BHU Institutional Repository :: Browsing by Author "Tiwari, Preeti"

Browsing by Author "Tiwari, Preeti"

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A Clinicopathological Study to Assess the Role of Intralesional Sclerotherapy Following Propranolol Treatment in Infantile Hemangioma
(Scientific Scholar LLC, 2021) Kumar, Rakesh; Tiwari, Preeti; Pandey, Vaibhav; Kar, Amrita Ghosh; Tiwary, Narendra; Sharma, Shiv Prasad
As propranolol has emerged as first-line therapy for problematic infantile hemangioma, the number of non-responders and partial responders to propranolol therapy is also increasing. Aims: The study was conducted to evaluate the response of intralesional bleomycin, triamcinolone, and a combination of both as second line of treatment for the residual hemangioma following propranolol therapy Settings and Design: A prospective comparative study was conducted in patients who were either non-responders or partial responders to previous propranolol treatment. Materials and Methods: The patients randomly received injection bleomycin, injection triamcinolone, and combination of both bleomycin and triamcinolone. The response to treatment was recorded clinically by using photographs. The pathological response was assessed by calculating pre-treatment and post-treatment microvessel density in biopsy of lesion from the non-cosmetic sites using immunohistochemistry. Statistical Analysis Used: ?2 test was used to test the association between the variables. The utility of microvessel diameter (MVD) in terms of clinical response to the therapy was predicted by using receiver operating characteristic (ROC) curve. Results: Out of the 134 patients, 42 received bleomycin and 44 received triamcinolone and were treated with a combination of both. The overall clinical response was better in the combination group compared with the bleomycin group (P = 0.018) and triamcinolone group (P = 0.0005), respectively, after 6 months of follow-up. There was no difference in clinical response between the triamcinolone and bleomycin groups. Change in MVD correlated with the clinical response. Conclusion: The combination of bleomycin and triamcinolone is effective and safe for the treatment of residual hemangioma. � 2022 Journal of Cutaneous and Aesthetic Surgery.
Adenomatous Hyperplasia of Palatal Minor Salivary Gland and Angiolipoma of the Floor of Mouth: The First Documented Case Report in a Neonate
(Springer, 2022) Bera, Rathindra Nath; Pandey, Vaibhav; Tiwari, Preeti
Adenomatous hyperplasia of the salivary glands usually affects the parotid gland. Within the oral cavity, palate is the most common site. However, this lesion occurs in adults and till date no case has been documented in neonates. Angiolipomas are a variant of congenital lipomas which undergoes vascular proliferation. Angiolipomas of the oral cavity have not been documented till date among neonates. We herein report the first case of combined angiolipoma of the floor of the mouth with adenomatous proliferation of the minor salivary glands in a neonate. The case was managed through surgical excision, and the follow-up was uneventful. Histopathology confirmed the diagnosis. � 2021, The Association of Oral and Maxillofacial Surgeons of India.
Adverse Drug Reactions Following Propranolol in Infantile Hemangioma
(Springer, 2021) Pandey, Vaibhav; Tiwari, Preeti; Imran, Mohammed; Mishra, Akash; Kumar, Deepak; Sharma, S.P.
Objectives: To assess the adverse effects of propranolol therapy in infantile hemangioma. Methods: An ambispective study was conducted from August 2011 to December 2019. In retrospective arm all children managed for infantile hemangioma with propranolol were included and case records were assessed for adverse reactions. In prospective arm the adverse reactions were identified on the basis of predefined criteria. Results: A total of 514 patients (358 retrospective records) were included. A majority, 378 (73.5%) patients had an excellent response, 75 (14.5%) had partial response and 61 (11.8 %) had no response. A total of 82 (15.9%) patients experienced at least one adverse effect. Diarrhea with weight loss (27, 32.9%) and irritability with decreased sleep (21, 25.6%) were the most common adverse effects. The adverse effects in 22 (4.2%) cases lead to the discontinuation of propranolol. Younger age, low body weight and early onset were risk factors for development of severe adverse reactions. Conclusion: Young children with low body weight were at higher risk for adverse effects of propranolol. � 2021, Indian Academy of Pediatrics.
Bleomycin-triamcinolone sclerotherapy in the management of propranolol resistant infantile hemangioma of the maxillofacial region: A single arm prospective evaluation of clinical outcome and Doppler ultrasound parameters
(Elsevier Masson s.r.l., 2023) Tiwari, Preeti; Bera, Rathindra Nath; Pandey, Vaibhav
Introduction: Propranolol has emerged as a first line agent in the management of hemangiomas. With increased use of propranolol, studies have also focused on relapses following propranolol therapy. Our current study evaluates the role of bleomycin triamcinolone sclerotherapy for the management of propranolol resistant Infantile Hemangioma (IH). We also evaluated the role color Doppler USG for response assessment of sclerotherapy. Methods: Patients with Propranolol resistant (Non- responders/ Partial responders) IHs were included in the study. Patients received intralesional bleomycin at a dose of 0.5 IU/kg followed by intralesional injection of triamcinolone at a dose of 2mg/kg body weight. Clinically patients were grouped into excellent, partial and non responders. Doppler parameters; Resistivity index (RI), Pulsatility index(PI) and Peak systolic velocity (PSV) were used to evaluate the response to sclerotherapy. These parameters were evaluated prior to sclerotherapy and 3 months following completion of therapy. The clinical responses of the patients were compared with the change in Doppler parameters before and after treatment. Results: A total of 115 participants were considered for analysis; 60.86% had excellent response, 32.17% had partial response and 6.95% had poor response. There was a significant change in terms of RI, PI and PSV in patients who were either excellent or partial responders. Poor responders did not have a significant change in Doppler parameters. Conclusion: Combined bleomycin- triamcinolone sclerotherapy is an effective therapy for the management of propranolol resistant IHs. Doppler parameters RI, PI and PSV are reliable indicators of response in the management of IH. � 2022 Elsevier Masson SAS
Capillary Malformation
(Springer Singapore, 2021) Gangopadhyay, Ajay Narayan; Tiwari, Preeti
Capillary malformations (CM), are the most common type of vascular malformations that have been usually referred by multiple confusing terminologies in past like port-wine stain or nevus flammeus. The International Society for the Study of Vascular Anomalies (ISSVA) classified capillary malformations as simple, low flow malformation on the basis of lack of endothelial proliferation, type of vessels, and the type of flow. Capillary malformations are further divided into different subtypes with a distinct clinical presentation, associated anomalies, and etiopathogenesis. The lesions are always congenital, presenting at birth as flat (macular) pink patch which most commonly involves the head and neck region. The lesions vary in color, consistency and undergo changes with age, but never involute with time and persist throughout the life. Different genetic mutations have been identified in association with capillary malformations which may be syndromic or non-syndromic depending upon the time of mutation during the developmental process. The non-syndromic lesions which are cosmetically insignificant do not require any intervention. The decision to treat a patient of CM depends on multiple factors like the site of involvement, associated syndromes, and complication. The modality and timing of treatment also depend on the size and location of the lesion. Flashlamp-pumped pulsed-dye laser (PDL) is the treatment modality of choice for patients with capillary malformations. Other medical and surgical modalities have also shown variable therapeutic efficacy in the lesions. � Springer Nature Singapore Pte Ltd. 2021.
Do medial sural artery perforator flaps have better clinical outcomes compared to the rectus abdominis perforator (DIEAP) flap in reconstruction of glossectomy defects? A Prisma guided meta-analysis
(Wolters Kluwer Medknow Publications, 2021) Bera, Rathindra; Tiwari, Preeti
Background: There is an increasing evidence for the use of thin flaps based on vascular perforators for reconstructive surgeries. The medial sural and deep inferior epigastric artery flaps offer versatility for the reconstruction of major defects of the head and neck. Objectives: 'Whether medial sural artery perforator (MSAP) flap or rectus abdominis perforator flap is better for the reconstruction of glossectomy defects in terms of functional outcome?' Data Sources: PubMed, Cochrane Library, clinicaltrials.gov and hand searches. Participants and Interventions: Patients who underwent tongue reconstruction with either MSAP flap or deep inferior epigastric artery perforator (DIEAP) flap. Study Appraisal and Synthesis Methods: Based on defined study criteria 6 studies were selected according to Prisma Guidelines. The overall estimated effect was categorized as significant where P < 0.05. Results: There was no significant difference between both flaps in terms of receptor site complications (P = 0.223). Overall odds ratio (OR) for complications was 1.35 (95% confidence interval [CI]: 0.412-0.736) and the test for overall effect t value was 2.836, P < 0.05. Overall OR was 6.01 (95% CI 0.5-7.45) and the test for overall effect t value was 1.41, P < 0.05 indicating there was a statistical difference in the intelligibility of speech. Limitations: Anatomical variations, under-reporting of studies and lack of universal tool for speech intelligibility. Conclusions and Implications of Key Findings: Both the flaps are comparable in terms of functional outcome. Medium-sized defects can be reconstructed with MSAP and composite larger defects would benefit from DIEAP. In females, anterolateral thigh flap still remains the choice for composite reconstructions. � 2021 Wolters Kluwer Medknow Publications. All rights reserved.
Does Early Treatment of Paediatric Orbital Fracture Offer Any Advantage in Terms of Post-Operative Clinical Outcomes
(Springer, 2022) Bera, Rathindra Nath; Tiwari, Preeti; Pandey, Vaibhav
Background: Trapdoor fractures commonly occur in children below 6�years of age. The high resiliency of bone, pneumatisation of sinuses and other factors lead to entrapment of muscle and/or soft tissue which undergoes ischaemic changes leading to residual diplopia. The timing of intervention in children ranges from 24�h to greater than 2�weeks. Early surgical intervention is particularly indicated in cases of Oculocardiac reflex. Methods: A Prisma guided systematic review of literature was conducted with no filters on language till September 2020. Studies on paediatric orbital fractures with data on timing of intervention and clinical outcomes were considered eligible for the review. The Oxford Level Of Evidence was used to assess the strength of individual studies. Results: A total of 19 studies (18 English, 1 French) were selected; except for one study all were retrospective series. The timing of intervention ranged from 24�h to more than 1�month. Most of the studies agreed that orbital fractures in children should receive early intervention preferably within 2�weeks. In case of white-eyed blowout fracture, oculocardiac reflex and trapdoor fractures with muscle entrapment surgical intervention should be carried out within 24�48�h. Discussion: Children presenting with facial injuries should be thoroughly examined for signs of muscle entrapment, diplopia, nausea, vomiting and bradycardia. If present these should receive early intervention. In cases with no signs of oculocardiac reflex and muscle entrapment a treatment within 2�weeks is recommended. If diplopia is mild or resolving with minimal hypoglobus and enophthalmos a wait and watch policy should be carried out. � 2021, The Association of Oral and Maxillofacial Surgeons of India.
Evaluating the role of intra articular injection of platelet-rich fibrin in the management of temporomandibular joint osteoarthritis: A STROBE compliant retrospective study
(John Wiley and Sons Inc, 2022) Bera, Rathindra N.; Tiwari, Preeti
Osteoarthritis (OA) is a debilitating disease. A number of treatments like conservative approach, minimally invasive procedures and surgical therapy have proved to be beneficial. However, there is no consensus regarding the use of a single modality of treatment. Our current study evaluates the role of intra articular injection iPRF along with arthrocentesis for the management of temporomandibular joint osteoarthritis (TMJ-OA). A total of 130 patients were selected and divided into two groups, Group A (arthrocentesis only group) and Group B (arthrocentesis +i-PRF). Patients were evaluated for pain scores and maximal mouth opening (MMO). After 1�year, mouth opening in arthrocentesis-only group was 32.13��1.46�mm compared with 36.48��0.89�mm in the i-PRF group (p-value <0.0001). There was a significant reduction in mouth opening in Group A from 6�months to 1�year compared with Group B (p-value <0.001).There was no statistical difference in mean VAS scores at the end of 6�months (p-value 1.00). Addition of iPRF to arthrocentesis did not improve joint pain after 6�months. Nevertheless, repeated injections did have a beneficial effect in MMO. Within the limitations of the study repeated injections of iPRF in conjunction with arthrocentesis might be recommended for the treatment of mild TMJ-OA. � 2021 The British Association of Oral Surgeons and John Wiley & Sons Ltd.
Kite String (Manjha) Injuries Among Children: Single Center Experience Over Four Years
(Springer, 2023) Tiwari, Preeti; Chauhan, Nishtha; Patel, Rahul; Bera, Rathindra Nath; Pandey, Vaibhav
We reviewed hospital records for kite-string injuries among children over four years (2017�2022). Of 42 affected children, mortality was 9.5%. The mean (SD) Pediatric Trauma Score (PTS) was 8.02 (2.66), with passively involved children facing greater severity [mean (SD) PTS, 5.58 (2.23)]. Kite-string injuries, alarmingly, endanger even bystanders, urging stricter preventive strategies. � 2023, Indian Academy of Pediatrics.
Management of Maxillary Sagittal Fracture by using Pre-activated Rapid Maxillary Expansion (RME)
(Springer, 2022) Tiwari, Preeti; Mishra, Nitesh; Rashid, Mohammed; Hirani, Mehul Shashikant
Introduction: Different techniques of the management of sagittal maxillary fractures have been described with different advantages and disadvantages. We herein present our experience and results of managing these cases by reversing pre-activated maxillary expanders and evaluation of its efficacy. Patient and Methods: A prospective study was conducted from April 2016 to February 2020 including all the patients managed for sagittal palatal fractures using the modified technique. The patients were evaluated for healing, occlusion and complications. Results: A total of five patients with sagittal palatal fracture were managed. The mean Glasgow Coma (GCS) score and injury severity score (ISS) of patients were 11.6 � 2.4 and 15.2 � 4.3, respectively. Both had a significant strong negative correlation with a correlation coefficient of ? 0.889 (p = 0.44). The median duration for initiating the treatment for facial fractures was 2�days (range 2�12�days). All patients achieved satisfactory outcomes and tolerated this technique well. No obvious complications were found. Conclusion: This method could produce enough transversal force to reduce fractured fragments and then serve as an external fixator to maintain stability for bony healing. � 2021, The Association of Oral and Maxillofacial Surgeons of India.
Outcome of Mandibular Reconstruction with Fibula free Flaps: Retrospective Analysis of Complications
(Springer, 2023) Murugan, Senthil; Bera, Rathindra Nath; Tiwari, Preeti
Rationale: Fibula free flap has become the workhorse for head and neck reconstruction. In this retrospective study we aimed at determining the outcomes of mandibular reconstruction with fibula free flaps. Methods: Any patient who underwent a mandibulectomy and reconstructed with vascularised fibula flap was included in the study. The predictor variables were age, sex, type of lesion, tobacco and alcohol use, tracheostomy, neck dissection, post operative radio and chemotherapy. Flap failure, fistulas, dehiscence, bone exposure and hardware complications were the outcomes. A P value of < 0.05 was considered statistically significant. Results: 242 patient records were selected for evaluation. PORT, CRT, neck dissection, no. of segments were the factors significantly associated with every complication. Malignant lesion was significantly associated with every complication except for plate fracture. Plate fracture although occurred more frequently with malignant diseases, the association was insignificant. Tobacco consumption was significantly associated with increased incidence of post �operative complications. Alcohol consumption was significantly associated with plate fracture, screw loosening, fistulas, bone exposure and flap failure. Conclusion: Overall the fibula free flap has a success rate of 90.0% with fistulas being the most significant complication. � 2022, Association of Otolaryngologists of India.
Sandwich therapy in the management of propranolol resistant infantile hemangioma of the lip
(Elsevier Masson s.r.l., 2022) Tiwari, Preeti; Pandey, Vaibhav; Bera, Rathindra Nath; Tiwary, Narendra; Mishra, Akash; Sharma, Shiv Prasad
Rationale: Propranolol has evolved as a first line management of infantile haemangiomas. Nevertheless, the resistance to propranolol has warranted alternative treatment modalities. We hypothesize that combination of medical and surgical therapy (sandwich therapy) to be beneficial in the management. Methods: Patients were divided into three groups (total=31), Group A (bleomycin sclerotherapy), Group B (surgical group), Group C (sandwich therapy). A p value <0.05 was taken as significant. Results: In Group A 54.5% of patients had excellent response, 27.3% partial response and 18.2% had no response. Comparing cosmetic outcome, 25% of patients in Group B and 16.7% of patients in Group C had excellent upshot. On the contrary 18.2% of patients in bleomycin had unsatisfactory and 18.2% had poor cosmetic outcome. Sandwich therapy was cosmetically more acceptable than Bleomycin sclerotherapy (p- value = 0.049). In terms of recurrence, sandwich therapy differed significantly from surgical therapy with fewer recurrences (p-value= 0.049). Conclusion: Sandwich therapy is superior to bleomycin sclerotherapy in terms of cosmetic outcome and has fewer recurrences compared to surgical group and requires single stage resection. However, further studies with the help of Doppler ultrasound are required in this regard. � 2022 Elsevier Masson SAS
Temporomandibular joint ankylosis: A tertiary center-based epidemiological study
(Wolters Kluwer Medknow Publications, 2021) Mishra, Nitesh; Sharma, Naresh Kumar; Dhiman, Neeraj Kumar; Jaiswara, Chandresh; Tiwari, Preeti; Singh, Akhilesh Kumar
Introduction: Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint (TMJ) as a sequel to trauma, infection, or autoimmune diseases. The incidence of TMJ ankylosis differs significantly in different parts of the world. The purpose of this study was to analyze the etiological incidence of TMJ ankylosis at our tertiary-level center, which covers a huge population from parts of Bihar and eastern Uttar Pradesh. Materials and Methods: This study was conducted from July 2016 to April 2019, and a total of 1607 children were screened in the duration of 33 months. Participants were included in this study as per the inclusion and exclusion criteria. Results: After screening of the 1607 children, 128 TMJ ankylosis cases were identified. Out of the 128 cases of TMJ ankylosis, 33 cases were bilateral and 95 cases were unilateral (48 left sided and 47 right sided). Most of the patients (83.5%) were in the 10�15-year-old age group (mean age was 12.1 � 2.83 years). There was a female preponderance, and the male-to-female ratio was 7:10. Overall, the most common cause of ankylosis was found to be childhood trauma. Conclusion: The major etiologic factor of TMJ ankylosis was found to be birth/childhood trauma. TMJ ankylosis cases were detected in significant numbers in this study. This increased prevalence may be due to the lack of knowledge about this pathological entity among the general population and health-care professionals at primary level, which leads to poor initial management. � 2021 National Journal of Maxillofacial Surgery.
The clinical utility of steroids in facial trauma: A retrospective study of 638 patients
(John Wiley and Sons Inc, 2022) Tiwari, Preeti; Bera, Rathindra Nath; Chauhan, Nishtha
Glucocorticosteroids reduce post-operative swelling, trismus and pain after third molar extraction, maxillofacial trauma and orthognathic surgery. Steroids may affect immune system and retard wound healing. However, the use of steroids may or may not lead to infection. Patients were divided into two groups based on steroid therapy. The minimum follow-up was for 6�months. Independent t-test and chi-square statistics were used for quantitative and categorical data respectively. A p�<�0.05 was considered significant at 95% confidence interval. A total of 638 patient records were divided into two groups; group A (steroid group) and group B (non-steroid group). After 6�months 45% of group A patients and 2% of group B patients had infection (p value-0.077). The mean duration of analgesic requirement in group A was 3.9��1.5�days compared to 4.4��2.1�days in group B (p�=�0.01). Oedema was present in 9% of patients in group A compared to 12.5% in group B after 1�week (p�<�0.0001). The mean VAS score at 1�week was 0.03��0.18 in group B compared to 0 in group A (p�<�0.001). Use of steroids does not increase the risk of infection. It significantly reduces the duration of analgesic requirement with the reduction in oedema and pain. � 2022 British Association of Oral Surgeons and John Wiley & Sons Ltd.

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