Browsing by Author "Soumya Khanna"

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Ambulatory venous pressure studies and its correlation with CEAP grading of varicose veins
(Edizioni Minerva Medica, 2020) Ajay K. Khanna; Shivanshu Singh; Satyendra K. Tiwary; Soumya Khanna; Shripad B. Deshpande; Ram C. Shukla; Puneet Kumar
BACKGROUND: Venous hypertension in the lower limb is predisposing factor for the chronic venous insufficiency and resultant skin changes. In a normal limb, during ambulation, there is a fall in lower limb venous pressure as the calf muscle pump and unidirectional valvular activity propel the blood from the lower limbs to the heart. Failure of this mechanism results in ambulatory venous hypertension predisposing to chronic venous insufficiency. The current study aimed at studying the lower limb ambulatory venous pressure in varicose veins, its co-relation with clinical severity of the disease according to the clinical grading of clinical-etiological-anatomical-pathophysiological (CEAP) classification and whether these measurements can help in assessing the anatomical sites of incompetence. METHODS: A prospective study was carried out at a University Teaching Hospital in Northern India. Ambulatory venous pressure was measured in 67 limbs. Limbs were classified according to the CEAP grading. Four groups were divided as follows: group 1, CEAP-0 (7 limbs); group 2, CEAP-1, 2 (24 limbs); group 3, CEAP-3, 4 (21 limbs); and group 4, CEAP-5, 6 (15 limbs). Following the duplex scan, limbs were also grouped according to the anatomical sites of incompetence. For pressure measurement, dorsal foot vein was cannulated with a 20-gauge cannula and connected to a physiograph through a pressure transducer filled with heparinized saline. Patient performed a standard 10 tip-toe exercise and following parameters were assessed: resting pressure in the sitting and standing position, mean ambulatory venous pressure, maximum fall in pressure, percentage decrease in pressure, 50%, 75%, 90% recovery time, initial recovery rate, recovery in first 4 seconds, pressure relief index. RESULT S: Median ambulatory venous pressure showed a progressive increase from group 1 (18.0 mmHg) to group 2 (51.5 mmHg) to group 3 (69.0 mmHg) and group 4 (91.0 mmHg). Median recovery times for 50%, 75% and 90% recovery of pressure after cessation of exercise were significantly lower while the percentage recovery in first 4 seconds was significantly higher in the ulcer group. Median pressure relief index showed a significant stepwise decreasing trend from group 1 to group 4 (2790.0 mmHg-sec in group 1to 534.0 in group 2 to 534.0 in group 3 to 40.0 in group 4; P<0.001). The prevalence of ulceration increased significantly with increasing median ambulatory venous pressure and decrease in time required for 90% recovery and median pressure relief index. None of the parameters showed significant variation among all the groups divided based on anatomical sites of incompetence. CONCLUSIONS: Ambulatory venous pressure measurement correlates with the clinical grading of the CEAP classification of varicose veins. Ambulatory venous pressure measurements do not help in determining the anatomical sites of incompetence. Pressure relief index, the recovery time intervals and the mean ambulatory venous pressure are the important parameters that can help in identifying and grading the severity of the disease. © 2020 EDIZIONI MINERVA MEDICA.
Approach to a Case of Ulcer of Extremity
(Springer Nature, 2023) Ajay K. Khanna; Soumya Khanna
An ulcer is a break in the skin or mucus membrane caused by the microscopic death of tissues. Ulcers can occur in any portion of the body, at any age, and in either gender. Ulcers can be either acute or persistent. Acute ulcers normally heal quickly, but chronic ulceration occurs when the ulcer lasts longer than 6 weeks and shows no signs of healing after three or more months. Ulcers are lesions that have a “full thickness depth”, and chronic ulcers heal slowly. Skin ulceration may be extremely painful and even fatal in severe cases. Chronic ulcers are frequently difficult to heal and may be related with a variety of psychological issues. It has a negative impact on one’s quality of life since it is connected with discomfort, swelling, and discharge that can be foul-smelling or bleeding. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.
Assessment and grading of pigmentation in chronic venous insufficiency
(SAGE Publications Ltd, 2020) Satyendra K Tiwary; Praveen KG Kumar; Neeraj Dhameeja; Puneet Kumar; Ajay K Khanna; Soumya Khanna
Introduction: Chronic venous insufficiency causes skin pigmentation of the leg ranging from small patches of mild dyschromia to extensive areas of severe skin pigmentation. It is thought that the pigmentation is mainly due to haemosiderin or melanin deposition. Erythrodiapedesis which occurs as a result of venular hypertension causes erythrocytes to migrate across the microvascular network into the dermis. Methods: We categorized the grading of pigmentation into four grades: +, few spots; ++, pigmentation over gaiter area; +++, pigmentation involving leg and ankle; ++++, heavily pigmented (dark). Skin biopsies were taken from the patient while undergoing surgery; two biopsies were taken from each patient, one from apparently normal skin and other from the site of pigmentation. A total of 45 patients diagnosed as chronic venous insufficiency with pigmentation were included in the study and five patients included in control. The biopsy specimens were sent to pathology department for H&E, Perls stain and IHC for S100. Results: Majority of cases, i.e. 62% of limbs fall under (++) grade of pigmentation, followed by (+) grade of pigmentation in 20%, while (+++) and (++++) constitute 9% of the cases each. Increased melanin deposition was seen in 40 pigmented skin biopsies and 3 normal skin biopsies from the case group, and normal melanin deposition was seen in all the non-varicose controls. Conclusion: We have tried to categorize pigmentation in chronic venous insufficiency into four grades. As the grade of pigmentation increases the per cent of cases with ulceration is increasing. It was observed that presence of melanin deposition irrespective of the grade of pigmentation was distributed more towards the advanced clinical classification (C5 and C6). © The Author(s) 2019.
Assessment of Quality of Life in venous ulcer
(Edizioni Minerva Medica, 2021) Satyendra K. Tiwary; Manoj Kumar; Soumya Khanna; Puneet Kumar; Ajay K. Khanna
BACKGROUND: Typically, venous ulcers are recurrent in nature and with increased treatment cost leads to personal, social, mental and economic impact affecting Quality of Life (QoL). Generic tools are widely available in various languages have been frequently used to assess QoL. Among the various specific tools, Charing Cross Venous Leg Ulcer (CCVLU) Questionnaire showed high reliability, validity and responsiveness and shows good correlation with SF-36 in assessing HRQoL(Health related Quality of Life). METHODS: This study included 50 patients with venous ulcer and 56 limbs (six patients had bilateral ulcers). Quality of Life of venous ulcer patients was assessed by using SF-36 Questionnaire, The Charing Cross Venous Ulcer Questionnaire (CXVUQ) and Revised venous clinical severity score (VCSS), the changes in Quality of Life after treatment was compared to initial presentation in venous ulcer patients. RESULTS: After treatment, venous ulcer healed in all, except in 7 (12.5%) patients. Recurrence of venous ulcer was seen in 12 (21.43%) limbs. Quality of Life of patients prior to treatment and after the treatment by using SF-36 Questionnaire, Charing Cross Venous Ulcer Questionnaire, Revised Venous Clinical Severity Score showed that there was significant improvement in Quality of Life of patients after treatment with P value of <0.001. CONCLUSIONS: In our study, we found significant improvement in Quality of Life in patients of Venous ulcers after giving various modality of treatment which included Endovascular intervention and Four-layer dressing. © 2021 Edizioni Minerva Medica. All rights reserved.
Bacteriological Study of Varicose Vein Specimens
(Springer, 2023) Ajay K. Khanna; Awaneesh Katiyar; Soumya Khanna; Gopal Nath; Puneet Kumar; Satyendra K. Tiwary
Varicosity and chronic venous insufficiency (CVI) are thought to be due to reflux or pathologic retrograde flow caused by an incompetent venous valve leading to venous hypertension followed by reflux. A variety of factors have been postulated in association with varicose veins. Venous hypertension leading to reflux and varicosity may be associated with inflammation due to microbiological activity. This study was carried out with the objective that infection can be an etiological factor for varicose veins. A prospective study was carried out at a tertiary health care center from June 2014 to December 2020. A total of 100 patients with varicose veins (with 120 limb involvement) were recruited. Samples of normal leg veins were taken as control from 10 patients who were undergoing saphenous vein bypass grafting or amputated limb following road traffic accidents. We studied the primary varicose veins for microbiological etiology of the disease by culture studies of varicose veins and further confirmation by 16 s-rRNA PCR analysis. The sample of veins harvested during intervention was submitted for microbiological culture. Out of 42 cultures, Pseudomonas spp. in 6 cases (14.29%), Klebsiella spp. in 4 cases (9.52%), 2 cases (4.76%) each of Staphylococcus aureus and Proteus spp., and one case of Citrobacter on bacterial culture of truncal veins and on 16 s-rRNA PCR on DNA extracted from truncal varicose vein samples. Pseudomonas spp., Staphylococcus aureus, Klebsiella spp., Proteus spp., and Citrobacter spp. were detected in 10 cases (23.81%), 6 cases (14.29%), 5 cases (11.9%), 2 cases (4.76%), and 1 case (2.38%), respectively. In the ten specimens of normal vein, taken as control, 9 cases show no bacterial growth and 1 (10%) case shows a growth of micrococci. In consideration of the results of the present study, microbiological etiology of varicose veins is a distinct association which was confirmed in this study. © 2021, Association of Surgeons of India.
Clinical anatomy of lower extremity
(Springer India, 2016) Soumya Khanna; Ajay K. Khanna
[No abstract available]
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.
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.
Degradation of Xenobiotic Pollutants: An Environmentally Sustainable Approach
(MDPI, 2022) Rashi Miglani; Nagma Parveen; Ankit Kumar; Mohd. Arif Ansari; Soumya Khanna; Gaurav Rawat; Amrita Kumari Panda; Satpal Singh Bisht; Jyoti Upadhyay; Mohd Nazam Ansari
The ability of microorganisms to detoxify xenobiotic compounds allows them to thrive in a toxic environment using carbon, phosphorus, sulfur, and nitrogen from the available sources. Biotransformation is the most effective and useful metabolic process to degrade xenobiotic compounds. Microorganisms have an exceptional ability due to particular genes, enzymes, and degradative mechanisms. Microorganisms such as bacteria and fungi have unique properties that enable them to partially or completely metabolize the xenobiotic substances in various ecosystems.There are many cutting-edge approaches available to understand the molecular mechanism of degradative processes and pathways to decontaminate or change the core structure of xenobiotics in nature. These methods examine microorganisms, their metabolic machinery, novel proteins, and catabolic genes. This article addresses recent advances and current trends to characterize the catabolic genes, enzymes and the techniques involved in combating the threat of xenobiotic compounds using an eco-friendly approach. © 2022 by the authors.
Effect of four-layer dressing on venous ulcer
(Edizioni Minerva Medica, 2020) Satyendra K. Tiwary; Katyayani K. Choubey; Soumya Khanna; Puneet Kumar; Ajay K. Khanna
Background: Venous ulcer is a chronic disease and has periods of exacerbation and remission. it takes a long time to heal, resulting in physical and psychological discomfort thereby negatively affecting the functional status of the patients. Various bandage systems, single layered, double layered and multiple layered with elastic and non elastic components have been commercialized. A requirement of sustained pressure brought the four-layer bandage into picture. We tried to study the bacteriology of the venous ulcers and the effect of our layer bandage on the healing of the ulcer. Methods: Sixty patients were recruited for the study. however, 4 patients had a bilateral disease and so a total of 64 limbs were taken into consideration in the study. clinical details of all patients with wound size measurement by gauze piece, wax paper and scale was done. the wounds were initially debrided and photographic records of all patients was maintained. Patients were followed up every week and the dressing was changed every week. Results: 93.8% had complete healing while 1.6% had partial healed ulcer and 4.7% had non healing ulcer. After excluding the four ulcers that did not heal, 16.6% had recurrence while 50 out 60 had no recurrence in the follow-up for one year. There was a significant correlation (P<0.001) between ulcer size and the number of dressings. Conclusions: compression therapy is the mainstay of treatment of venous ulcer. compression in the range of 30 mmhg to 40 mmhg is the most effective level for uncomplicated venous ulcers with adequate arterial competency. © 2020 Edizioni Minerva Medica. All rights reserved.
Embryology of Vascular Malformation
(Springer Singapore, 2021) Soumya Khanna; Ajay K. Khanna
A thorough understanding of vascular system is a prerequisite for vascular specialists. The knowledge of venous development is often ignored despite the fact that all the mature and named vessels originate from their precursor i.e. embryonic vessels and any vascular anomalies is closely correlated with its development This chapter has tried to cover the development of arterial, venous and lymphatic system and its associated anomalies. © Springer Nature Singapore Pte Ltd. 2021.
Geographical And Sociocultural Determinants Of Access To Medical Laboratory Services: A Cross-Regional Study In Urban And Rural Healthcare Settings
(Green Publication, 2025) Sumith Ourasang; Darshan Madhani; Soumya Khanna; Khalaf Mohamed Almazrouei; Noyonika Chatterjee; Vinay Raj R
Disparities in access to diagnostic healthcare services remain a persistent barrier to equitable health outcomes, particularly in geographically and socioeconomically marginalized settings. Laboratory diagnostics play a critical role in disease surveillance, timely intervention, and health system responsiveness. Yet, access to these services is often unevenly distributed across urban and rural regions. A cross-sectional quantitative study was conducted across four districts, encompassing 800 adult participants equally stratified between urban and rural settings. Data were collected using a structured survey measuring geographic distance to laboratories, frequency of monthly visits, perceived access satisfaction, income levels, and educational attainment. Descriptive statistics, chi-square tests, t-tests, and multivariate regression analyses were applied to examine disparities and identify predictors of perceived access. Findings revealed significant urban–rural disparities. Rural participants travelled greater distances (Mean = 8.96 km), had lower monthly laboratory visits (Mean = 0.95), and reported reduced perceived access (Mean = 3.12) compared to their urban counterparts. Socioeconomic factors further compounded these disparities. Regression results indicated that region, distance, income, and education significantly predicted perceived access (Adjusted R² = 0.628, p < 0.001). Diagnostic access remains closely tied to geographic and social determinants. Infrastructure expansion alone is insufficient; integrated strategies targeting rural diagnostic decentralization, socioeconomic support, and health literacy are necessary to ensure equitable service delivery. Policy recommendations include mobile laboratories, insurance portability, and equity-driven spatial planning. © 2025, Green Publication. All rights reserved.
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.
Glut 1, S-100, and Nerve Bundle Study in Vascular Anomalies
(Springer, 2023) Ajay K. Khanna; Akhilesh Kumar; Soumya Khanna; Amrita Kar; Puneet Kumar; S.K. Tiwary
Vascular anomalies grouped into vascular tumors (hemangioma) (HI) and vascular malformation (VM) are benign vascular lesions that are difficult to distinguish from one another clinically and often confused with each other at histopathology. This confusing terminology leads to improper diagnosis, illogical treatment, and misdirected research. This study aimed to study GLUT 1, S-100, and nerve bundle to differentiate hemangioma and vascular malformation. Thirty two cases of vascular lesions (26 vascular malformations and 6 hemangiomas) were taken into the study. For histological evaluation and immunohistochemistry (IHC), samples of vascular lesions were collected in formalin. All the hematoxylin and eosin-stained slides were evaluated under light microscope for histology and nerve bundles. Immunohistochemical staining was performed by streptavidin–biotin method for GLUT 1 and S-100. GLUT 1 was positive in all 6 cases of hemangiomas (100%) and only in 1 case of vascular malformation. Nerve bundle was present in 24 cases of vascular malformation (92.3%) out of 26 cases but not in any cases of hemangioma and S-100 was found positive in all vascular malformation cases (100%) but not in hemangioma. So GLUT 1 expression, S-100, and presence of nerve bundle in vascular lesions can help to differentiate hemangioma and vascular malformation. © 2021, The Author(s).
May-thurner syndrome
(Springer Singapore, 2018) Soumya Khanna; Ajay K. Khanna
[No abstract available]
Necrotizing soft tissue infection
(Springer India, 2016) Ajay Kumar Khanna; Parameswaran Sundaran; Soumya Khanna
[No abstract available]
Novel biomarkers in deep vein thrombosis
(Springer Singapore, 2018) Ajay K. Khanna; Manbendra Vaidya; Soumya Khanna
[No abstract available]
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.
Reply of letter to the editor: Assessment and grading of pigmentation in chronic venous insufficiency in Phlebology 2020
(SAGE Publications Ltd, 2023) Satyendra K Tiwary; Praveen KG Kumar; Neeraj Dhameeja; Puneet Kumar; Ajay K Khanna; Soumya Khanna
[No abstract available]