Papers by Jitendra Pariyar
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predicting outcome of CC. Performance was primarily evaluated using the sensitivity, specificity,... more predicting outcome of CC. Performance was primarily evaluated using the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Results We constructed and trained a multi-instance deep convolutional neural network (CCOSNet) based on a multiscale attention mechanism, in which an internal independent test set (50 patients in total) were used to evaluate the predictive performance of the network. Our network achieved an AUROC=0.88 in the cross-validation set and an AUROC=0.79 in the internal independent test set of the FUSCC cohort. The biomarker provided a hazard ratio for poor versus good prognosis of 7.058 (P = 0•009) in the primary analysis of the validation cohort. Conclusion/Implications A clinically useful prognostic marker was developed using deep learning allied to digital scanning of conventional H&E-stained tumour tissue sections, which will offer assistance to choose appropriate treatment to improve the survival status of CC patients.
Background Cervical cancer remains the leading cause of cancer-related death among Nepalese women... more Background Cervical cancer remains the leading cause of cancer-related death among Nepalese women. To this effect, Cancer Care Nepal established an international collaboration to implement a 'training of trainers' (TOT) program to expand the reach of cervical cancer prevention techniques. Methods The Nepal cervical cancer prevention program began with an in-person TOT session in Kathmandu in November 2019. Due to the COVID-19 pandemic, two additional TOT courses were held in October and November 2021 with virtual support, didactic lectures from international faculty, and a hands-on component by Nepalese faculty. The Nepalese providers underwent training in these courses and then held further training in five collaborating centers across Nepal. Participants completed pre-and post-course knowledge assessments. The trainings were supplemented by the creation of a new Project ECHO® (Extension for Community Healthcare Outcomes) telementoring hub at Cancer Care Nepal. A capstone refresher course was held in November 2022. Results 42 participants attended the initial TOT course in 2019. The two follow-up TOT courses held in October/November 2021 were two days long and included providers from five participating regions in Nepal. The courses included virtual didactic sessions followed by hands-on stations led by the Nepalese faculty who had participated in the 2019 TOT course. The stations included: visual inspection with acetic acid (VIA), colposcopy, thermal ablation, and loop electrosurgical excision procedure (LEEP). There were 41 participants in the October/November TOT courses. The trainers who received the TOT education then conducted local courses of similar content in each of the five regions for 152 local providers. Participants had improved mean knowledge scores after the training (0.70, 95% CI=0.67-0.72) in comparison to prior to training (0.50, 95% CI=0.47-0.53), p<0.001. The program concluded with a capstone course in November 2022 attended by 26 participants. To date, 11 Project ECHO sessions have been held, with an average of 20 participants per session. Conclusions Nepal's cervical cancer prevention program has increased the number of providers trained in cervical cancer prevention techniques. By increasing provider capacity, individuals will have increased access to cervical cancer screening and treatment of pre-invasive disease, hopefully decreasing the burden of cervical cancer in Nepal. Despite being both a preventable and potentially curable disease, cervical cancer is the fourth most common cause of cancer among women globally, with approximately 604,000 cases of cervical cancer and 342,000 related deaths diagnosed in 2020. 1,2 Highlighting great disparities in healthcare delivery, 90% of cervical cancer-related deaths occur in
Journal of Pathology of Nepal, Feb 25, 2021
Struma ovarii, also known as goiter of the ovary is a rare disease.1 Considering the rarity of th... more Struma ovarii, also known as goiter of the ovary is a rare disease.1 Considering the rarity of this tumor and constrained literature in Nepal's context, we hereby present a case of a 46-year-old female, asymptomatic, with normal blood parameters who presented with an abdominal mass. She was suspected of malignant ovarian mass on an ultrasonogram. Intraoperative frozen section examination revealed a benign tumor suggestive of dermal tumor versus struma ovarii. Postoperatively, histopathological examination was performed to assess the percentage of thyroid tissue and a diagnosis of benign struma ovarii was made which was confirmed by thyroglobulin positivity on immunohistochemistry. No features of immature teratoma and malignancy were identified.
Synchronous primary neoplasms are defined when two or more neoplasms take place concurrently in t... more Synchronous primary neoplasms are defined when two or more neoplasms take place concurrently in the same patient. Concomitant endometrial adenocarcinoma and uterine leiomyosarcoma are extremely rare. Here we present an extremely rare case of uterine leiomyosarcoma coexisting with endometrial endometrioid adenocarcinoma of the uterus. A 52-year-old woman was reported to a gynecology outpatient clinic with chief complaints lower abdominal pain, severe dysmenorrhea, and irregular vaginal bleeding for 7 months. Ultrasound of pelvis and abdomen showed a solitary intramural fibroid measuring 10x10 cm. Surgery was planned and a simple total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed and specimen was sent to the laboratory for examination. Histopathological examination from intramural mass showed high-grade leiomyosarcoma, spindle cell type with less than 50% of myometrial invasion. Sections from thickened endometrium showed endometrial endometrioid adenocarcinoma, FIGO grade I with an invasion of superficial fascicles of myometrium (<50%). Morphological diagnosis was supported by immunohistochemistry. Here we report an exceptionally rare case of synchronous uterine leiomyosarcoma and endometrial endometrioid adenocarcinoma. Our study may contribute to understand the prognosis of such multiple malignancies, common associations, and etiology of the disease so that a proper plan for further management of the patient can be implemented.
Journal of Karnali Academy of Health Sciences, Dec 31, 2018
Journal of Clinical Oncology, May 20, 2008
16578 Background: The pre-operative knowledge regarding the nature of adnexal mass is necessary s... more 16578 Background: The pre-operative knowledge regarding the nature of adnexal mass is necessary so that optimal surgery can be planned at the time of initial treatment. Tumour markers and/or radiol...
Nepalese journal of cancer, Sep 30, 2018
Introduction: Gynecological malignancies in pediatric and adolescent group are common. Germ cell ... more Introduction: Gynecological malignancies in pediatric and adolescent group are common. Germ cell tumors and gestational trophoblastic neoplasia are the most frequently found malignancies which are highly chemosensitive. With prompt and appropriate treatment higher cure rate is attainable in such malignancies even in resource constraints country like Nepal. Objective: To study the clinicopathological profile and treatment outcome of gynecological malignancies among pediatric and adolescent group seeking treatment at B.P. Koirala Memorial Cancer Hospital (BPKMCH), Nepal. Methodology: Descriptive study was done at BPKMCH Nepal. All available case records of pediatric and adolescent girls diagnosed to have gynecological malignancies from 2002 to 2011 were collected and analyzed in terms of age, clinical features, malignancy types, treatment modalities and outcome. Results: Total 60 girls were eligible for the study. There were five patients (8.3%) below five years, 14 (23.3%) between 6-12 years and 41 (68.4%) patients between 13-19 years. Gynecological malignancies observed among the study group were: ovarian cancer in 46 (76.66%), gestational trophoblastic disease in 11 (18.33%), uterine cancer in two (3.33%) and vaginal cancer in one (1.66%). Among the ovarian cancers, 42 had malignant germ cell cancer (91.3%), three had epithelial ovarian cancer (6.5%) and one had juvenile granulose cell tumor. The commonest presentation was abdominal distension and pain in 70%. Onset of symptoms ranged from three days to 730 days (mean 95 days). Early stage disease was noted in 18 (30%) and advanced disease in 42 (70%). Eight (13.33%) underwent fertility sparing surgery only, 21(35%) underwent chemotherapy only and 31(51.66%) underwent multimodality treatment. Twenty (33.33%) defaulted and 40 (66.66%) completed treatment among which progressive disease and mortality was recorded in seven (17.5%) patients and 33(82.5%) attended cure. Conclusion: Malignant germ cell cancer is the commonest gynecologic malignancy among pediatric and adolescent girls. In country where childhood marriage is still prevalent, GTT is also more common among adolescent girls. Early presentation and prompt appropriate treatment would offer chances of cure even with preservation of fertility.
Nepalese journal of cancer, Sep 30, 2018
Introduction: Gynecological malignancies in pediatric and adolescent group are common. Germ cell ... more Introduction: Gynecological malignancies in pediatric and adolescent group are common. Germ cell tumors and gestational trophoblastic neoplasia are the most frequently found malignancies which are highly chemosensitive. With prompt and appropriate treatment higher cure rate is attainable in such malignancies even in resource constraints country like Nepal. Objective: To study the clinicopathological profile and treatment outcome of gynecological malignancies among pediatric and adolescent group seeking treatment at B.P. Koirala Memorial Cancer Hospital (BPKMCH), Nepal. Methodology: Descriptive study was done at BPKMCH Nepal. All available case records of pediatric and adolescent girls diagnosed to have gynecological malignancies from 2002 to 2011 were collected and analyzed in terms of age, clinical features, malignancy types, treatment modalities and outcome. Results: Total 60 girls were eligible for the study. There were five patients (8.3%) below five years, 14 (23.3%) between 6-12 years and 41 (68.4%) patients between 13-19 years. Gynecological malignancies observed among the study group were: ovarian cancer in 46 (76.66%), gestational trophoblastic disease in 11 (18.33%), uterine cancer in two (3.33%) and vaginal cancer in one (1.66%). Among the ovarian cancers, 42 had malignant germ cell cancer (91.3%), three had epithelial ovarian cancer (6.5%) and one had juvenile granulose cell tumor. The commonest presentation was abdominal distension and pain in 70%. Onset of symptoms ranged from three days to 730 days (mean 95 days). Early stage disease was noted in 18 (30%) and advanced disease in 42 (70%). Eight (13.33%) underwent fertility sparing surgery only, 21(35%) underwent chemotherapy only and 31(51.66%) underwent multimodality treatment. Twenty (33.33%) defaulted and 40 (66.66%) completed treatment among which progressive disease and mortality was recorded in seven (17.5%) patients and 33(82.5%) attended cure. Conclusion: Malignant germ cell cancer is the commonest gynecologic malignancy among pediatric and adolescent girls. In country where childhood marriage is still prevalent, GTT is also more common among adolescent girls. Early presentation and prompt appropriate treatment would offer chances of cure even with preservation of fertility.
Nepalese journal of cancer, Sep 30, 2018
Leukaemia during pregnancy is rare, occurring approximately one in every 75,000 to 100,000 pregna... more Leukaemia during pregnancy is rare, occurring approximately one in every 75,000 to 100,000 pregnancies annually. Chemotherapeutic agents may have harmful effects to the developing baby though leukaemia itself rarely harms the baby. There is no evidence that pregnancy accelerates the progression of disease or affects the outcome. However, treatment dilemmas often occur. Aims: To study the clinical presentation, treatment and outcome of leukaemia with pregnancy managed at B. P. Koirala Memorial Cancer Hospital (BPKMCH). Methods: Descriptive study was conducted at BPKMCH. Case records of women with cancer and pregnancy from January 2006 to February 2013 were analyzed regarding their clinical details, treatment, follow-up and fetomaternal outcome. Results: Six women, of 20 to 28 years had leukaemia with pregnancy among which four were chronic myeloid leukaemia (CML), one was acute lymphocytic leukaemia (ALL) and acute myeloid leukaemia (AML) each. All four cases of CML had conceived while on oral Imatinib; the three case diagnosed in the first trimester opted for immediate termination of pregnancy while the fourth one diagnosed at 22 weeks of pregnancy continued pregnancy and delivered at 34 weeks by emergency caesarean section for severe oligohydramnios. The ALL case diagnosed at 26 weeks of pregnancy wanted termination of pregnancy and immediate induction chemotherapy. The AML case diagnosed at 32 weeks of pregnancy desired to undergo induction chemotherapy with pregnancy but she defaulted treatment and had intrauterine fetal death and died due to postpartum haemorrhage. The baby, delivered to a mother exposed to Imatinib throughout pregnancy, till date has normal growth and development. Five mothers are in remission. Conclusions: Leukaemia with pregnancy, more common in younger women is rare and posed treatment challenges. Definitive treatment should be individualized according to the desire of the pregnant woman and should include a multidisciplinary team.Termination of pregnancy in favour of definitive chemotherapy to mother is better and easier during the first trimester of pregnancy. Because of teratogenic effects of chemotherapy, effective contraception be used during therapy to prevent pregnancy.
Nepalese journal of cancer, Sep 30, 2018
Leukaemia during pregnancy is rare, occurring approximately one in every 75,000 to 100,000 pregna... more Leukaemia during pregnancy is rare, occurring approximately one in every 75,000 to 100,000 pregnancies annually. Chemotherapeutic agents may have harmful effects to the developing baby though leukaemia itself rarely harms the baby. There is no evidence that pregnancy accelerates the progression of disease or affects the outcome. However, treatment dilemmas often occur. Aims: To study the clinical presentation, treatment and outcome of leukaemia with pregnancy managed at B. P. Koirala Memorial Cancer Hospital (BPKMCH). Methods: Descriptive study was conducted at BPKMCH. Case records of women with cancer and pregnancy from January 2006 to February 2013 were analyzed regarding their clinical details, treatment, follow-up and fetomaternal outcome. Results: Six women, of 20 to 28 years had leukaemia with pregnancy among which four were chronic myeloid leukaemia (CML), one was acute lymphocytic leukaemia (ALL) and acute myeloid leukaemia (AML) each. All four cases of CML had conceived while on oral Imatinib; the three case diagnosed in the first trimester opted for immediate termination of pregnancy while the fourth one diagnosed at 22 weeks of pregnancy continued pregnancy and delivered at 34 weeks by emergency caesarean section for severe oligohydramnios. The ALL case diagnosed at 26 weeks of pregnancy wanted termination of pregnancy and immediate induction chemotherapy. The AML case diagnosed at 32 weeks of pregnancy desired to undergo induction chemotherapy with pregnancy but she defaulted treatment and had intrauterine fetal death and died due to postpartum haemorrhage. The baby, delivered to a mother exposed to Imatinib throughout pregnancy, till date has normal growth and development. Five mothers are in remission. Conclusions: Leukaemia with pregnancy, more common in younger women is rare and posed treatment challenges. Definitive treatment should be individualized according to the desire of the pregnant woman and should include a multidisciplinary team.Termination of pregnancy in favour of definitive chemotherapy to mother is better and easier during the first trimester of pregnancy. Because of teratogenic effects of chemotherapy, effective contraception be used during therapy to prevent pregnancy.
Journal of Perinatal Society of Nepal
Introduction: Caesarean delivery is the most commonly performed lifesaving procedure in obstetric... more Introduction: Caesarean delivery is the most commonly performed lifesaving procedure in obstetrics. Caesarean section can be done in emergency and elective basis. There has been rising trend of caesarean section over the last few decades. Both the caesarean sections are associated with fetal risks than vaginal delivery. Objectives: To assess and compare the perinatal outcomes of emergency and elective caesarean sections. Methods: It was a cross-sectional comparative study done in Civil Service Hospital of Nepal over the period of one year starting from January 2021 to December 2021. All the patients who underwent caesarean section during the study period were taken into study. Data regarding perinatal outcomes were analysed by SPSS software. Results: During the study period, there were 1349 total deliveries. Caesarean sections accounted for 52.2% (n=705) of all deliveries. There were a total of 373 (52.9%) emergency CS and 332 (47.1%) elective CS. Most common indications of emergenc...
Background: Early Childhood Caries (ECC) damages the tooth, adversely affects oral cavity and gen... more Background: Early Childhood Caries (ECC) damages the tooth, adversely affects oral cavity and general health. Gynecologists and pediatricians regularly visited by mothers during antenatal and after childbirth have important role in prevention of ECC. Methods: A cross sectional quantitative study was conducted among gynecologists and pediatricians working in various hospitals of Nepal from January 15 to March 15, 2020. The self-validated questionnaire consisted questions on demographic details, knowledge, attitude, and practices of respondents on ECC. The responses were tabulated and analyzed. Results: Total 205 out of which 132 gynecologists and 73 pediatricians participated in the study. Seventy-four percent of pediatricians examined teeth for cavities, 88 % suggest brushing twice daily and 83% referred children with oral diseases and dental caries to pediatric dentist. Majority (78%) of the respondents knew dental caries as an infectious disease and 91% thought untreated dental disease could cause systemic complications. About half (54.7%) answered first year to be ideal for the first dental visit, 51.3% thought dental visit should be every six monthly and 71.2% counselled children and parents on the importance of tooth brushing. Only 24% and 34% participants were aware of vertical transmission of bacteria and child born to a pregnant woman with dental caries could have ECC respectively. Ninety-four percent of the practitioners feel that they have a role in prevention of oral diseases. Realizing the importance, 83% of pediatricians and gynecologists desire to take oral health training. Conclusions: Moderate knowledge and attitude about childhood caries is reported among a sample of Nepalese gynecologists and pediatricians which signifies the importance of oral health training among these groups of practitioners. Keywords: Early childhood caries, Gynecologist, Knowledge, Pediatrician
• To compare post-platinum treatment outcomes between published and real-world sources in patient... more • To compare post-platinum treatment outcomes between published and real-world sources in patients with advanced/ recurrent EC Real-world data analysis • Treatment regimen and duration data were obtained from IBM ® MarketScan ® US Commercial and Medicare Supplemental claims databases from 01/2014 to 11/2018 (Figure 1)
Asian journal of oncology, Jul 1, 2016
Introduction: Mucinous ovarian carcinomas are less common than serous and endometriod type, and a... more Introduction: Mucinous ovarian carcinomas are less common than serous and endometriod type, and are more frequently confined to the ovary at the time of diagnosis. But primary signet ring cell mucinous carcinomas of the ovary are extremely rare. Case Presentation: A 40 yr old patient presented with extremely rare primary signet cell mucinous carcinoma of ovary. She presented with abdominal distension and frequency of urination for one month. She was evaluated and CECT whole abdomen was s/o large left ovarian mass. All the tumor markers were with in normal range. Laparotomy frozen section of left adnexal mass was done and was reported as malignant with sheets of signet ring cells seen. Hence complete staging laparotomy including TAH with RSO with bilateral pelvic lymph node dissection with total omentectomy with para aortic lymph node dissection. Final histopathology with IHC markers were S/O primary signet ring cell carcinoma of ovary with no extracapsular invasion, no lymph nodal involvement & no metastatic spread. Conclusion: We present a very rare case of primary signet ring cell of ovary, confined to ovary itself. On literature review only 14 cases have been reported and of them very few are malignant.
pharmacovigilance of many important Ayurvedic drugs are still not fully explored. Moreover, the c... more pharmacovigilance of many important Ayurvedic drugs are still not fully explored. Moreover, the comprehensive knowledge of the basic ideologies of Ayurveda is poorly acceptable scientifically due to lack of evidence. In the modern time, when the Western medicinal system is reached almost at the top because of validated research and advanced techniques. Methods. There is a lack of cooperation and willingness of Biomedical Scientists who are often unduly skeptical and carry prejudice. More than a thousand Ayurvedic postgraduates pass out each year and enter into the streamline of academics and practice. Among them, only a few choose their profession as researcher in Ayurveda. Neither has the Ayurvedic teaching changed in the last 50 years nor have the textbooks enriched with new research methodologies. Results Basic differences between Ayurveda and modern science should be taken into account when designing the research protocols• The main concern must be given to the classical approach of AyurvedaPrakriti, Agni, Dhatu, Srotas, Rasayana, Shatkriyakala, Agnibala, Ojabala, Manobala, etc. Conclusions The drug should be the last rather than first mean of treatment, beginning with the natural healing method like Ayurveda. One of the Ayurvedic treatment modalities such as Panchkarma can remove disease before its manifestation. Having all the above beauties, Ayurveda is still lagging behind because of the lack of scientific evidence in many cases and poor research methodology.
Nepalese journal of cancer, Oct 8, 2020
Introduction: Pediatric Germ cell tumors are rare disease in pediatric and adolescent age group. ... more Introduction: Pediatric Germ cell tumors are rare disease in pediatric and adolescent age group. Germ cell tumors are the most frequently found malignancies which are highly chemosensitive. GCTs are curable if diagnosed and treated adequately even in resources poor setting in resource constraints countries like Nepal. Objective: To study the clinicopathological profile and treatment outcome of Pediatrics Germ cell tumors (GCTs) among children and adolescent group seeking treatment at B.P. Koirala Memorial Cancer Hospital (BPKMCH), Nepal. Methodology: Descriptive study was done at BPKMCH Nepal. All available case records of pediatric and adolescent girls diagnosed to have GCTs from 2002 to 2011 were collected and analyzed in terms of age, clinical features, malignancy types, treatment modalities and outcome. Results: Total 70 girls were with female gynecological malignancy. There are 46 (76.66%) with ovarian malignancies. Among the ovarian cancers, 42 had malignant germ cell cancer (91.3%) among all ovarian malignancies which are enrolled in the study. The commonest presentation was abdominal distension and pain in 70%. Onset of symptoms ranged from three days to 730 days (mean 95 days). Disease stage at presentation was early stage 18 (30%) and advanced disseminated disease 42 (70%). In treatment modality, 8 (13.33%) underwent fertility sparing surgery only, 21(35%) underwent chemotherapy only and 31(51.66%) underwent multimodality treatment. 82.5% patients who were completed recommended treatment were cured. Conclusion: Malignant germ cell cancer is the commonest ovarian malignancies among pediatric and adolescent girls. Early presentation and prompt appropriate treatment would offer chances of cure even with preservation of fertility.
International journal of gynaecology and obstetrics, Oct 1, 2012
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Papers by Jitendra Pariyar