Browsing by Author "Shashi Prakash Mishra"

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A Case Series Analysis of Pancreatic Injury Patients from Level 1 Trauma Centre
(Springer, 2025) Prashant Shukla; Awaneesh Katiyar; Shashi Prakash Mishra
Traumatic pancreatic injuries account for less than 1% of all traumas. These injuries are often associated with high-energy mechanisms, such as motor vehicle collisions, falls from heights, and penetrating injuries. We analyzed pancreatic trauma patients to determine outcomes following surgical or non-surgical management of traumatic pancreatic injuries. Once the diagnosis is made, patient management depends on multiple variables. We analysed the Level 1 trauma center database from 2019 to 2023. Data reviewed included patients’ demographics, mode of injury, grade of pancreatic injury, associated injuries, type of management, complications, and mortality, which were collected for analysis. Fifty-one patients with pancreatic injuries were included, with a median age of 34 years (19–58). Among these, 43(84%) were male, and 8 (15%) were female. Road traffic injuries were the most common cause of pancreatic injury. The mechanism of injury was blunt in 93% of cases and penetrating in 7%. The median injury grade was 3. Most injuries involved the pancreatic head (60%). The mean Injury Severity Score (ISS) at the presentation was 11. Nine patients (17.64%) were managed surgically, while the remaining were managed non-operatively. Ileus and associated organ injuries were the most significant factors predicting failure of non-operative management (NOM). Fourteen per cent of patients required total parenteral nutrition (TPN), most of whom were managed non-operatively. There were three needed readmissions, and no patient required re-operation. Mortality occurred in 7 patients (14%). Blunt trauma is the primary mechanism of pancreatic injuries, with road traffic accidents being the most common cause. While the majority of cases (84%) can be managed conservatively, a significant proportion (17.64%) required surgical intervention due to complex injuries or failure of non-operative management. Ileus and associated organ injuries are critical predictors of conservative management failure. Nutritional support in the form of TPN was frequently required, particularly in non-operatively managed patients. Mortality (14%) underscores the seriousness of pancreatic injuries, particularly in those with higher injury grades or complications. Pancreatic injuries, especially high-grade and delayed presentations, are associated with significant morbidity and mortality. Non-operative management was effective for low-grade injuries, while higher-grade injuries often required surgical intervention. Mortality correlated with polytrauma, high ISS, and physiological derangements. Early diagnosis, timely intervention, and multidisciplinary care are critical for improving outcomes. © Association of Surgeons of India 2025.
A Comparative Evaluation of Topical Application Versus Perilesional Injection of Platelet-Rich Plasma in Diabetic Foot Ulcer
(SAGE Publications Inc., 2025) Digumarthi Asha Rani; Seema Khanna; Shashi Prakash Mishra; Sandip Kumar
Diabetic foot ulcer (DFU) is globally a major health burden predisposing to limb amputation. Among the various treatment modalities, platelet-rich plasma (PRP) is emerging as a promising agent. It stimulates wound healing by providing a higher concentration of essential growth factors locally. Though the role of PRP in DFU healing is established, still the route of administration with maximal efficacy is yet to be defined. Our study aims to evaluate the efficacy of autologous PRP in the treatment of diabetic ulcers and compare the effect of topical and perilesional injections of PRP in DFU healing. We conducted a single-centre, prospective, interventional study on 60 patients with DFU, in 2 groups of 30 patients each. They were treated with freshly prepared autologous PRP injection perilesionally and topically respectively, once a week for 4 weeks. Ulcer size was assessed, using “imito-measure” software at presentation and 2, 4, 8, and 12 weeks post-therapy. Serum MMP-9 levels were assessed in both groups, pretreatment and post-treatment. For statistical analysis, SPSS software V-23 was used. On assessment, both groups had comparable baseline characteristics, Wagner's grading, and glycemic indices. The percentage reduction in the size of the wound at 2 weeks, 1 month, 2 months, and 3 months was greater in the perilesional group as compared to the topical PRP group. © The Author(s) 2023
An introduction of tertiary peritonitis
(Medknow Publications, 2014) Shashi Prakash Mishra; Satyendra Kumar Tiwary; Manjaree Mishra; Sanjeev Kumar Gupta
Intraperitoneal infection known as peritonitis is a major killer in the practice of clinical surgery. Tertiary peritonitis (TP) may be defined as intra-abdominal infection that persists or recurs 48 h following successful and adequate surgical source control. A planned or on-demand relaparotomy after an initial operation is probably most frequent way to diagnose TP, but is a late event to occur. Hence it is desirable to have timely and nonoperative diagnosis of TP after the initial operation and subsequent initiation of an appropriate therapy to reduce the complications and to improve the outcome.
Carcinoma in accessory axillary breast
(BMJ Publishing Group, 2015) Seema Khanna; Shashi Prakash Mishra; Satendra Kumar; Ajay Kumar Khanna
We present a rare case of carcinoma developing in an accessory breast. The patient presented with a progressive lump in her right axilla for 1 year. On examination, there was a well-developed nipple areola complex in the right axilla overlying a hard, fixed 5×3 cm lump. On investigation, core biopsy revealed poorly differentiated carcinoma of the breast. Mammography also revealed features of a malignant lesion with skin and muscle infiltration. Neoadjuvant chemotherapy was administered followed by modified radical mastectomy after three cycles. Immunohistochemistry study showed positive status of oestrogen and progesterone receptors, and negative HER-2 neu. Three more cycles of chemotherapy along with 50 Gy radiotherapy were given in an adjuvant setting followed by hormone therapy. Copyright 2015 BMJ Publishing Group. All rights reserved.
Clonidine versus nitroglycerin infusion in laparoscopic cholecystectomy
(Society of Laparoendoscopic Surgeons, 2014) Manjaree Mishra; Shashi Prakash Mishra; Sharad Kumar Mathur
Background and Objectives: Laparoscopic surgery offers the advantages of minimally invasive surgery; however, pneumoperitoneum and the patient’s position induce pathophysiological changes that may complicate anesthetic management. We studied the effect of clonidine and nitroglycerin on heart rate and blood pressure, if any, in association with these drugs or the procedure, as well as the effect of these drugs, if any, on end-tidal carbon dioxide pressure and intraocular pressure. Methods: Sixty patients (minimum age of 20 years and maximum age of 65 years, American Society of Anesthesiologists class I or II) undergoing laparoscopic cholecystectomy were randomized into 3 groups and given an infusion of clonidine (group I), nitroglycerin (group II), or normal saline solution (group III) after induction and before creation of pneumoperitoneum. We observed and recorded the following parameters: heart rate, mean arterial blood pressure, end-tidal carbon dioxide pressure, and intraocular pressure. The mean and standard deviation of the parameters studied during the observation period were calculated for the 3 treatment groups and compared by use of analysis of variance tests. Intragroup comparison was performed with the paired t test. The critical value of P, indicating the probability of a significant difference, was taken as _.05 for comparisons. Results: Statistically significant differences in heart rate were observed among the various groups, whereas comparisons of mean arterial pressure, intraocular pressure, and end-tidal carbon dioxide pressure showed statistically significant differences only between groups I and III and between groups II and III. Conclusion: We found clonidine to be more effective than nitroglycerin at preventing changes in hemodynamic parameters and intraocular pressure induced by carbon dioxide insufflation during laparoscopic cholecystectomy. It was also found not to cause hypotension severe enough to stop the infusion and warrant treatment. © 2014 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
Evaluating Trainee Performance and Surgical Safety: A Comparison of Supine and Left Lateral Positioning in Pediatric Laparoscopic Appendectomy
(Mary Ann Liebert Inc., 2025) Vaibhav Pandey; Shashi Prakash Mishra; Indra Singh Choudhary; Bhanumurthy Marripati Kaushik; Amit Gupta; Ruchira Nandan
Background: Laparoscopic appendectomy is the preferred treatment for acute appendicitis, offering reduced morbidity and quicker recovery compared with open surgery. The positioning of the patient during surgery can significantly impact both the ergonomics for the surgeon and the operational outcomes. This study compares the conventional supine positioning with an innovative left lateral decubitus approach for surgical efficiency and recovery outcomes. Methods: This prospective, comparative study included 30 pediatric patients undergoing interval appendectomy at the Department of Pediatric Surgery, from October 2023 to March 2024. Patients were randomly assigned to undergo appendectomy either in the traditional supine position (Group A) or a modified left lateral position (Group B). The study measured operative times, complication rates, and surgical outcomes using the modified Objective Structured Assessment of Technical Skills (OSATS). Results: The study consisted of 15 patients in each group, with comparable demographics and baseline characteristics. Group B showed a significant reduction in mean operating time (55.25 ± 3.62 minutes) compared with Group A (62.45 ± 4.15 minutes) (P < .001). There were fewer complications in Group B, with no serosal tears reported compared with a 15.3% incidence in Group A. The modified OSATS scores were higher in Group B, indicating better flow of operation and overall performance. Conclusion: The left lateral positioning in pediatric laparoscopic appendectomy demonstrated a potential to enhance surgical efficiency, reduce operative time, and minimize complications compared with the traditional supine approach. These findings suggest that the left lateral position could be considered a preferable alternative in pediatric appendectomy, particularly beneficial for surgical trainees due to improved ergonomics. © 2025 Mary Ann Liebert, Inc., publishers
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 demographic, clinical characteristics and risk factors in patients with persistent hiccups due to traumatic brain injury: A trauma-ICU based study
(IP Innovative Publication Pvt. Ltd., 2024) Manjaree Mishra; Ghanshyam Yadav; Ravi Shankar Prasad; Shashi Prakash Mishra; Ashish Kumar Yadav
Background: Persistent hiccups in neurocritical care patients can lead to negative outcomes, including exhaustion, sleep deprivation, malnutrition, depression, and even death. This study aims to evaluate demographic and clinical characteristics, risk factors, and management in trauma intensive care unit patients. Materials and Methods: This study investigates persistent hiccups in traumatic brain injury (TBI) patients admitted to the Trauma ICU at Banaras Hindu University, Varanasi, from July 2020 to January 2024. The study involved monitoring and recording hiccups during patients’ ICU stays. Exclusion criteria included not participating, having GERD, advanced cancer, spinal cord injury, other CNS pathologies, deranged liver and renal profile, or on drugs causing hiccups, on sedative and neuro-muscular blocking agents. Results: The study involved 59.8% of patients aged <40 years, with a mean age of 41.75±17.16 years. Most patients were male, with a male-to-female ratio of 1.88:1. Road traffic accidents (RTAs) were present in 60.3% of patients, followed by falls from height (17.5%). 75.7% of patients had severe type TBI, while the remaining had moderate type TBI. Out of 189 patients, 86 (45.5%) died and 103 (54.5%) survived. Age was a significant factor in TBI-related persistent hiccups, with severe TBI significantly associated with female gender and ventilator-associated pneumonia and the need for mechanical ventilation. The type of TBI (moderate or severe) and length of ICU stay were also associated with TBI-related persistent hiccups. A strong relationship was observed between severe TBI patients who fall from height and were not responsive to drugs for hiccups compared to moderate TBI. The length of ICU stay was also associated with TBI-related persistent hiccups, with patients with a length of ICU stay of >14 days having a higher risk of hiccups. Conclusion: Severe TBI is linked to female gender, ventilator-associated pneumonia, and mechanical ventilation. The type of TBI and length of ICU stay are also linked to persistent hiccups. Patients with severe TBI who fell from height are less responsive to hiccup drugs. Patients with over 14 days of ICU stay have a higher risk of developing persistent hiccups. © 2024 Author(s).
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.
Genetics of Vascular Malformations
(Springer Singapore, 2021) Shashi Prakash Mishra; Ajay K. Khanna
Vascular malformations are nonneoplastic expansions of blood vessels that arise due to errors in angiogenesis. Here we report loss-of-function mutations in ELMO2, which translates extracellular signals into cellular movements, as causative for autosomal recessive intraosseous vascular malformation (VMOS) in five different families. Individuals with VMOS suffer from life threatening progressive expansion of the jaw, craniofacial and other intra membranous bones caused by malformed blood vessels that lack a mature vascular smooth muscle layer. Analysis of primary fibroblasts from an affected individual showed that absence of ELMO2 correlated with a significant down regulation of binding partner DOCK1, resulting in deficient RAC1-dependent cell migration. Unexpectedly, elmo2-knockout zebra fish appeared phenotypically normal, suggesting human-specific ELMO2requirements in bone vasculature homeostasis or genetic compensation by related genes. The genetic basis for vascular malformations is incredibly complex. The great deal of phenotypic variability within known gene mutations suggests that we do not fully comprehend the exact genetic contribution to syndromes. However, further investigation will allow us to identify at-risk patients in the hopes of preventing the more severe sequelae of the syndromes. Furthermore, in-depth knowledge of the molecular basis of these lesions will provide ample opportunity to develop tissue-targeted therapy. © Springer Nature Singapore Pte Ltd. 2021.
Gold nanoflower-functionalized ZnO thin film-based elliptical interdigital MSM structure for the detection of volatile organic compounds associated with breast cancer
(Elsevier Ltd, 2025) Anirudh Bahadur Yadav; Shashi Prakash Mishra; Sivanath Reddy G.v; Rahul Checker
Gold nanoflowers were synthesized in an aqueous solution and incorporated into the sol–gel derived zinc acetate salt precursor based colloidal solution. Five microliters of the colloidal solution, which contains a pure zinc acetate precursor solution and gold nanoflowers, was dropped onto a glass substrate to create a transparent functionalized and pristine ZnO thin film. XPS, XRD, scanning electron microscope and transmission electron microscope analysis revealed a successful functionalization of gold nanoflowers on ZnO. The functionalized ZnO films decorated with gold nanoflowers, when used in an MSM structure, showed excellent sensitivity to isopropyl myristate, a crucial biomarker of breast cancer. UV light was used to improve the sensing properties of the device. In addition to improving the sensing properties, the gold nanoflowers lower the specific contact resistance at the Al/gold nanoflower-functionalized ZnO interface. © 2025 Elsevier B.V.
Minimally invasive techniques as adjuncts in low-versus high-lying retained rectal foreign bodies of autoerotic nature in young men: a tailored management algorithm with two contrasting case reports from India
(The Korean Society of Traumatology, 2024) Shubham Kumar Gupta; Vivek Kumar Katiyar; Sumit Sharma; Shashi Prakash Mishra; Satyanam Kumar Bhartiya
Retained rectal foreign bodies (RFBs) of an autoerotic nature represent an emerging and rare surgical emergency, posing a sensitive challenge for surgeons. RFBs exhibit a wide range of presentations and require varied management approaches, with the choice of treatment modality differing from case to case. Recently, minimally invasive techniques have been employed for the retrieval of RFBs. In 2021, the World Society of Emergency Surgery and the American Association for the Surgery of Trauma released guidelines on anorectal emergencies, highlighting the usefulness of these techniques as adjunctive tools for both diagnosis and ruling out associated complications. In this report, we describe two noteworthy cases of men who presented to the trauma emergency department with foreign bodies lodged in their rectums. We also highlight the potential role of minimally invasive techniques within a “step-up” approach for the management of retained RFBs. © 2024 The Korean Society of Traumatology.
Necrotizing soft tissue infections: Surgeon's prospective
(Hindawi Publishing Corporation, 2013) Shashi Prakash Mishra; Shivanshu Singh; Sanjeev Kumar Gupta
Necrotizing soft tissue infections (NSTIs) are fulminant infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Delay in diagnosing and treating these infections increases the risk of mortality. Early and aggressive surgical debridement with support for the failing organs significantly improves the survival. Although there are different forms of NSTIs like Fournier's gangrene or clostridial myonecrosis, the most important fact is that they share common pathophysiology and principles of treatment. The current paper summarizes the pathophysiology, clinical features, the diagnostic workup required and the treatment principles to manage these cases. © 2013 Shashi Prakash Mishra et al.
Postoperative Cognitive Dysfunction: A Review
(2024) Neelesh Anand; Reetika Gupta; Shashi Prakash Mishra; Manjaree Mishra
Elderly patients are more vulnerable to cognitive dysfunction in the postoperative period. Patients who are apparently well in cognitive functions in the preoperative period after undergoing anesthesia in noncardiac surgery will develop symptoms of cognitive dysfunction. Postoperative cognitive dysfunction (POCD) doesn't continue for a long duration and usually undergoes self-resolution. Proper definitions and congruous tests for diagnosis are absent. Rigorous preoperative assessment of cognitive function and distinguishing risk factors are indispensable for recognizing the range of POCD and its association with surgery and anesthesia. Recent studies haven't revealed any anesthesia technique or drug which can significantly reduce the incidence of POCD. Therefore, giving accurate information to patients can be challenging.
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.
Prospective clinical study to evaluate role of centchroman in regression of mastalgia in rural population
(Regional Institute of Medical Sciences, 2022) Shashi Prakash Mishra; Somendra Pal Singh; Shailendra Pal Singh; Vipin Gupta; Prashant Gupta; Anil Kumar Sharma; Shesh Kumar; Manish Agarwal
Background: Mastalgia in the reproductive age group is common among women. Treatment is not yet standardized for these conditions. The majority of treatments used for mastalgia is costly and have side effects. The aim of our study was to find the efficacy of centchroman for regression of mastalgia in a predominantly rural population, measured by the visual analog scale (VAS). Materials and Methods: A total of 140 patients were randomized into two groups: Group 1 (n = 70) patients treated with centchroman and Group 2 (n = 70) patients treated with placebo for 12 weeks. The main outcomes are evaluated after one week to look for any intolerance, followed by repeated follow-ups at four, twelve, and twenty-four weeks to evaluate the treatment response using the VAS score and the side effects. Results: The mean age of patients in Group 1 was 29.63 ± 9.67 years and 32.32 ± 9.74 years in Group 2. The baseline mean VAS score was 6.40 ± 1.65 and 5.83 ± 1.69, respectively. After 2, 4, 8, 12, and 24 weeks of follow-up, the mean VAS score was significantly decreased in patients treated with centchroman. On intragroup comparison, the mean VAS score was significantly decreased at baseline to 2, 4, 8, 12, and 24 weeks of follow-ups. In both the groups, gastritis and headache were comparable, and delayed menstruation was significantly more in patients treated with centchroman. Conclusion: Centchroman has substantial efficacy, with a marginal effect on regression, of mastalgia in women of the reproductive age group, and it can be used as the first line of treatment. © 2022 Journal of Medical Society | Published by Wolters Kluwer-Medknow.
Thiolated Gold Nanoflowers for Breast Cancer Volatile Organic Compound Biomarker Sensing
(Institute of Electrical and Electronics Engineers Inc., 2025) Malkari Sravani; Anirudh Bahadur Yadav; Shashi Prakash Mishra; G. V.Sivanath Reddy; Rahul Checker
Breast cancer is a malignant disease, and patient prognosis significantly improves when it is detected at an early stage. Consequently, various advanced techniques have been adopted to enable early stage detection. One promising approach involves the classification of volatile organic compounds (VOCs) byproducts of cellular metabolism that are exhaled in breath, using chemiresistors based on thiolated gold nanoparticles. These sensors can selectively detect a range of VOCs, with tunability achieved by selecting thiols of specific molecular shapes. In this work, we synthesized gold nanoflowers (AuNFs) with a high surface-area-to-volume ratio, a face-centered cubic (FCC) crystalline structure, and an average size of 203 nm, as confirmed by energy-dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD), and scanning electron microscopy (SEM). The AuNFs were dispersed in deionized (DI) water, pipetted, and drop coated onto interdigital gold electrodes patterned on SiO2/p-Si (100) substrates to form a continuous film with an initial resistance of up to 5 kΩ. Subsequently, the AuNF films were functionalized with 2-ethyl-1-hexanethiol, 2-methyl-1-propanethiol, and phenylethyl mercaptan using a simple and controllable drop coating method; this technique offers advantages over the ligand ion exchange method. Thiolation increased the film resistance to approximately 10 kΩ. The resulting chemiresistor sensors demonstrated excellent sensitivity to breast cancer VOC biomarkers, including 2-ethyl-1-hexanol, 2-propanol, and heptaldehyde. Notably, 2-methyl-1-propanethiol functionalized AuNFs exhibited the highest sensitivity (21.07%) toward heptaldehyde, outperforming other thiol-modified sensors and previously reported values in literature. The sensors also demonstrated ultrafast response and recovery times of 5 and 6 s, respectively. To the best of the author's knowledge, neither this novel sensor design nor this approach has been previously reported. © 2025 IEEE. All rights reserved.
Transversus abdominis plane block: The new horizon for postoperative analgesia following abdominal surgery
(Central Society of Egyptian Anaesthesiologists, 2016) Manjaree Mishra; Shashi Prakash Mishra
Post operative pain management is the key factor to decide the outcome of the patient. TAP block is relatively newer method for management of postoperative pain after abdominal surgery. Technique involves the injection of local anesthesia into the plane between the internal oblique and transversus abdominis muscle and thus giving pain relief. The technique when performed under ultrasound guidance improves the yield. TAP block provides good analgesia between T10 and L1 level hence very useful for lower abdominal and gynecological procedures. This significantly reduces the analgesic requirement in postoperative period and hence reduces the side effects of analgesics. © 2016 Production and hosting by Elsevier B.V.
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.