to anesthetic management of Allgrove syndrome
(Elsevier Inc., 2016) Mridul Dhar; Nimisha Verma; Ram Badan Singh; Vishal Krishna Pai
Introduction Allgrove syndrome (AS) is a rare autosomal recessive disorder characterized by achalasia cardia, alacrimia, and adrenocorticotropic hormone-resistant adrenal insufficiency which is sometimes associated with autonomic dysfunction. It has also been referred to as the triple A syndrome in view of the cardinal symptoms described above. First described by Allgrove et al in 1978, the disorder usually presents mostly during the first decade of life. These patients have the threat of adrenal crisis, shock, and hypoglycemia and are usually on steroid supplementation. Case report The anesthesiologist's encounter with such patients, although rare, is mostly for repair of the achalasia cardia. We thus report a similar case of AS in a 2-year-old girl who was scheduled to undergo Heller myotomy along with the preoperative evaluation and intraoperative management of the same. Conclusion Being aware of the pathophysiology of AS gives useful insight about the disease and successful perioperative management in the form of the triple S strategy, that is, stress dose of steroids, slow induction and positioning, and finally maintenance of stable hemodynamics and euglycemia. © 2016 Elsevier Inc. All rights reserved.
Unlocking the potential of TRPV1 based siRNA therapeutics for the treatment of chemotherapy-induced neuropathic pain
(Elsevier Inc., 2022) Akhilesh; Ankit Uniyal; Anagha Gadepalli; Vineeta Tiwari; Meghana Allani; Deepak Chouhan; Obulapathi Ummadisetty; Nimisha Verma; Vinod Tiwari
Chemotherapy-induced neuropathic pain (CINP) is among the most common clinical complications associated with the use of anti-cancer drugs. CINP occurs in nearly 68.1% of the cancer patients receiving chemotherapeutic drugs. Most of the clinically available analgesics are ineffective in the case of CINP patients as the pathological mechanisms involved with different chemotherapeutic drugs are distinct from each other. CINP triggers the somatosensory nervous system, increases the neuronal firing and activation of nociceptive mediators including transient receptor protein vanilloid 1 (TRPV1). TRPV1 is widely present in the peripheral nociceptive nerve cells and it has been reported that the higher expression of TRPV1 in DRGs serves a critical role in the potentiation of CINP. The therapeutic glory of TRPV1 is well recognized in clinics which gives a promising insight into the treatment of pain. But the adverse effects associated with some of the antagonists directed the scientists towards RNA interference (RNAi), a tool to silence gene expression. Thus, ongoing research is focused on developing small interfering RNA (siRNA)-based therapeutics targeting TRPV1. In this review, we have discussed the involvement of TRPV1 in the nociceptive signaling associated with CINP and targeting this nociceptor, using siRNA will potentially arm us with effective therapeutic interventions for the clinical management of CINP. © 2021 Elsevier Inc.