Browsing by Author "Satyendra Tiwary"

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A case report of rare, giant adrenal myelolipoma
(Wolters Kluwer Medknow Publications, 2021) Puneet Kumar; Katyayani Choubey; Ajay Khanna; Satyendra Tiwary
Giant adrenal myelolipoma is a rare entity. It becomes evident due to symptoms of dragging sensation and discomfort or pain. We report hereby a rare case report giant adrenal myelolipoma. A 51-year-old female presented with pain in the right upper abdomen, dull aching, non radiating, no aggravating, or relieving factor present. It was associated with a lump in the right upper abdomen. Computed tomography of the abdomen suggested a 20 cm × 18 cm well encapsulated, hypodense mass, arising from right suprarenal gland inferior to the right lobe of the liver, pushing right kidney inferiorly, and inferior vena cava medially. It showed predominantly fat component and a small area of soft-tissue attenuation with maintained adjacent fat planes, suggestive of right adrenal myelolipoma. After preoperative stabilization, excision of right adrenal myelolipoma was done under general anesthesia and epidural anesthesia. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
Correlation of various platelet indices and its association with susceptibility to develop DVT
(Edizioni Minerva Medica, 2022) Satyendra Tiwary; Anand Das; Soumya Khanna; Debabrata Das; Puneet Kumar; Ajay Khanna
BACKGROUND: Venous thromboembolism (VTE) comprises DVT and PE, and either of them can be asymptomatic. The major disaster associated with deep vein thrombosis is when thrombus embolizes towards the heart and lungs where it lodges in the pulmonary arteries, known as pulmonary embolism. Deep venous thrombosis (DVT) is a serious disease not only because of the risk of developing pulmonary embolism (PE), but also of its risk for long-term sequelae. Several parameters may help in the identification of deep vein thrombosis (DVT). Several studies proposed that larger mean platelet volume (MPV) is an indicator of increased in-vivo platelet activation. Several studies have shown that increased platelet activity is associated with a greater risk of vascular events. Platelets play an important role in thrombus formation and the pathogenesis of atherosclerosis. METHODS: A total number of 33 cases and 33 controls were included in this study. We included all patients who were positive for acute deep vein thrombosis (DVT) as confirmed by Duplex scan. Patients on antiplatelet/anticoagulant therapy were excluded from the study. Clinical assessment of all patients, detailed history and physical examination was performed and recorded in proforma. Two mL of blood were collected in lavender top vials containing Di-potassium Ethylenediaminetetraacetic acid (K2EDTA) and analyzed in Beckmann Coulter fully automatic analyzer. RESULTS: Out of 33 patients, 16 patients were males and 17 were females. Majority of patients (16 out of 33, 48.4%) belong to middle age group (20-40 yrs). Receiver operating characteristic (ROC) curve analysis for platelet larger cell ratio (P-LCR) showed area under curve 0.701, P=0.005 (significant). Cut-off value was 38.25, sensitivity and specificity were both 60%. Patients were divided in two groups with PLCR<38.25% and P-LCR>38.25%. When compared, MPV was significantly low in P-LCR<38.25% and high in P-LCR>38.25% (9.2±0.9 fL vs. 10.3±1.2 fL; P=0.012). Rest correlations were insignificant. CONCLUSIONS: In conclusion, leukocytosis present in deep venous thrombosis (DVT) may be due to associated comorbidities. Moreover, combination of various platelet indices with D-dimer test can increase detection sensitivity of cases with deep venous thrombosis. © 2022 EDIZIONI MINERVA MEDICA.
Gene expression study in venous ulcer
(Edizioni Minerva Medica, 2024) Satyendra Tiwary; Ankush Sharma; Khushbu Priya; Geeta Rai; Vivek K. Katiyar; Puneet Kumar; Ajay K. Khanna
BACKGROUND: Venous leg ulcers are responsible for more than half of all lower extremity ulcerations. Therefore, in this study we have proposed to understand the genetic changes associated with underlying disease mechanisms in venous ulcer by evaluating the gene expression of inflammatory gene/marker WAKMAR1, E2F1, RAD21 and NIPBL. METHODS: WAKMAR1, E2F1, RAD21 and NIPBL genes sequence was pulled out from NCBI database. The gene-specific primers were designed using Primer 3 software and were synthesized. Tissue sample collected before starting treatment and after 50% healing or after 2-6 months in non- healing ulcers. Samples stored at -80 °C, were thawed and dissected into small pieces. In all samples RNA was isolated and quantified using a Nano Drop. Standard 1% agarose gel under denaturing condition with ethidium bromide was used to assess the integrity of RNA. WAKMAR1, E2F1, RAD21 and NIBPL gene expression was directly analyzed by one step RT-PCR. Gene expression was made relative to expression of house-keeping beta actin gene. Statistical comparisons performed using Student’s t-test with the help of GraphPad Prism version 8.0.2, NIH. RESULTS: RAD21 gene expression increased significantly in tissue samples from venous ulcer patients post treatment. NIPBL gene expression increased but not significantly in tissue samples from venous ulcer patients post treatment. Relative expression of RAD21 gene significantly increased in healing venous ulcer samples as compared to non-healing samples (P<0.05 in healing v/s non-healing group). Relative expression of NIPBL gene significantly increased in healing venous ulcer samples as compared to non-healing samples (P<0.0001 in healing v/s non-healing group). No expression for WAKMAR1 and E2F1 were noticed in venous ulcer tissue samples. CONCLUSIONS: NIPBL & RAD21 gene expression increased significantly in healed venous ulcers. This finding could be harnessed for the development of more effective wound therapy. © 2024 EDIZIONI MINERVA MEDICA.
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.