Browsing by Author "Puneet"

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Abdominal compartment syndrome--an old syndrome, a new perspective.
(2007) Puneet; V. Chauhan; S. Singh; S.K. Gupta; V.K. Shukla
The abdominal compartment syndrome is a life threatening condition resulting from pathologic elevation of the intraabdominal pressure. Prompt diagnosis is required to avoid significant sequelae. Diagnosis of this syndrome is based on clinical findings and intra abdominal pressure monitoring. Treatment consists of decompressive laparotomy, which corrects the pathology. Various surgical techniques are described to manage the open abdomen. Despite considerable attention accorded to this disorder, it is still associated with high morbidity and mortality. This review article deals with the identification of risk factors, pathophysiology, diagnostic criteria and treatment of critically ill patients with the abdominal compartment syndrome.
Activated Protein C Resistance in Deep Venous Thrombosis
(2009) Nikhil Agrawal; Sanjeev Kumar; Puneet; R. Khanna; Jyoti Shukla; A.K. Khanna
Several risk factors for deep venous thrombosis (DVT) have been identified, and inherited thrombophilias constitute a significant proportion of them. The most common inherited thrombophilia is activated protein C (APC) resistance, and factor V Leiden is the most common cause of APC resistance. The high prevalence of APC resistance in Caucasians is established, and the prevalence among persons of Asian and African descent has been shown to be low in previous studies. Twenty-three patients with lower limb DVT were included in the study. Diagnosis was confirmed by duplex ultrasonography. Patients were tested for APC resistance with use of the STA Staclot APC-R system (Diagnostica Stago, Asnieres, France), as per the manufacturer's guidelines. Ten patients (43.5%) tested positive for APC resistance, while 13 (56.5%) tested negative. APC resistance, although considered a rarity, has been found to have a high prevalence in patients with DVT from the northeastern region of India. APC resistance estimation should be done for all patients with DVT. © 2009 Annals of Vascular Surgery Inc.
Analysis of Endoplasmic Reticulum Stress-Associated Proteins As Prognostic Markers In Breast Cancer
(Bentham Science Publishers, 2025) Smriti Shreya; Shweta Pandey; Debasish Kumar Ghosh; Puneet; Shyam Babu Prasad; Christophe François Grosset; Buddhi Prakash Jain
Introduction: Breast cancer is a complex, heterogeneous disease that poses a significant global health risk. Both internal and external cellular stresses contribute to breast cancer progression. Endoplasmic reticulum (ER) stress is one such cellular stress response that activates intricate intracellular signaling pathways collectively known as the unfolded protein response (UPR). Maintaining protein homeostasis and regulating these pathways is essential in breast cancer progression. Methods: Using STRING and Harmonizome Reactome pathway datasets, we identified a list of UPR-associated genes. The Human Protein Atlas and UALCAN databases were used to analyze these genes as potential prognostic markers in breast cancer. Results: Three prognostic markers were identified in patients with breast cancer: FK506 binding protein 14 (FKBP14), S-phase kinase-associated protein 1 (SKP1), and Baculoviral IAP repeat containing 3 (BIRC3). Discussion: Expression levels of FKBP14, SKP1, and BIRC3 were compared to TCGA normal and GTEx data using the GEPIA2 database. Our analysis indicates that higher SKP1 expression is associated with poor overall survival and prognosis, whereas higher BIRC3 expression correlates with better prognosis and overall survival. BIRC3 protein levels are elevated in tumor tissue and increase as the tumor progresses through various stages. Additionally, the expression of these markers varies according to sex, age, ethnicity, breast cancer subtype, nodal metastasis, and menopause status. Conclusion: Overall, our study identifies that the genes involved in ER stress that are associated with breast cancer can serve as prognostic markers. 2025, Bentham Science Publishers
Association of altered metabolic profiles and long non-coding RNAs expression with disease severity in breast cancer patients: analysis by 1H NMR spectroscopy and RT-q-PCR
(Springer, 2023) Anusmita Shekher; Puneet; Nikee Awasthee; Umesh Kumar; Ritu Raj; Dinesh Kumar; Subash Chandra Gupta
Introduction: Globally, one of the major causes of cancer related deaths in women is breast cancer. Although metabolic pattern is altered in cancer patients, robust metabolic biomarkers with a potential to improve the screening and disease monitoring are lacking. A complete metabolome profiling of breast cancer patients may lead to the identification of diagnostic/prognostic markers and potential targets. Objectives: The aim of this study was to analyze the metabolic profile in the serum from 43 breast cancer patients and 13 healthy individuals. Materials & methods: We used 1H NMR spectroscopy for the identification and quantification of metabolites. q-RT-PCR was used to examine the relative expression of lncRNAs. Results: Metabolites such as amino acids, lipids, membrane metabolites, lipoproteins, and energy metabolites were observed in the serum from both patients and healthy individuals. Using unsupervised PCA, supervised PLS-DA, supervised OPLS-DA, and random forest classification, we observed that more than 25 metabolites were altered in the breast cancer patients. Metabolites with AUC value > 0.9 were selected for further analysis that revealed significant elevation of lactate, LPR and glycerol, while the level of glucose, succinate, and isobutyrate was reduced in breast cancer patients in comparison to healthy control. The level of these metabolites (except LPR) was altered in advanced-stage breast cancer patients in comparison to early-stage breast cancer patients. The altered metabolites were also associated with over 25 signaling pathways related to metabolism. Further, lncRNAs such as H19, MEG3 and GAS5 were dysregulated in the breast tumor tissue in comparison to normal adjacent tissue. Conclusion: The study provides insights into metabolic alteration in breast cancer patients. It also provides an avenue to examine the association of lncRNAs with metabolic patterns in patients. © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Biliary nitrate and risk of carcinoma of the gallbladder
(2004) V.K. Shukla; A. Prakash; V.S. Chauhan; S. Singh; Puneet
[No abstract available]
Cannabis and its constituents for cancer: History, biogenesis, chemistry and pharmacological activities
(Academic Press, 2021) Samridhi Lal; Anusmita Shekher; Puneet; Acharan S. Narula; Heidi Abrahamse; Subash C. Gupta
Cannabis has long been used for healing and recreation in several regions of the world. Over 400 bioactive constituents, including more than 100 phytocannabinoids, have been isolated from this plant. The non-psychoactive cannabidiol (CBD) and the psychoactive Δ9-tetrahydrocannabinol (Δ9-THC) are the major and widely studied constituents from this plant. Cannabinoids exert their effects through the endocannabinoid system (ECS) that comprises cannabinoid receptors (CB1, CB2), endogenous ligands, and metabolizing enzymes. Several preclinical studies have demonstrated the potential of cannabinoids against leukemia, lymphoma, glioblastoma, and cancers of the breast, colorectum, pancreas, cervix and prostate. Cannabis and its constituents can modulate multiple cancer related pathways such as PKB, AMPK, CAMKK-β, mTOR, PDHK, HIF-1α, and PPAR-γ. Cannabinoids can block cell growth, progression of cell cycle and induce apoptosis selectively in tumour cells. Cannabinoids can also enhance the efficacy of cancer therapeutics. These compounds have been used for the management of anorexia, queasiness, and pain in cancer patients. Cannabinoid based products such as dronabinol, nabilone, nabiximols, and epidyolex are now approved for medical use in cancer patients. Cannabinoids are reported to produce a favourable safety profile. However, psychoactive properties and poor bioavailability limit the use of some cannabinoids. The Academic Institutions across the globe are offering training courses on cannabis. How cannabis and its constituents exert anticancer activities is discussed in this article. We also discuss areas that require attention and more extensive research. © 2020 Elsevier Ltd
Co-existent Median Arcuate Ligament Syndrome and Superior Mesenteric Artery Syndrome
(Springer, 2024) Panchanana Panigrahy; Soumya Khanna; Puneet; Ajay K. Khanna
Median arcuate ligament syndrome (MALS) and superior mesenteric artery syndrome (SMAS) are well known abdominal vascular compression syndrome, but coexistence of these is rarely described in literature. We report a patient presenting with chronic abdominal pain, occasional emesis and weight loss and was diagnosed as having coexistent MALS and SMAS. The patient underwent release of celiac artery compression with posterior gastrojejunostomy with good outcome. Coexistent MALS and SMAS is a rare entity. © Association of Surgeons of India 2024.
Cyclin D1 and cyclin E2 are differentially expressed in gastric cancer
(Humana Press Inc., 2016) Soni Kumari; Puneet; Shyam Babu Prasad; Suresh Singh Yadav; Mohan Kumar; A. Khanna; V.K. Dixit; Gopal Nath; Sunita Singh; Gopeshwar Narayan
Cell cycle regulators cyclin D1 and cyclin E2 function in G1/S transition by activating downstream cyclin-dependent kinases. Deregulated expression of these cyclins has been reported in various cancers. However, little is known about their clinical significance in gastric carcinoma. We aimed to explore that whether there is differential expression of these cyclins in clinically distinct gastric cancer patients. In this study we recruited a total of 92 subjects including 20 controls and 72 cases of histopathologically proven gastric carcinoma. Expression profiling at transcript level was done by semiquantitative RT-PCR and of protein by immunohistochemistry. Receiver operator characteristics analysis was done for determining diagnostic utility of cyclin D1 and cyclin E2. We demonstrate that cyclins D1 and E2 are frequently overexpressed in early stages of gastric carcinoma. Interestingly, expression of cyclins D1 and E2 significantly correlates with different clinical parameters such as gender, histological type (intestinal and diffuse), tumor location (proximal, middle, and distal), tumor differentiation (differentiated and undifferentiated), tumor invasion (serosal, lymphatic, and venous) and tumor metastasis (lymph node, peritoneal, ascites, and liver). Cyclin D1 has significantly higher sensitivity and specificity as diagnostic biomarker than cyclin E2. Our results suggest that overexpression of cyclin D1 and cyclin E2 is an early event in gastric carcinogenesis. The differential expression of these cyclins may be useful as diagnostic biomarkers for early detection of gastric carcinoma. © 2016, Springer Science+Business Media New York.
Epigenetic Mechanisms and Events in Gastric Cancer-Emerging Novel Biomarkers
(Springer Netherlands, 2018) Puneet; Hasan Raza Kazmi; Soni Kumari; Satendra Tiwari; A. Khanna; Gopeshwar Narayan
Gastric cancer is one of the most common malignancy worldwide. The various genetic and epigenetic events have been found to be associated with its carcinogenesis. The epigenetic is a heritable and transient/reversible change in the gene expression that is not accompanied by modification in the DNA sequence. This event is characterized by the alteration in the promoter CpG island of the gene or histone modification. These events are associated with silencing of critical tumor suppressor gene and activation of oncogenes leading to carcinogenesis. The DNA methylation is a chemical change in the DNA sequence that most commonly occurs at cytosine moiety of CpG dinucleotide and histone, primarily on N- terminal tail that ultimately effect the interaction of DNA with chromatin modifying protein. Hypermethylation of tumor suppressor genes and global hypomethylation of oncogenes are widely studied epigenetic modifications. There are large number of publish reports regarding epigenetic events involving gastric cancer. These changes are potentially useful in identifying markers for early diagnosis and management of this lethal malignancy. Also, role of specific miRNAs and long non coding RNAs in regulation of gene expression is gaining interest and is a matter of further investigation. In this review, we aimed to summarize major epigenetic events (DNA methylation) in gastric cancer along with alteration in miRNAs and long non coding RNAs which plays an important role in pathology of this poorly understood malignancy. © 2018, Arányi Lajos Foundation.
Genes involved in phosphatidylcholine biosynthesis correlate with nuclear factor-κB in biliary tract cancer patients: Evidence from 1H NMR and computational analyses
(Elsevier B.V., 2021) Anusmita Shekher; Amit Kumar Tiwari; Nikee Awasthee; Sumit Singh Verma; Vinod Kumar Dixit; Neeraj Sinha; Subash Chandra Gupta; Puneet
Gallbladder cancer (GBC) is an aggressive malignancy of gastrointestinal tract. Due to uncontrolled growth, GBC cells rapidly synthesize biomolecules including lipids. The lipids are integral component of cell membrane with a wide range of cellular functions. In this study, we measured the clinicopathological features in 40 cases of histologically confirmed GBC and 16 cases of chronic cholecystitis (CC). The female to male ratio in the GBC and CC groups were 3.44:1 and 2.2:1, respectively. The GBC patients exhibited well to poorly differentiated tumor. In the CC group, all patients showed cholecystitis with no evidence of dysplasia or malignancy. The majority of GBC and CC patients reported pain. Using 1H NMR spectroscopy, we observed 4-folds increase in the level of choline containing phospholipids (CCPLs) in the gallbladder of GBC patients as compared to CC patients. Other lipid metabolites such as cholesterol ester, C18-cholesterol and saturated fatty acids were insignificantly changed between GBC and CC patients. Moreover, the level of CCPLs in the GBC patients with BMI <25 kg/m2 was significantly higher as compared to CC patients. Further, a significant increase in the CCPLs level was observed in GBC female patients in comparison to CC patients. From the computational analyses, we observed that the genes involved in the biosynthesis of phosphatidylcholine (PtdCho) indirectly interact with the RELA, which encodes the NF-κB p65 subunit. The genes involved in the PtdCho biosynthesis were also correlated with the overall and disease-free survival of cholangiocarcinoma patients. The study opens new window for exploring the diagnostic and therapeutic potential of CCPLs in GBC patients. © 2021 Elsevier B.V.
Giant Adrenal Myelolipoma: Review of Indian Literature and a Case Report
(Springer, 2024) Nyima Bole; Soumya Khanna; Rohit Kumar Singh; Satyendra Tiwary; Puneet; Ajay K Khanna
Adrenal myelolipoma is a rare benign tumor which consists of mature adipose tissues and hematopoietic tissues in variable proportion. These tumors are mostly detected incidentally on imaging done for other reasons but due to advancement in non-invasive imaging modalities they are found more frequently now. The incidence of adrenal myelolipoma is found to be 0.08 to 0.4%, whereas they constitute 15% of all adrenal incidentalomas. Usually, these tumors are small, unilateral, and hormonally inactive, arising from adrenal gland, but there are articles that have reported about giant, bilateral, extra-adrenal, or hormonally active myelolipomas. Here, we present a unique case of right adrenal myelolipoma with an unusual presentation as the patient was in the 2nd decade of life (24 years old) and the tumor weighed 5 kg which was successfully managed by right adrenalectomy. Further, we have reviewed the articles published in Indian literature. © Association of Surgeons of India 2023.
Gossypiboma: Intramural and transmural migration causing small bowel obstruction
(2008) Santosh Kumar Mahalik; Puneet; Sanjeev Kumar Gupta; Ajay Kumar Khanna
[No abstract available]
Incisional hernia - Comparison of mesh repair with Cardiff repair: An university hospital experience
(2005) V.K. Shukla; R. Mongha; N. Gupta; V.S. Chauhan; Puneet
Background: Incisional hernia is a frequent complication of abdominal surgery. Various types of repair are recommended for incisional hernia. Suture and mesh repair are compared in the present study. Method: One hundred seventy one patients with incisional hernia underwent Cardiff repair (far and near sutures with reinforcement sutures) which was used as an open suture repair while onlay polypropylene mesh was used in the mesh repair technique. Result: Cardiff repair was performed in 116 patients with no mortality with recurrence in two patients with mean follow up of 7.1 years. Both these patients with recurrence had a defect measuring more than 10 cm in width. Mesh repair was carried out in 55 patients with no recurrence in mean follow up of 37 months. Seroma formation was noted in 7 (12.72%) with mesh repair as compared to 4 (3.44%) patients with Cardiff repair. Conclusion: We recommend Cardiff repair for primary and small to medium size incisional hernias. Onlay polypropylene mesh is ideal for tension-free hernia repair, recurrent incisional hernia and hernia defects wider than 10 cm. © Springer-Verlag 2005.
Infective subcutaneous emphysema after laparoscopic rectopexy: A rare complication
(2008) Puneet; Santosh K. Mahalik; Sanjeev K. Gupta
Subcutaneous emphysema after laparoscopic surgery is not uncommon but infection of the subcutaneous space because of gas forming organisms causing emphysema after a laparoscopic procedure is an extremely rare entity. We report a case of infective subcutaneous emphysema after laparoscopic rectopexy. © 2008 by Lippincott Williams & Wilkins.
Intra-operative Tube Stenting, Palliation for Jaundice in Carcinoma Gall Bladder
(Evangel Publishing, 2001) Puneet; R. Khanna; A.K. Khanna
Majority of patients with advanced carcinoma gall bladder have irresectable disease and require palliation for jaundice, pruritus and cholangitis. These cases presenting with jaundice are usually high risk cases to undergo arty major surgical procedure like segment-III hepaticodochojejunostomy. So intra-operative tube stenting was attempted in 6 patients of carcinoma gall bladder but technically, it was possible in 4 cases only. In 2 cases because of massive locoregional disease it was not possible to cannulate the proximal part of the bile duct. The distal end of the tube was passed either in the duodenum or proximal part of the jejunum. Patients were followed up, showed good recovery from jaundice and pruritus.
Intravaginal foreign body - A rare cause of large bowel obstruction
(Evangel Publishing, 2002) Puneet; A. Khanna; A.K. Khanna
Intravaginal foreign body rarely causes bowel obstruction. A 60-year-old female presented with pain in lower abdomen. On examination, her abdomen was found distended with muscle guard. Per rectal examination revealed a hard mass 3-4 cm away from the anal verge. There was leucocytosis and straight x-ray showed features of large bowel obstruction. Exploratory laparatomy was perfomed. The large bowel was distended with a hard mass felt in the pelvis. On manipulation the mass of about 15cm x 12cm x 12 cm size came out of the vagina and it happended to be a brick. The recovery was uneventful.
Management of polypoidal lesions of gallbladder in laparoscopic era.
(2005) Puneet; Ritu Ragini; S.K. Gupta; Sanjay Singh; V.K. Shukla
The detection of polypoidal lesion of gallbladder (PLG) has increased particularly with widespread use of ultrasonography (US) as a diagnostic modality. Most of the PLG are diagnosed incidentally during scanning. Differentiation of benign from malignant PLG is a major concern and further management is based on this differentiation. DATA SOURCE: A Pubmed database search was performed. Abstract and articles were reviewed in detail. Other references were extracted by cross-reference. CONCLUSION: The risk factors for malignancy in PLG are identified. The newer investigative procedures may differentiate benign from malignant PLG. Follow up of the asymptomatic patient and indication for surgery is established in PLG.
Pancreas: Embryology, anatomy and endocrine physiology
(CRC Press, 2021) Rahul; Puneet; Sanjeev Kumar
[No abstract available]
Possible strategies of bacterial involvement in cancer development
(Springer Netherlands, 2014) Puneet; Gopal Nath; V.K. Shukla
Infections have been implicated in around 18% of all malignancy in humans. The common infections include viruses, bacteria and Schistosomes. The role of bacteria in carcinogenesis is now quite evident particularly in H. pylori induced gastric cancer and mucosa associated lymphnoid tissue (MALT) lymphoma and Salmonella typhi causing carcinoma gallbladder. The chronic inflammation is the important mechanism involved in the majority of bacteria induced malignancies. The chronic inflammation is mediated by various pro and anti - inflammatory cytokines including IL-1, IL-6, IL-17, TNF-α and IL-10. The key factor in the inflammatory process is the activation of NF-kB. Various toxins are produced by different bacteria which cause direct damage to the host cells by DNA damage or affecting DNA repair mechanism resulting in alteration in the enzyme transcription or translation. It has also been postulated that bacterial infection activate inflammatory/immune cells to generate reactive oxygen species (ROS) and reactive nitrogen species (RNS) which causes DNA damage leading to cancer. The free radicals generated also acts at different levels which affects the cellular homeostasis. The epigenetic alteration in form of DNA methylation and histone modification has also been reported in bacteria induced carcinogenesis. The other alternative molecules has been evolved by the bacteria that involved in adhesions of bacteria to cell surfaces, modulation of cytoskeleton or junctional activities and affecting specific signaling pathways. The studies have shown that bacterial infection also causes immune modulation and result in persistence of the infection. It is also seen that not only the bacterial pathogen but the host genetic factors also determine the susceptibility and persistence-of infection. The certain genotypes of inflammatory mediators are associated with increased risk of cancer. Thus, the bacteria induced carcinogenesis is a multifaceted, complex process. © 2012 Springer Science+Business Media B.V. All rights reserved.
Prothrombin Fragment 1 + 2 in Urine and Plasma and D-dimer in Patients with Clinically Suspected Venous Thromboembolism
(Springer, 2023) Ajay K. Khanna; Pramesh Chander; Soumya Khanna; Sandeep Kumar; S.K. Tiwary; Puneet; Sujit Yadav
In recent years, several biomarkers have been found to be associated with deep vein thrombosis (DVT). D-dimer is a degradation product of a cross-linked fibrin blood clot and has a negative value in the diagnosis of DVT. Prothrombin fragment 1 + 2 (p F1 + 2) is a non-thrombotic polypeptide that is cleaved from Prothrombin during its conversion to thrombin. The study aims to evaluate the D-dimer and to evaluate Prothrombin fragment 1 + 2 in urine and plasma in clinically suspected DVT patients. This study comprised of 30 patients who are clinically suspected cases of deep vein thrombosis, carried out from July 2018 to May 2020 in the Department of General Surgery, IMS BHU, Varanasi. In our study, D-dimer and plasma F1 + 2 both showed comparable results in patients of venous thromboembolism (VTE). Proximal DVT tended to have higher levels of D-dimer and had significantly higher levels of F1 + 2 than patients with distal DVT. In our study, a positive correlation was found between D-dimer and plasma F1 + 2 (r = 0.588 and p-value 0.006) in DVT-positive patients. There is no correlation between plasma D-dimer and urine F1 + 2 (r = − 0.0.07 and p-value 0.769) In conclusion, Prothrombin F1 + 2 is an important marker raised in patients with DVT. © 2022, Association of Surgeons of India.