Browsing by Author "Ram Niwas Meena"

Now showing 1 - 12 of 12

Audit of Neurological Complications After Thyroid Surgery
(Springer, 2021) Rahul Khanna; Ram Niwas Meena; Rajesh Kumar; Siddharth Khanna
The incidence of permanent neurological complications after thyroid surgery is less than 2% and rarely life threatening. Most of the reported neurological complications are related to changes in voice or breathing difficulty. Symptoms of a foreign body sensation in the throat are an unpleasant and persistent complication, which has rarely been reported after thyroid surgery. Analysis of records of 170 patients undergoing various types of thyroid operations over a 6-year period was done. Postoperative complications with emphasis on the neurological complications were documented. The common post-thyroidectomy neurological complications noted were hoarseness of voice (6 patients), loss of voice pitch (7), breathy voice (8), respiratory stridor (2), and dysphagia to liquids (8). Most of these were transient and recovered spontaneously within weeks. Furthermore, we report a foreign body/sticky sensation in the throat as an atypical neurological complication. It was found to occur in 5 patients and significantly persisted in 3 patients at a 6-month follow-up after surgery. The postoperative symptoms commonly noticed after thyroid surgery were related to the motor innervation component of the external branch of the superior laryngeal or the recurrent laryngeal nerve. These symptoms underwent spontaneous resolution over a few weeks period after surgery in most of the patients. Additionally, we documented a foreign body sensation in the throat in 5 patients which is possibly a sequela of sensory denervation of the supra-glottic mucosa in the region supplied by the internal branch of the superior laryngeal nerve. Unlike motor symptoms, this foreign body sensation persisted in 3 out of 5 patients (60%) at 6 months of follow-up. © 2021, Association of Surgeons of India.
Case Report of a Pleomorphic Adenoma of Ear Lobule
(Wolters Kluwer Medknow Publications, 2024) Ram Niwas Meena; Roshit Jain; Rahul Khanna; Vipul Kumar Srivastava
Pleomorphic adenoma (PA) is the most common benign tumor which affects both major and minor salivary glands. The parotid gland is affected most of the time. Among the minor salivary glands, the palate is the most affected site, followed by lips, cheeks, gingiva, floor of the mouth, and tongue. PA of the auricle is very rare and even if they do so, they mostly arise from the external auditory canal. In this report, we present a case of PA of the ear lobule. © 2024 Indian Journal of Otology.
Chronic Lower Limb Edema
(Springer Nature, 2022) Ram Niwas Meena; Vipul Srivastava; Akanksha; B.R. Akshay
Chronic edema is a word that refers to edema that has been present for longer than 3 months duration. It is a catch-all word that encompasses not only traditional “lymphedema” but also chronic swelling with a more complicated origin. With persistent consequences of edema such as cellulitis and the impact on quality of life, it imposes a large burden of hidden illness and unacknowledged morbidity. The goal of chronic edema treatment is to minimize swelling and prevent its recurrence. Chronic edema management is dependent on three things. First is the early detection and treatment which are critical for avoiding problems. Second is a multidisciplinary approach to all of the physical, psychological, and social consequences that come with it. Third, collaboration among healthcare experts which is critical so that the best therapy is administered in the best healthcare setting, thereby enhancing patient quality of life and allowing them to participate actively in their own care. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.
Correlating Receptor Status with Nottingham Prognostic Index in Breast Cancer
(Springer, 2024) Rohan Gupta; Rahul Khanna; Amrita G. Kar; Seema Khanna; Siddharth Khanna; Ram Niwas Meena
The biological behavior and prognosis of breast cancer is often unpredictable with a number of factors contributing to the outcome. Nottingham’s Prognostic Factor (NPI) takes into account the tumor size, nodal status, and histological grade of tumor. The receptor status considers the hormone receptor and HER2 status. The aim of the study was to correlate the NPI score with the receptor status expression in Indian women with breast cancer. A total of 78 breast cancer patients who underwent upfront modified radical mastectomy were recruited. NPI score and receptor status assessment was done at histopathological examination of the specimen. Hormone receptor negative breast cancer tended to have a higher NPI score compared to hormone receptor positive patients. However, this difference did not achieve statistical significance. NPI score parameters except for the histological grade are a reflection of the duration or time span of the tumor. On the contrary, the receptor status is indicative of the tumor biology and not of its time duration. A scoring system which incorporates the three parameters of the NPI as well as the receptor status would be the best prognostic index as well as predictive regarding the choice of adjuvant therapy. © Association of Surgeons of India 2023.
Evaluation of axillary lymph nodes in breast cancer patients with clinically negative axilla using contrast enhanced ultrasonography
(BioMed Central Ltd, 2024) Roshit Jain; Rahul Khanna; Ashish Verma; Shashi Prakash Mishra; Ram Niwas Meena; Seema Khanna; Siddharth Khanna
Contrast enhanced ultrasonography enables dynamic evaluation of the microvasculature down to the capillaries when using high resolution ultrasound probes. It’s application in the evaluation of axillary lymph nodes in breast cancer patients with clinically negative axilla has been studied in 42 patients. The results of pre operative CEUS evaluation was correlated with histopathology status of axillary nodes after the harvesting of nodes during modified radical mastectomy or sentinel node biopsy. Heterogeneous enhancement with micro bubbles of the axillary nodes was found to be the most distinguishing criteria for malignant nodes. © The Author(s) 2024.
Evaluation of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 Status Before and After Neoadjuvant Chemotherapy in Breast Cancer Patients
(Springer, 2021) Adarsh Verma; Amrita Ghosh Kar; Ram Niwas Meena; S.C.U. Patne; Shashi Prakash Mishra; Seema Khanna; Rahul Khanna
Evaluation of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2/neu) receptor was carried out on 80 breast cancer patients before and after neoadjuvant chemotherapy (NAC). No differences in expression were noted in 89% with reference to ER, 95% with reference to PR, and 91% with reference to HER2/neu status. A change in receptor status from positive to negative was noted in 12% for ER, 5% for PR, and 21% for HER2/neu after NAC. A negative to positive shift was noted in 11% for ER, 4% for PR, and 4% for HER2/neu after NAC. The possible reasons ascribed for change in receptor status after NAC are as follows: (1) Selection of chemoresistant clones with different receptor expression after NAC. (2) Tumor heterogeneity with variable receptor expression in different areas. (3) Ovarian suppression during NAC leading to alteration in receptor expression. (4) Technical considerations such as staining techniques and intra-observer and inter-observer differences in IHC slide interpretation before and after NAC. © 2020, Association of Surgeons of India.
Expression of poly(Adenosine Diphosphate-Ribose) polymerase protein in breast cancer
(Wolters Kluwer Medknow Publications, 2022) Akanksha; Shashi Prakash Mishra; Amrita Ghosh Kar; J.S. Karthik; Aviral Srivastava; Rahul Khanna; Ram Niwas Meena
Background: The use of poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors for breast cancer (BC) therapy is the subject of debate, and there is an urgent need to understand much the expression and prognostic role of the PARP1 protein. In this study, we have compared the expression of PARP between BC and benign breast disease (BBD) patients and also analyzed the association of PARP expression with clinicopathological parameters in BC. Methods: The study consists of 30 patients with newly diagnosed operable BC who were planned for surgery without neoadjuvant chemotherapy and 15 patients of BBD as a control between 2019 and 2021. Immunohistochemical analyses were performed prospectively on tissue samples. Anti-human PARP1 rabbit polyclonal antibody gives strong nuclear positivity. Internal control was the adipose tissue and the BBD acted as the external control. PARP1 expression was evaluated using the multiplicative quickscore method. Results: The mean age for BC patients was 51.30 ± 10.694 years (range: 25-75 years) while BBD was below 30 years. Overexpression of PARP was present in 25 (83.3%) and weak expression in 5 (16.7%) of BC patients compared to BBD, only 2 (13.3%) patients demonstrated an overexpression of PARP, and 13 (86.6%) patients showed weak expression which showed significant association (P < 0.001). In BC, nuclear PARP (nPARP) overexpression was seen in 22 (73.3%) patients and weak expression of nPARP in 8 (26.7%), whereas 5 (16.7%) patients showed cytoplasmic overexpression. On comparing expression of PARP with clinicopathological parameters, PARP overexpression was significantly associated with older population (age >50 years) (P = 0.002), postmenopausal women (P = 0.029), higher TNM stage (Stage II and III) (P = 0.014), higher histological grade (grade 2) (P = 0.043), and presence of lymphovascular invasion (P = 0.015). Enhanced PARP1 expression is closely correlated with positive estrogen receptor status (P = 0.001) and PR status (P = 0.001). Overall PARP and nPARP overexpression was significantly associated with ER- (P = 0.006 and P = 0.008) and PR-positive (P = 0.006 and P = 0.008) patients. The PARP and nPARP overexpression was significantly associated with nontriple-negative BC patients (P = 0.001 and P = 0.001). Conclusion: We have not come across any study in the literature to compare PARP expression in BC and BBD patients. On the basis of our observations, we concluded that PARP overexpression is a poor prognostic marker in BC. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Infective leg ulcers
(Springer India, 2016) Rahul Khanna; Ram Niwas Meena; M.Venkat Mukunda; Seema Khanna
[No abstract available]
Preoperative Assessment of the Axilla by Ultrasonogram-Guided FNAC in Breast Cancer Patients with a Clinically Negative Axilla
(Springer, 2021) Meenakshi; Ishan Kumar; Neeraj Dhameja; Ram Niwas Meena; Shashi Prakash Mishra; Seema Khanna; Rahul Khanna
Ultrasonogram-guided fine needle aspiration cytology of the axillary lymph nodes using a 7–12 MHz linear transducer was carried out on 102 breast cancer patients in whom there was no clinically palpable lymph node in the axilla. Ultrasound was able to visualize an axillary node in 55 patients (54%) while in 47 patients (46%), no node was visualized. USG-guided FNAC on the 55 patients found 9 (16%) patients to be positive for metastases, 27 (49%) to be negative, and 19 (35%) in whom an inconclusive or inadequate sample was reported. On correlation with post-modified radical mastectomy (MRM) histopathology, the preoperative USG-guided FNAC had a sensitivity of 60%, specificity of 100%, and an overall diagnostic accuracy of 58%. It can be concluded that patients with a positive for malignancy USG-guided FNAC report on the axilla should be treated as such. Patients who have a negative for malignancy or inconclusive/inadequate FNAC report or in patients in whom no axillary node is visualized on USG should undergo a sentinel node biopsy procedure for further evaluation of the axilla. © 2020, Association of Surgeons of India.
Sacral Pressure Ulcer Management by Negative Pressure Dressing: a Randomized Open Label Study
(Springer, 2023) Irshad Ahmad; Rahul Khanna; Pradyot Prakash; Siddharth Khanna; Ram Niwas Meena
The treatment of sacral pressure sores is associated with a high rate of failure and recurrence. If inadequately treated, they severely compromise the quality of life and may herald a terminal event. The present study was undertaken to compare the efficacy of negative pressure wound therapy (NPWT) with conventional dressing treatment for sacral pressure sores. Over a 4-year period, 38 patients of grade III and IV sacral pressure sores were treated by either NPWT (22 patients) or conventional dressing (16 patients) method. Prior to application of NPWT, the wound was debrided and complete hemostasis achieved. The NPWT device was set to deliver a negative pressure of 125 mmHg with 7-min cycle (5 min on pump followed by 2 min off). The dressing was changed after 5 to 7 days. At the end of 3 months of treatment, 4 patients had died in each group. Of the 18 patients alive in NPWT group, 6 patients (33%) achieved complete healing and 9 (50%) had wound size reduction by more than 50%. The corresponding figures in the conventional dressing group were 1 (8%) and 4 patients (33%), respectively. NPWT was found to achieve superior clearance of slough, better generation of granulation tissue, and obliteration of ulcer crater compared to conventional dressing. The negative pressure led to faster reduction of bacterial load promoted angiogenesis and obtained a better rate of wound healing. Moreover, it resulted in a much cleaner and hygienic wound environment, reduced the nursing time in change of dressing, and significantly decreased patient discomfort. © 2022, Association of Surgeons of India.
Triple Negative Breast Cancer: Experience from a North Indian Tertiary Care Center
(Springer, 2018) Rahul Khanna; Ram Niwas Meena; Akash Bansal; S.C.U. Patne; Shashi Prakash Mishra; Tej Bali Singh; Seema Khanna
Triple negative breast cancer (TNBC) is characterized by absence of estrogen and progesterone receptors (ER and PR) expression and lack of amplification of HER2 gene expression. It accounts for 15–20% of all breast cancer worldwide. The aim of the study was to determine the prevalence of TNBC patients visiting Surgery Department of Banaras Hindu University and correlate various clinico-pathological parameters vis-a-vis non-TNBC patients. TNBC accounted for 64/196 (32.6%) of all breast cancer patients. TNBC patients presented at a younger age (49 versus 55 years) compared to non-TNBC patients. TNBC patients had a higher chance of lymph node involvement (84 versus 75%), more grade III lesions (64 versus 50%), higher chance of lympho-vascular invasion (62.5 versus 45.5%) compared to non-TNBC patients. On follow-up of 36 months, the incidence of locoregional recurrence was 26.5% and distant metastasis 17.2% among TNBC patients compared to 16.6 and 12% respectively for non-TNBC patients. None of the TNBC patients developed bone metastasis which was seen in 7 of the non-TNBC patients. Stage for stage TNBC tumors had a worse histological profile and higher incidence of locoregional and distant metastases compared to non-TNBC patients. Although the prevalence of TNBC in our study was three times higher than reported worldwide yet their biological behavior is by and large similar to those reported worldwide. © 2017, Association of Surgeons of India.
Vaccine human clinical trial
(Elsevier, 2022) Bhawana Singh; Shyamali; Dharmendra Kumar Maurya; Rajiv Kumar; Shashi Bhushan Chauhan; Shyam Lal Mudavath; Ram Niwas Meena; Shyam Sundar; Om Prakash Singh
Globally incidence of infectious diseases has declined over the past decades, but still, they continue to have major public health and economic costs. Treatment of infectious diseases is complicated by patients’ late presentation at an advanced stage of their illness. Other challenges include high cost of treatment (drug and hospitalization) and increasing drug resistance. Because of this lack of effective, affordable, minimally toxic drug therapies, an effective vaccine to control infectious diseases is needed. The development of a prophylactic vaccine would prove to be the most effective strategy of disease control and one of the most cost-effective investments in the health sector. However, each newly developed vaccine needs to be evaluated for safety, immunogenicity, and prophylactic efficacy in humans before it is licensed for public use. In this book chapter, we discuss the key elements that should be considered to conduct the vaccine clinical trials against infectious diseases including COVID-19. © 2022 Elsevier Inc. All rights reserved.