Browsing by Author "Agrawal N.K."

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    Comparative Analysis of Radial Forearm Free Flap and Submental Island Flap in Reconstruction of Post-glossectomy Defects of Oral Squamous Cell Carcinoma and Quality of Life Assessment
    (Springer, 2024) Singh A.K.; Mahajan A.; Anandkumar J.; Sharma N.K.; Durrani F.; Agrawal N.K.; Kumar P.G.N.; Neville J.F.
    Aim: Reconstruction of tongue defects has always been a challenging aspect of onco-surgery. Although a variety of locoregional and free flaps have been advocated, it still poses a challenge due to its complex function in deglutition and speech articulation. Hence, this study aims at reducing the dilemma of flap selection for better patient outcome. Materials and Methods: Among 16 tongue carcinoma cases, 6 cases were reconstructed using submental island flap (SIF) and 10 using radial forearm free flap (RFFF). These 2 flaps were compared in terms of parameters like intraoperative time, hospital stay, overall survival, pain, cosmesis, and recreation of anatomy, and functions like deglutition and articulation of speech. Patients were followed for oncologic safety and recurrence. Obtained data were statistically analysed using IBM� SPSS�. Result: SIF showed significantly higher activity score (P = 0.001) with reduced flap harvest time (P = 0.014) but showed difficulty in deglutition (P = 0.03) compared to RFFF. It was concluded that in cases of RFFF mobility and functional outcome was superior, but flap harvest time was considerably higher. Overall patient survival rate was better in cases of RFFF in long-term follow-up, but flap survival rate was significantly higher in SIF owing to better vascularity. Conclusion: In highly compromised cases and salvage cases where microvascular flaps are contraindicated, submental flap being a local flap with comparable overall survival rate, better cosmesis hence, serves as a reliable flap for reconstruction of glossectomy defects. � The Association of Oral and Maxillofacial Surgeons of India 2024.
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    Congenital adrenal hyperplasia complicated by gonadotropin-dependent precocious puberty
    (BMJ Publishing Group, 2024) Alam A.; Agrawal N.K.; Singh S.K.
    Precocious puberty, characterised by the early appearance of secondary sexual characteristics, poses challenges in diagnosis and management. Here, we describe a case of precocious puberty diagnosed in a boy in middle childhood, who presented with progressive phallus enlargement, pubic hair development and increased aggressive behaviour. Hormonal evaluation confirmed the diagnosis of congenital adrenal hyperplasia (CAH), complicated by gonadotropin-dependent precocious puberty. The case highlights the importance of assessment of testicular volume in a patient presenting with precocious puberty. Symmetrical testicular enlargement in a patient with CAH suggests premature activation of the hypothalamic-pituitary-gonadal axis. The patient received glucocorticoid therapy to suppress androgen production related to CAH and gonadotropin-releasing hormone analogue therapy to control premature activation of the hypothalamic-pituitary-gonadal axis. Follow-up visits showed regression of secondary sexual characteristics and improved growth velocity. � BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.
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    Integrated use of contrast-enhanced and grey-scale ultrasound in assigning American College of Radiology Thyroid Imaging�Reporting and Data System scores for characterisation of thyroid nodules: A prospective observational study
    (SAGE Publications Ltd, 2024) Verma A.; Krishna K A.; Kumar I.; Singh P.K.; Kar A.G.; Agrawal N.K.
    Background: The advent and increased use of high-resolution ultrasonography has resulted in improved detection of thyroid nodules. Even with the use of various Thyroid Imaging�Reporting and Data System, accurate imaging diagnosis of malignant thyroid nodules has been suboptimal, which necessitated use of newer modalities like contrast-enhanced ultrasonography alone and in combination for this purpose. Although the combined use of various Thyroid Imaging�Reporting and Data System and contrast-enhanced ultrasonography has turned out to be accurate in many studies, the ideal way to integrate contrast-enhanced ultrasonography into the Thyroid Imaging�Reporting and Data System algorithm is under-investigated. Purpose: To estimate and compare the diagnostic accuracy of American College of Radiology Thyroid Imaging�Reporting and Data System and contrast-enhanced ultrasonography in differentiating benign and malignant nodules alone and in combination. To estimate the diagnostic accuracy of contrast-enhanced ultrasonography in re-categorisation of Thyroid Imaging�Reporting and Data System 3 and Thyroid Imaging�Reporting and Data System 4 thyroid nodules. Materials and methods: This was a prospective cohort study performed in a tertiary care university�based hospital for 3 years. Adult patients with clinical or previous sonographic diagnosis of thyroid nodules were selected. Each of the nodules were assessed using ultrasonography and categorised using American College of Radiology Thyroid Imaging�Reporting and Data System criteria. The lesion was then assessed for contrast-enhanced ultrasonography features. The final diagnosis of the nodules was made using fine needle aspiration cytology. The diagnostic accuracy in diagnosis of malignant thyroid nodules for each of the American College of Radiology Thyroid Imaging�Reporting and Data System and contrast-enhanced ultrasonography alone and in combination was assessed. The diagnostic accuracy of contrast-enhanced ultrasonography in diagnosis of malignant thyroid nodules categorised as Thyroid Imaging�Reporting and Data System 3 and Thyroid Imaging�Reporting and Data System 4 was also assessed. Results: American College of Radiology Thyroid Imaging�Reporting and Data System had a sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 86.6%, 54.5%, 17.4%, 97.3% and 57.7%, respectively, in diagnosis of malignant thyroid nodules. Contrast-enhanced ultrasonography had a sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 86.6%, 95.4%, 67.9%, 98.4% and 94.4%, respectively, in diagnosis of malignant thyroid nodules. Contrast-enhanced ultrasonography had sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 93.3%, 100.0%, 100.0%, 99.2% and 99.3%, respectively, in re-categorisation of Thyroid Imaging�Reporting and Data System 3 and Thyroid Imaging�Reporting and Data System 4 nodules. Conclusion: Contrast-enhanced ultrasonography can play a key role in diagnosis of malignant thyroid nodules which are categorised as indeterminate on grey-scale ultrasound. � The Author(s) 2024.
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    Molecular study of the KCNJ11 gene and its correlation with Prakriti to preventing and managing type 2 diabetes
    (National Taiwan University, 2024) Singh S.; Gehlot S.; Agrawal N.K.; Singh G.; Singh D.; Kaur P.; Singh S.K.; Singh R.
    In Ayurveda, every individual is believed to possess a unique entity known as Prakriti, which distinguishes them from others physically, physiologically, and psychologically. This entity also determines an individual's response to a particular stimulus, and it is believed that such responses are not solely determined by genetics. The present research aims to validate the Ayurvedic concept of Prakriti from a modern molecular perspective to strengthen the personalized and precise treatment approach. A study was conducted to investigate the role of the KCNJ11gene in the susceptibility of individuals to type 2 diabetes mellitus (T2DM) with their metabolic status. The research involved allele mining on three major Prakriti groups - Vata, Pitta, and Kapha - in 112 patients with T2DM and 112 healthy individuals. The KCNJ11 gene, responsible for insulin secretion membrane pore formation, was analyzed to determine the susceptibility of different Prakriti types to T2DM. The MutPred tool predicted the molecular cause of disease-related amino acid substitution. According to the study, only Pitta and Kapha Prakriti were diagnosed with diabetes, while all three Prakriti types were present in the control group of healthy individuals. A protein model was prepared, and the changes resulting from mutations were observed for each group in their protein sequence, both as synonymous and non-synonymous mutations. Ultimately, these changes contributed to the manifestation of T2DM. Based on the findings, it appears that Prakriti groups may experience changes in protein function due to nonsynonymous mutations and differences in amino acids at the protein level. � 2024 Center for Food and Biomolecules, National Taiwan University
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    Patterns and outcomes of late onset thyroid disturbances after COVID-19 vaccination: A report of 75 cases
    (John Wiley and Sons Inc, 2024) Kaur U.; Reddy N.T.S.; Reddy J.; Krishna D.V.V.; Dehade A.; Agrawal N.K.
    Isolated cases of subacute thyroiditis exist in the early period of COVID-19 vaccination, largely after mRNA vaccines. Here we report late onset thyroid disturbances and persistent health issues in patients of thyroid disorders after COVID-19 vaccination. Seventy-five patients with post COVID-19 vaccination thyroid disturbances were identified. Among these, 41 had flare of underlying thyroid illness, majority occurring at a median time lag of 28.4 weeks since 2nd dose. Thirty-one cases of new onset hypothyroidism and three of new onset hyperthyroidism were reported, with a median time lag respectively of 17.2 and 22.6 weeks since 2nd dose. Most cases occurred after ChAdOx1-nCoV-19, which was the commonest vaccine employed in mass roll out in India. Significant improvement was observed in majority, after a median follow up of 22�26 weeks. New onset health issues persisting for ?4 weeks were reported in 37.3% and were common in individuals with history of COVID-19 before vaccine. New onset metabolic, musculoskeletal, and reproductive disorders were the common health complaints. Active monitoring is warranted for late onset adverse events after COVID-19 vaccines of all types. Larger studies with involvement of unvaccinated individuals are required to understand the incidence and causality of late onset thyroid disturbances after COVID-19 vaccines. � 2023 John Wiley & Sons Ltd.
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    Quality of Life Assessment and Comparative Analysis of Anterolateral Thigh Flap and Pectoralis Major Myo-cutaneous Flap for Reconstruction of Post Excision Defects of Oral Squamous Cell Carcinoma
    (Springer, 2024) Mahajan A.; Kumar J.A.; Singh A.K.; Sharma N.K.; Durrani F.; Agrawal N.K.; JF N.
    Present study is a comparative evaluation of the financial impact on choice of flap, clinical results as well as post resection quality of life assessment of cancer patients reconstructed with anterolateral thigh(ALT) flap and pectoralis major myo-cutaneous(PMMC) flap. Ethical clearance was obtained from institutional ethical committee. In this non-randomised, prospective study design among 49 oral squamous cell carcinoma cases, 39 cases were reconstructed using PMMC flap and 10 using ALT flap from year 2020 to 2022. These 2 flaps were compared in terms of parameters like time utilised for reconstruction, hospital stay, overall survival and Washington University Quality of Life index(UW-QOL) for head and neck cancer. Patients were followed regularly for post-operative complications. The University of Washington Quality of Life score (UW-QOL) questionnaire, version 4, was completed at six months post-operatively. Obtained data was statistically analysed using IBM� SPSS?. Washington University Quality of Life index scores and esthetics are better with Antero-lateral thigh flap, with less overall post-operative complications. On the other hand Pectoralis myocutaneous flap has less surgical time and more salvage potential. Despite of Antero-lateral thigh flap having Good Washington University Quality of Life index scores, lesser post-operative complications and better esthetics; scale of developing nations is still tipping towards economical, less time consuming and less technique sensitive Pectoralis major myocutaneous flap. � Association of Otolaryngologists of India 2024.
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    Recurrent femoral neck fractures: keep an eye out for Cushing�s syndrome
    (BMJ Publishing Group, 2024) Alam A.; Patra S.; Agrawal N.K.; Singh S.K.
    Prolonged glucocorticoid overexposure leads to Cushing�s syndrome (CS). It is characterised by diverse metabolic, cardiovascular and bone mineral manifestations. A middle-aged woman presented for a preoperative evaluation of a pathological fracture of the left neck of the femur. She had a history of a hip fracture on the opposite side 3 years back. She exhibited several features specific to CS and was subsequently diagnosed with Cushing�s disease. She underwent transsphenoidal adenoma resection and achieved remission. Glucocorticoids primarily affect the trabecular bone compared with cortical bones, and vertebral fractures are common in CS. The femoral neck consists of both trabecular and cortical bone and can be involved in CS. Our patient was not diagnosed as C at the first pathological fracture and was subsequently diagnosed only after the second fracture. This case report underscores the importance of a diligent search for a possible endocrinological aetiology in any case of pathological fractures. Copyright 2023 BMJ Publishing Group. All rights reserved.
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    Study of Correlation between Serum Vitamin B12 Level and Aberrant DNA Methylation in Infertile Males
    (Wolters Kluwer Medknow Publications, 2024) Kumar D.; Agrawal N.K.
    Introduction: Altered DNA methylation pattern in sperms has been associated with infertility in males demonstrating defective spermatogenesis or low semen quality. Vitamin B?12, by affecting 1?carbon metabolism pathways, might alter the DNA methylation pattern. We aimed to study the correlation of serum vitamin B12 levels with aberrant DNA methylation in infertile male patients. Methods: A cross?sectional study was conducted on 17 oligozoospermic infertile males (WHO criteria, 2010) and 10 healthy fertile males. Serum vitamin B12 levels were estimated using the chemiluminescence method. Global methylation was determined using the ELISA system (Imprint Methylated DNA Quantification Kit, Sigma�Aldrich). The levels of global DNA methylation were calculated and compared relative to the methylated (100%) control DNA provided with the kit. Results: Mean serum vitamin B12 concentration in the control group was higher than that of the case group. This difference in serum vitamin B12 concentration in both groups was found statistically significant. Although the results of this study show that oligozoospermic men have relatively lower global DNA methylation as compared to normozoospermic control, the values could not reach a statistically significant level. A small positive correlation was found between serum vitamin B12 levels and percent methylation defect (r = 0.14) but was statistically insignificant. Conclusion: Our study concludes that oligozoospermic infertile males have a significant deficiency of vitamin B12 as compared to normozoospermic fertile males. This study did not find any significant difference in global DNA methylation between the two groups. The present study does not suggest any correlation between serum vitamin B12 level and percent DNA methylation. � 2024 Indian Journal of Endocrinology and Metabolism.