Malignant melanoma is a potentially aggressive and lethal tumour of melanocytic origin. The incid... more Malignant melanoma is a potentially aggressive and lethal tumour of melanocytic origin. The incidence is 1-3% of all malignancies with a death rate of 1-2% (amongst all cancers). 1 Cancer registries in India report an incidence of less than 0.5%. One third of patients develop metastasis, the median time to metastasis in localized disease being 28 months. 2 A 65 year-old female presented with sudden onset multiple swellings over the body (one month duration). [Figure 1] There was a history of significant weight loss (8 kgs in past 2 months). There was a history of removal of a black spot on her foot 3 years back. Documents revealed excisional biopsy with a histopathological diagnosis of nodular malignant melanoma (stage 2b, tumour depth of 5mm into the reticular dermis, without lymphovascular invasion, no ulceration and 4mm free margin from the edge). Adjuvant chemotherapy was not given.
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: Gallbladder cancer (GBC) is one of the commonest cancers in North India. Despite th... more Introduction: Gallbladder cancer (GBC) is one of the commonest cancers in North India. Despite the high incidence, very little data is available of the staging distribution of GBC in this region. We aimed at getting a snapshot of the distribution of GBC at a single high volume centre. Material and Methods: One hundred and forty seven patients who were evaluated between 1 st July 2017 and 31 st October 2018 for staging of GBC, were included in this study. Radiological staging was done according to the AJCC TNM 8 th edition using a standardized reporting format. Results: Majority of patients were females (70%). Fundus of GB was the most common site of tumor (39.4%) and liver (76.8%) was the most common adjacent organ involved as well as the most common site of metastatic disease (36%). Only 42 (28.5%) patients had non-metastatic disease. Biliary obstruction was present in 63 (42.8%) patients, with majority being type 2 hilar blocks (65%). Loco-regional nodal involvement was present in 87.1% patients, station 12 nodal involvement being most common (76.1%). Conclusion: This is the first study to describe the distribution of GBC stages in the high incidence region of North India. This should provide information for future research and funding for GBC related research.
2017 IEEE International Conference on Communications Workshops (ICC Workshops), 2017
In this paper, we propose the use of OFDM-CDMA based transmission schemes to support Variable Bit... more In this paper, we propose the use of OFDM-CDMA based transmission schemes to support Variable Bit Rate (VBR) services at the physical layer of Digital Video Broadcast Satellite Handheld (DVB-SH)-A architecture. For this purpose, multicarrier schemes namely Spread Orthogonal Frequency Division Multiplexing (SOFDM), Complementary Code Keying (CCK-OFDM) and conventional OFDM are analyzed over integrated satellite-terrestrial system, employing 3-state Fontan Land Mobile Satellite (LMS), and TU6 and RA6 terrestrial channel models. Variable rates are assumed for SOFDM and CCK-OFDM. The VBR multicarrier performance analysis over the employed integrated system would be helpful in investigating the 5G communication scenario in future. At the receiver, linear Minimum Mean Squared Error (MMSE) equalizer is applied for the considered multicarrier schemes. The BER performance results illustrate that SOFDM outperforms OFDM, and CCK-OFDM for all the considered data rates, in both the Land Mobile Satellite (LMS) and terrestrial channel conditions. Later, the block-by-block system computational complexity of the multicarrier schemes is evaluated. It is shown that the complexity of SOFDM system is rate-dependent as compared to the fixed complexity CCK-OFDM system. Hence, a trade-off exists between the achieved error performance and system complexity. Therefore, for high data rate transmission SOFDM scheme could be a suitable candidate for integrated satellite-terrestrial communication system, or 5G satellite system in future.
2021 Second International Conference on Electronics and Sustainable Communication Systems (ICESC), 2021
In current technology, the majority of data is transferred over the internet, and the most useful... more In current technology, the majority of data is transferred over the internet, and the most useful data type is image. As a result, image security is necessary for safe transmission. Image security methods are used to safeguard the image. Low MSE and high PSNR values are necessary for improved hiding. This paper shows the comparative analysis of DCT, LSB and XOR image security techniques and obtained the MSE and PSNR values from these techniques and shown techniques, which provided the better image security.
Dear Editor, Psoriatic patients with HIV infection often present with a more severe and refractor... more Dear Editor, Psoriatic patients with HIV infection often present with a more severe and refractory disease course. Psoriasis has been seen at all stages of HIV infection, occasionally presenting as the initial manifestation. A 35-year-old diabetic female with a 1-year history of chronic plaque psoriasis without Psoriatic arthritis presented with an erythrodermic flare for one month. Initial evaluation 1 year ago had revealed HIV seropositivity and she is on antiretroviral therapy since. Prior treatment history for Psoriasis includes acitretin and cyclosporine. Cyclosporine was withdrawn after the patient developed diastolic hypertension. Prior to flare, the patient was on acitretin (25 mg) twice daily for the past 6 months with good disease control. On physical examination, the patient was obese (BMI: 32.2 kg/m). Cutaneous examination showed erythroderma with the Psoriasis assessment severity Index (PASI) of 34.7 (Figure 1A). Dermatology life quality index (DLQI) score was 24. Psoriatic erythroderma being an emergency, and considering the limited therapeutic options available, we chose an anti-TNFα blocker, Etanercept. Prior tuberculosis infection was excluded and baseline investigations were conducted; Chest X-Ray was normal; Tuberculin Skin test, TB Quantiferon Gold Assay, Hepatitis B and C serology were negative and CD4 count prior to therapy was 580 cells/μl. Considering financial restrictions and difficulty in commuting frequently, Etanercept dosing was modified to once-weekly subcutaneous injections of Inj.Etanercept (50 mg). Clinical improvement was noted from fourth week onwards with PASI being 3.3 at the end of six weeks of therapy (Figure 1B). Noting monetary issues, Etanercept had to be discontinued after sixth week, and sequential therapy with acitretin (25 mg) twice daily was started. CD4 count and DLQI post-treatment were 545 cells/μl and 5, respectively. No opportunistic infections were seen. Anti-TNFα therapy (Infliximab, Adalimumab, and Etanercept) is relatively contra-indicated in HIV infection, which is usually excluded before starting therapy. However, TNFα is also seen to be elevated in all stages of HIV infection, possibly responsible for fatigue, fever, and cachexia. Overall, limited experience of anti-TNF agents in HIV positive patients
Indian Journal of Otolaryngology and Head & Neck Surgery, 2020
Verrucous carcinoma (VC) is a locally invasive uncommon histopathological variant of oral squamou... more Verrucous carcinoma (VC) is a locally invasive uncommon histopathological variant of oral squamous cell cancer. There is paucity of literature regarding control rates in these cases. We intend to report the outcomes in terms of administered treatment and control rates. 28 patients of oral cavity verrucous carcinomas treated at our institute from March 2014 to December 2018 were reviewed retrospectively. Demographic profile, histopathological features and clinical outcomes were analyzed. Statistical analysis was performed with SPSS for Mac (version 23.0). Median age was 54 years (range 31-75) with M:F ratio of 25:3. Buccal mucosa was the most common site. All patients underwent surgical resection except one. Of these, 24 had neck dissection; 12 had supra-omohyoid neck dissection, eleven had modified neck dissection and one patient underwent radical neck dissection. Three patients had their histology upgraded to squamous cell carcinomas in the post-operative histopathology. The post-operative staging was as follows: 21% stage I and 35% stage II. One patient opted for non-surgical approach and received radical concurrent chemoradiotherapy. Median follow up was 12 months (range 6-36). Two patients had local failures and one had a regional failure. No distant metastasis was found. There was one death. 14-Months survival rate was 92%. Estimated 18 month loco-regional control rate was 92%. Curative surgical resection remains the cornerstone for VC of oral cavity. Any change of histopathology post-operatively to squamous cell carcinoma is a poor prognostic sign and needs appropriate adjuvant treatment.
Journal of Medical Science And clinical Research, 2018
Background: Ovary is a paired organ located in pelvic cavity of women. Despite being small in siz... more Background: Ovary is a paired organ located in pelvic cavity of women. Despite being small in size, ovary is an organ that requires the attention of several specialties like gynaecology, endocrinology and pathology. It is the common site for neoplastic and non-neoplastic lesions. That is why ovary constitutes a major health concerns for women all over the world. Aims: To study histomorphological spectrum of ovarian tumors in a tertiary care centre of kumaon region of uttarakhand. Settings and Design: Cross sectional study. Material and Methods: This is one year study of 54 cases of ovarian tumors, submitted for histopathological examination in the department of pathology, GMC Haldwani. Clinical history and examination were recorded and histopathological evaluation of specimen was done. Ovarian tumors were classified according to WHO Classification 2016. Results: Out of total 54 ovarian tumors studied, 40 (74.1%) cases were of benign tumors and 13 (24.1%) were of malignant tumors. There was only 1(1.8%) case of borderline tumor. Among total 54 tumors, 35 (64.8%) were epithelial, 18 (33.3%) were germ cell and 1 (1.8%) was sex-cord stromal tumor. Age of presentation ranged from 12 to 80 years. Pain in lower abdomen was the commonest presentation. Conclusions: This study will provide histomorphological spectrum of ovarian tumors in this region which will help in proper management and prognosis of the patients.
In this paper, the exact closed-form Signal-to-Interference-Noise Ratio (SINR) expression, for th... more In this paper, the exact closed-form Signal-to-Interference-Noise Ratio (SINR) expression, for the joint impact of Carrier Frequency Offset (CFO) and Phase Noise (PHN) is derived for each channel link in multi-relay hybrid satelliteterrestrial broadcast system, employing Walsh Hadamard (WH) based Spread-Orthogonal Frequency Multiplexing (S-OFDM) and OFDM transmission scheme at satellite terminal and terrestrial repeaters (relays) respectively. Additionally, Bit Error Rate (BER) and spectral efficiency is analyzed for such hybrid system with M-relay, based on the obtained SINR expressions. To examine that, Adaptive Decode and Forward (ADF) strategy is employed at relay terminals. Also, 3-state Fontan Land Mobile Satellite (LMS) and 6-path Typical Urban (TU6) terrestrial channel models are considered. This analysis is performed to support Variable Bit Rate (VBR) Quality of Service (QoS) at the physical layer of Digital Video Broadcast Satellite Handheld (DVB-SH)-A architecture, the provision of which is absent in DVB-SH standard. Variable Bit Rates (VBR)s are assumed for S-OFDM. The results illustrate that both single-relay and three-relay ADF based VBR WH-SOFDM yield an identical performance in presence of the combined effect of CFO and PHN, under both the performance measures. However, the improvement in performance for three-relay strategy is observed in presence of only CFO. Further, Pilot-based channel estimation technique is performed at the receiver and estimated error variance is evaluated for every channel link. Later, the blockby-block system computational complexity of singlerelay and Mrelay ADF based VBR WH-SOFDM is evaluated. It is shown that the complexity of M-relay ADF strategy is ratedependent and almost M-1 times the single-relay strategy. Hence, an increase in the number of relays would not yield any significant performance gain, but would enhance the system computational complexity considerably. Therefore, for high data rate transmission single-elay ADF based WH-SOFDM scheme could be a suitable candidate for hybrid satellite-terrestrial communication system in future.
The current study investigates the role of circulating free DNA (cfDNA) as a liquid biopsy in dia... more The current study investigates the role of circulating free DNA (cfDNA) as a liquid biopsy in diagnosis gall bladder carcinoma (GBC) utilizing levels of long DNA fragments (ALU247) derived from tumor necrosis, short apoptotic fragments (ALU115) denoting total cfDNA and cfDNA integrity denoting ratio of ALU247 and ALU115. The global methylation status of cfDNA was also estimated with the hypothesis that these parameters provide a diagnostic distinction between cancer and non-cancer subjects, with higher or altered values favoring presence of malignancy. Study group included 60 cases of GBC and 36 controls including diseased controls (cholecystitis) and healthy subjects. Median levels of ALU115, ALU247 and cfDNA integrity were significantly different in GBC at 1790.88, 673.75, 0.4718 vs. controls at 840.73, 165.03, 0.1989 ng/ml respectively. Global DNA methylation was not significantly different between GBC at 0.679% and controls at 0.695%. The sensitivity and specificity of ALU 247 i...
Asian Pacific journal of cancer prevention : APJCP, Jan 29, 2017
Purpose: Liquid biopsy has entered the arena of cancer diagnostics in the past decade and detecti... more Purpose: Liquid biopsy has entered the arena of cancer diagnostics in the past decade and detection of circulating tumor cells (CTC) is one diagnostic component. CTCs in gallbladder cancer (GBC) have hitherto not been comprehensively analysed. Methods and Results: The current study focused on the diagnostic role of CTCs in 27 cases of treatment-naive GBC and 6 normal controls as well as 6 cases of cholecystitis. An EasySep kit featuring negative immunomagnetic bead separation and flow cytometric detection of EpCAM positive and CD45 negative cells revealed CTCs in 25 of the 27 cases. At a cut-off point of ≥1, the CTC count discriminated GBC from controls with a sensitivity, specificity and diagnostic accuracy of 92.6%, 91.7% and 92.3%, respectively. CTC levels in turn correlated significantly with clinico-pathological parameters of cases in terms of known prognostic indicators, with significant diagnostic potential at a cut-off point of >4, to discriminate disease stage I and II v...
The paper highlights detailed analysis of increasing trends of electronic contracts in India. Wit... more The paper highlights detailed analysis of increasing trends of electronic contracts in India. With the advancement of information technology, standard of living of people have enhanced phenomenally and contract which were used to form via papers are now being formed through the boom of internet. The advent of e-commerce has transformed the use of internet and today almost everything is being done through e-commerce and due to significant alleviation in this field gave birth to a large number of electronic contracts. Several users sitting at several parts of the world are now entering into electronic contract with each other and so due to such advancement, it is necessary to identify the pros and cons of electronic contract.
2015 International Conference on Computing, Communication and Security (ICCCS), 2015
Power utilities around the world are modernizing their grid by adding layers of communication cap... more Power utilities around the world are modernizing their grid by adding layers of communication capabilities to allow for more advanced control, monitoring and preventive maintenance. Wireless Sensor Networks (WSNs), due to their ease of deployment, low cost and flexibility, are considered as a solution to provide diagnostics information about the health of the connected devices and equipment in the electrical grid. However, in specific environments such as high voltage substations, the equipment in the grid produces a strong and specific radio noise, which is impulsive in nature. The robustness of off-the-shelf equipment to this type of noise is not guaranteed; it is therefore important to analyze the characteristics of devices, algorithms and protocols to understand whether they are suited to such harsh environments. In this paper, we review several WSN standards: 6LoWPAN, Zigbee, WirelessHART, ISA100.11a and OCARI. Physical layer specifications (IEEE 802.15.4) are similar for all standards, with considerable architectural differences present in the higher layers. The purpose of this paper is to determine the appropriate WSN standard that could support reliable communication in the impulsive noise environment, in electrical substations. Our review concludes that the WirelessHART sensor network is one of the most suitable to be implemented in a harsh impulsive noise environment.
www.thelancet.com/oncology Vol 16 September 2015 1189 Cancer surgery is an integral part of the m... more www.thelancet.com/oncology Vol 16 September 2015 1189 Cancer surgery is an integral part of the multimodal management of solid cancers and has a central role in the treatment of several common cancers in Asian countries. As stressed in The Lancet Oncology Commission on global cancer surgery, there is a need for surgery—curative or palliative—in over 80% of patients with cancer. Providing safe, aff ordable, and timely surgery for cancer is a complex task. It involves health-care policy, training and education, management and delivery of health care, fi nance, social, and economic issues. Many of the general principles for providing safe surgery—described in The Lancet Commission on global surgery—apply also to cancer surgery. The diffi culty for economically constrained low-income and middle-income countries (LMICs) in Asia is to fi nd resources to fund and manage the infrastructure and manpower needed to achieve this task. Some of the unique diffi culties faced in countries such as India and China are the many alternative and traditional systems of medicine available. In India, a large proportion of the population is illiterate and not knowledgeable about health care and tends to opt for easy (eg, non-invasive treatments requiring no investigations or waiting, with minimum side-eff ects and few functional and cosmetic problems) and less expensive methods of treatment. These unproven methods of treatment result in delays and disease progression, and the potential curative role of surgery may be lost. The government policy of promoting alternative and traditional systems of medicine only worsens this situation. Myths and prejudice against surgery and surgical interventions for cancer also exist, which drives patients to seek inappropriate non-surgical treatments. Finally, when these patients reach the cancer surgeon, they have advanced unresectable disease and surgical interventions are doomed to fail. In India, the National Cancer Control Programme has been in place for almost four decades. However, this programme ignores the need for cancer surgery and places strong emphasis on providing infrastructure for radiotherapy alone. No concerted eff ort has been made to develop surgical oncology as a specialty, and there is a major shortage of trained cancer surgeons. Few surgical oncology training opportunities are available at present. In the absence of formal guidelines, general surgeons, who might have a limited understanding and ability of cancer surgery, perform most of the surgery for patients with cancer. Incomplete and inadequate primary surgery further complicates the management of these patients. Finances for cancer surgery, in the absence of health insurance, remain an out-of-pocket expenditure by patients. In India, to some extent, government hospitals provide cancer surgery at a subsidised cost or fund the management of patients who are below the poverty line. However, these facilities are not available in all places, and a large inequality exists in the aff ordability and quality of cancer care, including cancer surgery, in India. Major infrastructure defi ciencies also exist. Highquality pathology, imaging, safe anaesthesia, and ancillary specialties (eg, reconstructive surgery) are scarce. Quality cancer care is available in only a handful of government institutions and a rapidly expanding group of private or corporate hospitals. Most patients with cancer cannot aff ord treatment in these exclusive hospitals. The absence of a standardised referral system Cancer surgery: an Indian-Asian perspective timely, and safe interventions with the aim of achieving cost-eff ective global technological advances. Laproscopes and robots do not operate, surgeons do.
Incidentally discovered gallbladder cancer (IGBC) is defined as the gallbladder cancer (GBC) diag... more Incidentally discovered gallbladder cancer (IGBC) is defined as the gallbladder cancer (GBC) diagnosed during or after the cholecystectomy done for unsuspected benign gallbladder disease. Laparoscopic cholecystectomy (LC) is the most common procedure performed for benign gallbladder disease worldwide. Majority of GBC patients have associated gallstones. With the advent of ultrasonography more patients are being diagnosed with gallstones and are being subjected to cholecytectomy. IGBC is found in 0.2-2.9 % of all cholecytectomies done for gallstone disease. It represents 27-41 % of all GBC. Patients with IGBC having Tis and T1a stage, with negative cystic duct margin can be treated by simple cholecystectomy alone. Patients with stage T1b and beyond should undergo restaging, and should be treated with radical re-resection (R0). Residual disease is found in 40-76 % patients on re-exploration. The survival rates of patients undergoing re resection for IGBC is similar to those undergoing primary radical surgery. LC is contraindicated in patients with GBC. Patients presenting post LC should undergo radical re-resection and additional port site excision, as they have a high incidence of port site metastasis. At cholecystectomy for benign gallbladder disease all gallbladder specimens should be opened before closing abdomen and if available all suspicious specimens should be sent for immediate frozen section. All gallbladder specimens should be subjected to histopathology examination to avoid missing GBC. The surgeon should have a high index of suspicion for GBC if encountering difficult cholecystectomy for a benign disease, and in patients with atypical clinical and ultrasound findings in high incidence areas.
Available data for a large number of AB2 compounds were subjected to a rigorous study using a com... more Available data for a large number of AB2 compounds were subjected to a rigorous study using a combination of Principal Component Analysis (PCA) technique, multiobjective genetic algorithms, and neural networks that evolved through genetic algorithms. The ...
Failure behavior of Zn coated Fe is simulated through molecular dynamics (MD) and the energy abso... more Failure behavior of Zn coated Fe is simulated through molecular dynamics (MD) and the energy absorbed at the onset of failure along with the corresponding strain of the Zn lattice are computed for different levels of applied shear rate, temperature and thickness. Data-driven models are constructed by feeding the MD results to an evolutionary neural network. The outputs of these neural networks are utilized to carry out a multi-objective optimization through genetic algorithms, where the best possible tradeoffs between two conflicting requirements, minimum deformation and maximum energy absorption at the onset of failure, are determined by constructing a Pareto frontier.
American Journal of Obstetrics and Gynecology, 2001
Objective: This study was undertaken to determine whether dexamethasone or betamethasone is super... more Objective: This study was undertaken to determine whether dexamethasone or betamethasone is superior for the antepartum treatment of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Study Design: This prospective, randomized, clinical investigation compared intravenously administered dexamethasone and intramuscularly administered betamethasone in the treatment of gravid women with HELLP syndrome. Efficacy end points included laboratory values (platelet count,
Malignant melanoma is a potentially aggressive and lethal tumour of melanocytic origin. The incid... more Malignant melanoma is a potentially aggressive and lethal tumour of melanocytic origin. The incidence is 1-3% of all malignancies with a death rate of 1-2% (amongst all cancers). 1 Cancer registries in India report an incidence of less than 0.5%. One third of patients develop metastasis, the median time to metastasis in localized disease being 28 months. 2 A 65 year-old female presented with sudden onset multiple swellings over the body (one month duration). [Figure 1] There was a history of significant weight loss (8 kgs in past 2 months). There was a history of removal of a black spot on her foot 3 years back. Documents revealed excisional biopsy with a histopathological diagnosis of nodular malignant melanoma (stage 2b, tumour depth of 5mm into the reticular dermis, without lymphovascular invasion, no ulceration and 4mm free margin from the edge). Adjuvant chemotherapy was not given.
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: Gallbladder cancer (GBC) is one of the commonest cancers in North India. Despite th... more Introduction: Gallbladder cancer (GBC) is one of the commonest cancers in North India. Despite the high incidence, very little data is available of the staging distribution of GBC in this region. We aimed at getting a snapshot of the distribution of GBC at a single high volume centre. Material and Methods: One hundred and forty seven patients who were evaluated between 1 st July 2017 and 31 st October 2018 for staging of GBC, were included in this study. Radiological staging was done according to the AJCC TNM 8 th edition using a standardized reporting format. Results: Majority of patients were females (70%). Fundus of GB was the most common site of tumor (39.4%) and liver (76.8%) was the most common adjacent organ involved as well as the most common site of metastatic disease (36%). Only 42 (28.5%) patients had non-metastatic disease. Biliary obstruction was present in 63 (42.8%) patients, with majority being type 2 hilar blocks (65%). Loco-regional nodal involvement was present in 87.1% patients, station 12 nodal involvement being most common (76.1%). Conclusion: This is the first study to describe the distribution of GBC stages in the high incidence region of North India. This should provide information for future research and funding for GBC related research.
2017 IEEE International Conference on Communications Workshops (ICC Workshops), 2017
In this paper, we propose the use of OFDM-CDMA based transmission schemes to support Variable Bit... more In this paper, we propose the use of OFDM-CDMA based transmission schemes to support Variable Bit Rate (VBR) services at the physical layer of Digital Video Broadcast Satellite Handheld (DVB-SH)-A architecture. For this purpose, multicarrier schemes namely Spread Orthogonal Frequency Division Multiplexing (SOFDM), Complementary Code Keying (CCK-OFDM) and conventional OFDM are analyzed over integrated satellite-terrestrial system, employing 3-state Fontan Land Mobile Satellite (LMS), and TU6 and RA6 terrestrial channel models. Variable rates are assumed for SOFDM and CCK-OFDM. The VBR multicarrier performance analysis over the employed integrated system would be helpful in investigating the 5G communication scenario in future. At the receiver, linear Minimum Mean Squared Error (MMSE) equalizer is applied for the considered multicarrier schemes. The BER performance results illustrate that SOFDM outperforms OFDM, and CCK-OFDM for all the considered data rates, in both the Land Mobile Satellite (LMS) and terrestrial channel conditions. Later, the block-by-block system computational complexity of the multicarrier schemes is evaluated. It is shown that the complexity of SOFDM system is rate-dependent as compared to the fixed complexity CCK-OFDM system. Hence, a trade-off exists between the achieved error performance and system complexity. Therefore, for high data rate transmission SOFDM scheme could be a suitable candidate for integrated satellite-terrestrial communication system, or 5G satellite system in future.
2021 Second International Conference on Electronics and Sustainable Communication Systems (ICESC), 2021
In current technology, the majority of data is transferred over the internet, and the most useful... more In current technology, the majority of data is transferred over the internet, and the most useful data type is image. As a result, image security is necessary for safe transmission. Image security methods are used to safeguard the image. Low MSE and high PSNR values are necessary for improved hiding. This paper shows the comparative analysis of DCT, LSB and XOR image security techniques and obtained the MSE and PSNR values from these techniques and shown techniques, which provided the better image security.
Dear Editor, Psoriatic patients with HIV infection often present with a more severe and refractor... more Dear Editor, Psoriatic patients with HIV infection often present with a more severe and refractory disease course. Psoriasis has been seen at all stages of HIV infection, occasionally presenting as the initial manifestation. A 35-year-old diabetic female with a 1-year history of chronic plaque psoriasis without Psoriatic arthritis presented with an erythrodermic flare for one month. Initial evaluation 1 year ago had revealed HIV seropositivity and she is on antiretroviral therapy since. Prior treatment history for Psoriasis includes acitretin and cyclosporine. Cyclosporine was withdrawn after the patient developed diastolic hypertension. Prior to flare, the patient was on acitretin (25 mg) twice daily for the past 6 months with good disease control. On physical examination, the patient was obese (BMI: 32.2 kg/m). Cutaneous examination showed erythroderma with the Psoriasis assessment severity Index (PASI) of 34.7 (Figure 1A). Dermatology life quality index (DLQI) score was 24. Psoriatic erythroderma being an emergency, and considering the limited therapeutic options available, we chose an anti-TNFα blocker, Etanercept. Prior tuberculosis infection was excluded and baseline investigations were conducted; Chest X-Ray was normal; Tuberculin Skin test, TB Quantiferon Gold Assay, Hepatitis B and C serology were negative and CD4 count prior to therapy was 580 cells/μl. Considering financial restrictions and difficulty in commuting frequently, Etanercept dosing was modified to once-weekly subcutaneous injections of Inj.Etanercept (50 mg). Clinical improvement was noted from fourth week onwards with PASI being 3.3 at the end of six weeks of therapy (Figure 1B). Noting monetary issues, Etanercept had to be discontinued after sixth week, and sequential therapy with acitretin (25 mg) twice daily was started. CD4 count and DLQI post-treatment were 545 cells/μl and 5, respectively. No opportunistic infections were seen. Anti-TNFα therapy (Infliximab, Adalimumab, and Etanercept) is relatively contra-indicated in HIV infection, which is usually excluded before starting therapy. However, TNFα is also seen to be elevated in all stages of HIV infection, possibly responsible for fatigue, fever, and cachexia. Overall, limited experience of anti-TNF agents in HIV positive patients
Indian Journal of Otolaryngology and Head & Neck Surgery, 2020
Verrucous carcinoma (VC) is a locally invasive uncommon histopathological variant of oral squamou... more Verrucous carcinoma (VC) is a locally invasive uncommon histopathological variant of oral squamous cell cancer. There is paucity of literature regarding control rates in these cases. We intend to report the outcomes in terms of administered treatment and control rates. 28 patients of oral cavity verrucous carcinomas treated at our institute from March 2014 to December 2018 were reviewed retrospectively. Demographic profile, histopathological features and clinical outcomes were analyzed. Statistical analysis was performed with SPSS for Mac (version 23.0). Median age was 54 years (range 31-75) with M:F ratio of 25:3. Buccal mucosa was the most common site. All patients underwent surgical resection except one. Of these, 24 had neck dissection; 12 had supra-omohyoid neck dissection, eleven had modified neck dissection and one patient underwent radical neck dissection. Three patients had their histology upgraded to squamous cell carcinomas in the post-operative histopathology. The post-operative staging was as follows: 21% stage I and 35% stage II. One patient opted for non-surgical approach and received radical concurrent chemoradiotherapy. Median follow up was 12 months (range 6-36). Two patients had local failures and one had a regional failure. No distant metastasis was found. There was one death. 14-Months survival rate was 92%. Estimated 18 month loco-regional control rate was 92%. Curative surgical resection remains the cornerstone for VC of oral cavity. Any change of histopathology post-operatively to squamous cell carcinoma is a poor prognostic sign and needs appropriate adjuvant treatment.
Journal of Medical Science And clinical Research, 2018
Background: Ovary is a paired organ located in pelvic cavity of women. Despite being small in siz... more Background: Ovary is a paired organ located in pelvic cavity of women. Despite being small in size, ovary is an organ that requires the attention of several specialties like gynaecology, endocrinology and pathology. It is the common site for neoplastic and non-neoplastic lesions. That is why ovary constitutes a major health concerns for women all over the world. Aims: To study histomorphological spectrum of ovarian tumors in a tertiary care centre of kumaon region of uttarakhand. Settings and Design: Cross sectional study. Material and Methods: This is one year study of 54 cases of ovarian tumors, submitted for histopathological examination in the department of pathology, GMC Haldwani. Clinical history and examination were recorded and histopathological evaluation of specimen was done. Ovarian tumors were classified according to WHO Classification 2016. Results: Out of total 54 ovarian tumors studied, 40 (74.1%) cases were of benign tumors and 13 (24.1%) were of malignant tumors. There was only 1(1.8%) case of borderline tumor. Among total 54 tumors, 35 (64.8%) were epithelial, 18 (33.3%) were germ cell and 1 (1.8%) was sex-cord stromal tumor. Age of presentation ranged from 12 to 80 years. Pain in lower abdomen was the commonest presentation. Conclusions: This study will provide histomorphological spectrum of ovarian tumors in this region which will help in proper management and prognosis of the patients.
In this paper, the exact closed-form Signal-to-Interference-Noise Ratio (SINR) expression, for th... more In this paper, the exact closed-form Signal-to-Interference-Noise Ratio (SINR) expression, for the joint impact of Carrier Frequency Offset (CFO) and Phase Noise (PHN) is derived for each channel link in multi-relay hybrid satelliteterrestrial broadcast system, employing Walsh Hadamard (WH) based Spread-Orthogonal Frequency Multiplexing (S-OFDM) and OFDM transmission scheme at satellite terminal and terrestrial repeaters (relays) respectively. Additionally, Bit Error Rate (BER) and spectral efficiency is analyzed for such hybrid system with M-relay, based on the obtained SINR expressions. To examine that, Adaptive Decode and Forward (ADF) strategy is employed at relay terminals. Also, 3-state Fontan Land Mobile Satellite (LMS) and 6-path Typical Urban (TU6) terrestrial channel models are considered. This analysis is performed to support Variable Bit Rate (VBR) Quality of Service (QoS) at the physical layer of Digital Video Broadcast Satellite Handheld (DVB-SH)-A architecture, the provision of which is absent in DVB-SH standard. Variable Bit Rates (VBR)s are assumed for S-OFDM. The results illustrate that both single-relay and three-relay ADF based VBR WH-SOFDM yield an identical performance in presence of the combined effect of CFO and PHN, under both the performance measures. However, the improvement in performance for three-relay strategy is observed in presence of only CFO. Further, Pilot-based channel estimation technique is performed at the receiver and estimated error variance is evaluated for every channel link. Later, the blockby-block system computational complexity of singlerelay and Mrelay ADF based VBR WH-SOFDM is evaluated. It is shown that the complexity of M-relay ADF strategy is ratedependent and almost M-1 times the single-relay strategy. Hence, an increase in the number of relays would not yield any significant performance gain, but would enhance the system computational complexity considerably. Therefore, for high data rate transmission single-elay ADF based WH-SOFDM scheme could be a suitable candidate for hybrid satellite-terrestrial communication system in future.
The current study investigates the role of circulating free DNA (cfDNA) as a liquid biopsy in dia... more The current study investigates the role of circulating free DNA (cfDNA) as a liquid biopsy in diagnosis gall bladder carcinoma (GBC) utilizing levels of long DNA fragments (ALU247) derived from tumor necrosis, short apoptotic fragments (ALU115) denoting total cfDNA and cfDNA integrity denoting ratio of ALU247 and ALU115. The global methylation status of cfDNA was also estimated with the hypothesis that these parameters provide a diagnostic distinction between cancer and non-cancer subjects, with higher or altered values favoring presence of malignancy. Study group included 60 cases of GBC and 36 controls including diseased controls (cholecystitis) and healthy subjects. Median levels of ALU115, ALU247 and cfDNA integrity were significantly different in GBC at 1790.88, 673.75, 0.4718 vs. controls at 840.73, 165.03, 0.1989 ng/ml respectively. Global DNA methylation was not significantly different between GBC at 0.679% and controls at 0.695%. The sensitivity and specificity of ALU 247 i...
Asian Pacific journal of cancer prevention : APJCP, Jan 29, 2017
Purpose: Liquid biopsy has entered the arena of cancer diagnostics in the past decade and detecti... more Purpose: Liquid biopsy has entered the arena of cancer diagnostics in the past decade and detection of circulating tumor cells (CTC) is one diagnostic component. CTCs in gallbladder cancer (GBC) have hitherto not been comprehensively analysed. Methods and Results: The current study focused on the diagnostic role of CTCs in 27 cases of treatment-naive GBC and 6 normal controls as well as 6 cases of cholecystitis. An EasySep kit featuring negative immunomagnetic bead separation and flow cytometric detection of EpCAM positive and CD45 negative cells revealed CTCs in 25 of the 27 cases. At a cut-off point of ≥1, the CTC count discriminated GBC from controls with a sensitivity, specificity and diagnostic accuracy of 92.6%, 91.7% and 92.3%, respectively. CTC levels in turn correlated significantly with clinico-pathological parameters of cases in terms of known prognostic indicators, with significant diagnostic potential at a cut-off point of >4, to discriminate disease stage I and II v...
The paper highlights detailed analysis of increasing trends of electronic contracts in India. Wit... more The paper highlights detailed analysis of increasing trends of electronic contracts in India. With the advancement of information technology, standard of living of people have enhanced phenomenally and contract which were used to form via papers are now being formed through the boom of internet. The advent of e-commerce has transformed the use of internet and today almost everything is being done through e-commerce and due to significant alleviation in this field gave birth to a large number of electronic contracts. Several users sitting at several parts of the world are now entering into electronic contract with each other and so due to such advancement, it is necessary to identify the pros and cons of electronic contract.
2015 International Conference on Computing, Communication and Security (ICCCS), 2015
Power utilities around the world are modernizing their grid by adding layers of communication cap... more Power utilities around the world are modernizing their grid by adding layers of communication capabilities to allow for more advanced control, monitoring and preventive maintenance. Wireless Sensor Networks (WSNs), due to their ease of deployment, low cost and flexibility, are considered as a solution to provide diagnostics information about the health of the connected devices and equipment in the electrical grid. However, in specific environments such as high voltage substations, the equipment in the grid produces a strong and specific radio noise, which is impulsive in nature. The robustness of off-the-shelf equipment to this type of noise is not guaranteed; it is therefore important to analyze the characteristics of devices, algorithms and protocols to understand whether they are suited to such harsh environments. In this paper, we review several WSN standards: 6LoWPAN, Zigbee, WirelessHART, ISA100.11a and OCARI. Physical layer specifications (IEEE 802.15.4) are similar for all standards, with considerable architectural differences present in the higher layers. The purpose of this paper is to determine the appropriate WSN standard that could support reliable communication in the impulsive noise environment, in electrical substations. Our review concludes that the WirelessHART sensor network is one of the most suitable to be implemented in a harsh impulsive noise environment.
www.thelancet.com/oncology Vol 16 September 2015 1189 Cancer surgery is an integral part of the m... more www.thelancet.com/oncology Vol 16 September 2015 1189 Cancer surgery is an integral part of the multimodal management of solid cancers and has a central role in the treatment of several common cancers in Asian countries. As stressed in The Lancet Oncology Commission on global cancer surgery, there is a need for surgery—curative or palliative—in over 80% of patients with cancer. Providing safe, aff ordable, and timely surgery for cancer is a complex task. It involves health-care policy, training and education, management and delivery of health care, fi nance, social, and economic issues. Many of the general principles for providing safe surgery—described in The Lancet Commission on global surgery—apply also to cancer surgery. The diffi culty for economically constrained low-income and middle-income countries (LMICs) in Asia is to fi nd resources to fund and manage the infrastructure and manpower needed to achieve this task. Some of the unique diffi culties faced in countries such as India and China are the many alternative and traditional systems of medicine available. In India, a large proportion of the population is illiterate and not knowledgeable about health care and tends to opt for easy (eg, non-invasive treatments requiring no investigations or waiting, with minimum side-eff ects and few functional and cosmetic problems) and less expensive methods of treatment. These unproven methods of treatment result in delays and disease progression, and the potential curative role of surgery may be lost. The government policy of promoting alternative and traditional systems of medicine only worsens this situation. Myths and prejudice against surgery and surgical interventions for cancer also exist, which drives patients to seek inappropriate non-surgical treatments. Finally, when these patients reach the cancer surgeon, they have advanced unresectable disease and surgical interventions are doomed to fail. In India, the National Cancer Control Programme has been in place for almost four decades. However, this programme ignores the need for cancer surgery and places strong emphasis on providing infrastructure for radiotherapy alone. No concerted eff ort has been made to develop surgical oncology as a specialty, and there is a major shortage of trained cancer surgeons. Few surgical oncology training opportunities are available at present. In the absence of formal guidelines, general surgeons, who might have a limited understanding and ability of cancer surgery, perform most of the surgery for patients with cancer. Incomplete and inadequate primary surgery further complicates the management of these patients. Finances for cancer surgery, in the absence of health insurance, remain an out-of-pocket expenditure by patients. In India, to some extent, government hospitals provide cancer surgery at a subsidised cost or fund the management of patients who are below the poverty line. However, these facilities are not available in all places, and a large inequality exists in the aff ordability and quality of cancer care, including cancer surgery, in India. Major infrastructure defi ciencies also exist. Highquality pathology, imaging, safe anaesthesia, and ancillary specialties (eg, reconstructive surgery) are scarce. Quality cancer care is available in only a handful of government institutions and a rapidly expanding group of private or corporate hospitals. Most patients with cancer cannot aff ord treatment in these exclusive hospitals. The absence of a standardised referral system Cancer surgery: an Indian-Asian perspective timely, and safe interventions with the aim of achieving cost-eff ective global technological advances. Laproscopes and robots do not operate, surgeons do.
Incidentally discovered gallbladder cancer (IGBC) is defined as the gallbladder cancer (GBC) diag... more Incidentally discovered gallbladder cancer (IGBC) is defined as the gallbladder cancer (GBC) diagnosed during or after the cholecystectomy done for unsuspected benign gallbladder disease. Laparoscopic cholecystectomy (LC) is the most common procedure performed for benign gallbladder disease worldwide. Majority of GBC patients have associated gallstones. With the advent of ultrasonography more patients are being diagnosed with gallstones and are being subjected to cholecytectomy. IGBC is found in 0.2-2.9 % of all cholecytectomies done for gallstone disease. It represents 27-41 % of all GBC. Patients with IGBC having Tis and T1a stage, with negative cystic duct margin can be treated by simple cholecystectomy alone. Patients with stage T1b and beyond should undergo restaging, and should be treated with radical re-resection (R0). Residual disease is found in 40-76 % patients on re-exploration. The survival rates of patients undergoing re resection for IGBC is similar to those undergoing primary radical surgery. LC is contraindicated in patients with GBC. Patients presenting post LC should undergo radical re-resection and additional port site excision, as they have a high incidence of port site metastasis. At cholecystectomy for benign gallbladder disease all gallbladder specimens should be opened before closing abdomen and if available all suspicious specimens should be sent for immediate frozen section. All gallbladder specimens should be subjected to histopathology examination to avoid missing GBC. The surgeon should have a high index of suspicion for GBC if encountering difficult cholecystectomy for a benign disease, and in patients with atypical clinical and ultrasound findings in high incidence areas.
Available data for a large number of AB2 compounds were subjected to a rigorous study using a com... more Available data for a large number of AB2 compounds were subjected to a rigorous study using a combination of Principal Component Analysis (PCA) technique, multiobjective genetic algorithms, and neural networks that evolved through genetic algorithms. The ...
Failure behavior of Zn coated Fe is simulated through molecular dynamics (MD) and the energy abso... more Failure behavior of Zn coated Fe is simulated through molecular dynamics (MD) and the energy absorbed at the onset of failure along with the corresponding strain of the Zn lattice are computed for different levels of applied shear rate, temperature and thickness. Data-driven models are constructed by feeding the MD results to an evolutionary neural network. The outputs of these neural networks are utilized to carry out a multi-objective optimization through genetic algorithms, where the best possible tradeoffs between two conflicting requirements, minimum deformation and maximum energy absorption at the onset of failure, are determined by constructing a Pareto frontier.
American Journal of Obstetrics and Gynecology, 2001
Objective: This study was undertaken to determine whether dexamethasone or betamethasone is super... more Objective: This study was undertaken to determine whether dexamethasone or betamethasone is superior for the antepartum treatment of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Study Design: This prospective, randomized, clinical investigation compared intravenously administered dexamethasone and intramuscularly administered betamethasone in the treatment of gravid women with HELLP syndrome. Efficacy end points included laboratory values (platelet count,
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Papers by akash agarwal