vishal rao | Health Care Global cancer hospital (original) (raw)

Papers by vishal rao

International Journal of Head and Neck Surgery

Introduction: Elucidation of the genomic basis of head and neck cancers (HNCs) may help in reduci... more Introduction: Elucidation of the genomic basis of head and neck cancers (HNCs) may help in reducing cancer-related mortality and morbidity. This is because prognostication by predicting disease course and treatment response will help to individualize treatment protocols. Materials and methods: This prospective pilot study used a 48-gene mutation panel on tumor tissue samples obtained from 18 patients suffering from HNCs. The clinical significance of these mutations was analyzed in terms of treatment resistance, presence of distant metastasis, family history, and disease recurrence. Results: Two patients carried germline mutations, nine carried somatic mutations and seven samples had no mutation detected on the 48-gene panel. The genomic studies detected germline mutations in BRCA and AIP, and somatic mutations in TP53, phosphatase and tensin homolog (PTEN), RB1, STK11, GNA11, and HRAS. Conclusion: The study appears to validate early genomic testing of HNC cases to modify treatment protocols and offers more specific and personalized treatment options to patients. Clinical significance: The study demonstrates the potential benefit of integrating genomic data with clinical details to map out a tailored treatment plan to benefit individual patients.

JCO Global Oncology, 2021

The COVID-19 pandemic has caused unprecedented impact across the globe, severely affecting the na... more The COVID-19 pandemic has caused unprecedented impact across the globe, severely affecting the national health systems, as well as mobility and commuting. Several key health issues are inadvertently being overlooked, bearing impact on mortality and other outcomes, particularly for patients with cancer.

Journal of Oral Medicine and Oral Surgery, 2020

Dear Editor, Salivary diagnostics has taken a major leap in infectious disease diagnosis with the... more Dear Editor, Salivary diagnostics has taken a major leap in infectious disease diagnosis with the SARS-CoV-2 pandemic. The U.S. Food and Drug Administration (FDA) authorised the Rutgers University Clinical Genomics Laboratory and the Curative-Korva SARS-CoV-2 Assay (the Curative-Korva test) for diagnosis of SARS-Cov-2 in saliva samples [1,2]. Since then, the Covid-19 diagnosis has become easier and more accessible. Saliva has been the major vector in the spread of COVID-19. SARS-CoV-2 is excreted in the oral cavity and spreads via aerosols. The droplets origin from nasopharyngeal or oropharyngeal, which is associated with saliva. While, larger droplets contribute to viral transmission to subjects nearby, the longdistance transmission is possible with smaller droplets infected with air-suspended viral particles [3]. The collection of saliva is a non-invasive, safe, quick process and eliminates the fear of inadequate sampling. In large-scale testing, sample collection methods that are technique sensitive, requiring trained professionals and increased protection measures (like personal protective equipment) are challenging and hard on available resources. Such a scenario demands the use of more efficient and convenient methods. Furthermore, the ease of self Àadministration facilitates at home sample collection eliminating the need to travel to a collection centre, reducing the risk of exposure to the individual as well as the healthcare personnel. While the Food and Drug Administration (FDA) has approved the at home saliva collection kits, these samples still need laboratory processing that uses RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) technology for SARS-Cov2 detection [1,2]. Going one step ahead, SkillCell

Frontiers in Oncology, 2021

Head and neck squamous cell carcinomas (HNSCC) include heterogeneous group of tumors, classified ... more Head and neck squamous cell carcinomas (HNSCC) include heterogeneous group of tumors, classified according to their anatomical site. It is the sixth most prevalent cancer globally. Among South Asian countries, India accounts for 40% of HNC malignancies with significant morbidity and mortality. In the present study, we have performed exome sequencing and analysis of 51 Head and Neck squamous cell carcinoma samples. Besides known mutations in the oncogenes and tumour suppressors, we have identified novel gene signatures differentiating buccal, alveolar, and tongue cancers. Around 50% of the patients showed mutation in tumour suppressor genes TP53 and TP63. Apart from the known mutations, we report novel mutations in the genes AKT1, SPECC1, and LRP1B, which are linked with tumour progression and patient survival. A highly curated process was developed to identify survival signatures. 36 survival-related genes were identified based on the correlation of functional impact of variants ide...

Journal of Indian Speech Language & Hearing Association, 2020

Speech errors are commonly reported in the literature for postsurgical treatment in lingual carci... more Speech errors are commonly reported in the literature for postsurgical treatment in lingual carcinomas. The degree of errors relate to the extent of resection and reconstruction. Residual organ compensation is reported in partial glossectomy, while adjacent articulator compensation in total glossectomy. This case report describes an early atypical labial compensation for lingual sounds in a young female postpartial glossectomy and free flap reconstruction. Speech articulation errors were specific to distortion of tongue tip stops, laterals, and liquids. Bilabial flicker like movements were noted during the production of alveolar stops which subsequently developed into a bilabial compensatory articulation. This error indicates that compensation for the affected articulator function may begin at a very early postsurgical stage. The compensation needs to be identified and intervened at an early stage where facilitation must be sought as a modality for speech correction in smaller surgeries to achieve new or near normal speech.

Authorea

Background: Increasing the use of tobacco by the younger generation has increased in oral cavity ... more Background: Increasing the use of tobacco by the younger generation has increased in oral cavity tumours. Surgical treatment is radical and results in severe functional morbidity. Using computer-aided designing technology, surgical and rehabilitative planning can be better. We present here our concept of a biomechanical 3D tongue model and its clinical utility in the management of tongue tumours. Methods: Patients diagnosed with Carcinoma of Tongue were included. These patients underwent a pre-operative Magnetic Resonance Imaging (MRI) of the head and neck region at our center. These patients were informed about the use of a 3D biomechanical patient-specific model for treatment planning and execution. Using Materialise Mimics Innovation Suite 19 DICOM data was imported, visualized, edited and segmented. Flashforge 'Creator-pro'3D Printer was used for 3D Printing. Fused Deposition Modeling (FDM) technology was used to print the tumour and uninvolved tongue in two different colors for easy identification. These patients underwent surgery with the 3D model serving as a guide for margins. Results: Two patients with stage III squamous cell carcinoma of tongue underwent the surgery based on the plan evolved from the 3D model. All the surgical margins were clear. The model helped address the discordance between patient expectations and surgical outcomes. We found that the model aided the reconstructive surgeon to plan the flap volume better and this translated into better rehabilitative outcomes. Discussion and Conclusion: The 3D biomechanical tongue model is a novel concept and may aid in improving our overall treatment outcomes.

Journal of Oral Medicine and Oral Surgery, 2020

Oral Oncology, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2018

We describe 3 rare cases of metastatic renal cell carcinoma in the head and neck region. Our firs... more We describe 3 rare cases of metastatic renal cell carcinoma in the head and neck region. Our first case was a 72 years old male presented with profuse bleeding from the left ear. On examination, proliferative, pink, friable mass was present in the left external auditory canal. On eliciting the detailed history, it was found that patient had renal cell carcinoma in the left kidney four years back and underwent left radical nephrectomy. Patient underwent left lateral temporal bone resection with cul-de-sac closure. Histopathological examination of the specimen showed metastatic renal cell carcinoma. Our second case was a 64 years old male presented with complaints of growth in the oral cavity of 1 month duration. On examination, 5×3 cms proliferative growth was present in the hard palate. Biopsy from the growth in the hard palate showed metastatic renal cell carcinoma. Patient gave history of renal cell carcinoma in the past for which he did not receive treatment. Our third case was a...

Heliyon, 2019

Cutaneous squamous cell carcinoma is a common global cancer with Ultraviolet light recognized as ... more Cutaneous squamous cell carcinoma is a common global cancer with Ultraviolet light recognized as the most significant risk factor. The other definite or plausible risk factors include immunosuppression, infection with oncogenic viruses, exposure to toxins, chemicals, chronic inflammatory skin disease and a high body mass index. This case highlights the rarity of the pathology in terms of size, the subtle transition of verrucous hyperplasia to cutaneous squamous cell carcinoma over a period of time and the fallibility of the frozen section report in deciding the optimum resection margins. The initial innocuous presentation represented a diagnostic challenge as it can be mistaken for other benign entities. A correlation between the history, clinical presentation, tumor biology and the histopathological characteristics helped us to unlock the jigsaw puzzle of approaching a rare condition with a modification in the surgical approach.

Indian Journal of Surgical Oncology, 2017

The incidence of small differentiated thyroid carcinomas is increasing worldwide in the recent ye... more The incidence of small differentiated thyroid carcinomas is increasing worldwide in the recent years, especially tumours of size less than 2 cm in diameter. In this study, we have analysed the patterns of behaviour of small-sized thyroid carcinomas (<2 cm, T1 tumours) in comparison with largesized thyroid carcinomas. This is a retrospectively analysed data of patients with thyroid carcinoma. The following parameters were analysed: distribution with regard to age, sex and the presence of metastasis based on radioiodine scan. The following histopathological details were collected: maximal tumour diameter, extrathyroidal extension and lymphovascular invasion. Out of 152 patients, 39 patients were excluded due to the non-availability of complete details. Among the 113 patients of thyroid carcinomas, 43 patients (28%) were presented with small-sized tumours (measuring less than 2 cm). In smallsized thyroid tumours, 21.6% showed extrathyroidal extension. 2.7% of the small-sized thyroid carcinomas showed perineural invasion as compared to 6.3% of the large-sized thyroid carcinomas. Twenty percent of the small-sized thyroid carcinomas showed lymphovascular emboli. 51.2% of the small-sized thyroid carcinomas were presented with nodal metastasis as compared to 40% of the large-sized thyroid carcinomas. 57.5% of the small-sized thyroid carcinomas showed extracapsular extension as compared to 57.8% of the large-sized thyroid carcinomas. Despite small size, thyroid carcinomas have properties to behave aggressively as comparable to large-sized thyroid carcinomas. Taking the above facts into account, the small thyroid cancers should be treated with considerable caution as large thyroid cancers, especially since we have limited tools to predict the preoperative poor prognostic factors.

International Journal of Head and Neck Surgery, 2014

Background: Vascular complications are seen in 2 to 13% of cases with internal carotid artery (IC... more Background: Vascular complications are seen in 2 to 13% of cases with internal carotid artery (ICA) injuries with or without reconstruction. The hypoglossal and vagus appeared most vulnerable for permanent paralysis due to traction or resection. Mortality with surgical excision of carotid body tumor (CBT) has become negligible with newer vascular surgical techniques and the morbidity has fallen to minimal 2.56%. Case report: We report a case of 24-year-old female with symptomatic CBT excision with external carotid artery (ECA) ligation. She developed asymptomatic infarction of the occipital lobe. All the cranial nerves were intact with a follow-up uneventful for the past 2 years. Conclusion: Minimizing complications in CBT surgery include an accurate preoperative imaging assessment of the tumor with comorbidities and evidence-based mana gement.

Indian Journal of Otolaryngology and Head & Neck Surgery, 2009

The role of vitamin A in the maintenance of epithelial integrity is well known. Several animal st... more The role of vitamin A in the maintenance of epithelial integrity is well known. Several animal studies have dealt with the induction of cholesteatoma in vitamin A defi ciency states and prevention and treatment of otitis media with vitamin A treatment. We treated fi ve patients of cholesteatoma with vitamin A oral supplements and no other treatment and found signifi cant resolution of cholesteatoma in four patients. Though this may not be an explanation in every case of cholesteatoma, our study highlights that there is a subset of patients with vitamin A defi cient cholesteatoma who could substantially benefi t from intervention with this wonderful vital amine.

Journal of Cancer Research and Therapeutics, 2010

Angiogenesis plays a key role in the initiation of growth and metastatic process in cancers. The ... more Angiogenesis plays a key role in the initiation of growth and metastatic process in cancers. The angiogenic switch may be one of the earliest events in conferring a metastatic potential to the tumor. Further evolution in this multi-step cascade is controlled by the positive and negative regulators of angiogenesis. Recent advances in molecular biology have given a better insight into the mechanisms governing head neck cancer with promising data elaborating the role of angiogenesis. Metastasis to neck nodes is a very important determinant of prognosis, and is more frequently encountered than distant metastasis in head and neck cancers. Systematic PUBMED search of English-language literature of studies involving humans between 1990 and 2008 using the Mesh terms 'pathologic neovascularization', 'head and neck neoplasms', 'lymphatic metastasis' was performed. Quality assessment of selected studies included clinical pertinence, publication in peer reviewed journals, adequate number of enrolled patients. The present article reviews the utility value of various angiogenic parameters and markers that have been utilized to predict regional metastasis including micro vessel density, positive and negative regulators of angiogenesis, and genetic markers for angiogenesis. Although there seems promising preclinical and clinical evidence paving way for novel diagnostic and therapeutic interventions, the implicit role of angiogenesis in metastatic head and neck cancers needs further substantiation.

Indian Journal of Surgical Oncology, 2016

Carotid body tumours are rare and mostly benign neoplasm. They are slow growing but can evade or ... more Carotid body tumours are rare and mostly benign neoplasm. They are slow growing but can evade or exert pressure on neighbouring important neurovascular structures. Hence, surgical resection remains the treatment modality of choice for large tumours partially or completely encasing the carotid arteries. But the surgical resection of these tumours with minimum morbidity is challenging because of their highly vascular nature. Earlier literature has dealt with various aspects of management of carotid body tumours including classification, morbidity, work-up, embolisation and extent of resection. However, the options in techniques of dissection for carotid body tumours have not been elaborated much. Here, we describe a stepwise dissection technique of carotid body tumours from the internal carotid towards the external carotid artery. This surgical technique, named as Bthe internal to external (INT-EX) technique^, provides better control of bleeding during the surgery, ease of dissection and lesser post-operative morbidity.

bioRxiv, 2021

India is at the 3rd position worldwide in terms of publication of scientific literature. However,... more India is at the 3rd position worldwide in terms of publication of scientific literature. However, in terms of productivity, it has been consistently failing to transform the research knowledge into industrial output. This study compares India with the leading countries to understand its lacuna in terms of R&D policy and outputs. Although scientific publications are regarded as the output of basic research, patent applications serve as a better indicator of the applied research. This paper assesses the important determinants for patent filings of a nation. It also focuses on the role of academia and industry collaboration in R&D and the productivity of a nation. We found that the higher the GERD (total Gross Domestic Expenditure of R&D) and the R&D personnel in a nation, the higher the patent filings of the nation. Moreover, we show that academia-industrial collaboration plays a key role in transforming basic research into real-world applications, as we illustrate the government’s ro...

Medical Hypotheses, 2020

Majority of patients infected with the COVID 19 virus display a mild to moderate course of diseas... more Majority of patients infected with the COVID 19 virus display a mild to moderate course of disease and spontaneously recover at 14-20 days. However, about 15% of patients progress to severe stages and 2.5% of these patients succumb to this illness. Most patients with severe disease belong to the elderly age group (< 65 years of age) and have multiple associated co-morbidities. The immune responses induced by the COVID 19 virus, during the incubation and non-severe stages, requires the early initiation of a specific adaptive immune response to eliminate the virus and prevent the progress to severe stages. In patients with a dysfunctional bridge adaptive immunity, the innate immune response becomes exaggerated due to the lack of feedback from the adaptive immune cells. The resultant cytokine storm is responsible for the severe lung injury leading to acute respiratory distress syndrome seen in COVID 19 patients. Mesenchymal stem cells are known to suppress overactive immune responses as well as bring about tissue regeneration and repair. This immuno-modulatory effect of MSCs could hold potential to manage a patient with severe symptoms of COVID 19 infection due to a dysfunctional adaptive immune system.

Medical Hypotheses, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

International Journal of Head and Neck Surgery

Introduction: Elucidation of the genomic basis of head and neck cancers (HNCs) may help in reduci... more Introduction: Elucidation of the genomic basis of head and neck cancers (HNCs) may help in reducing cancer-related mortality and morbidity. This is because prognostication by predicting disease course and treatment response will help to individualize treatment protocols. Materials and methods: This prospective pilot study used a 48-gene mutation panel on tumor tissue samples obtained from 18 patients suffering from HNCs. The clinical significance of these mutations was analyzed in terms of treatment resistance, presence of distant metastasis, family history, and disease recurrence. Results: Two patients carried germline mutations, nine carried somatic mutations and seven samples had no mutation detected on the 48-gene panel. The genomic studies detected germline mutations in BRCA and AIP, and somatic mutations in TP53, phosphatase and tensin homolog (PTEN), RB1, STK11, GNA11, and HRAS. Conclusion: The study appears to validate early genomic testing of HNC cases to modify treatment protocols and offers more specific and personalized treatment options to patients. Clinical significance: The study demonstrates the potential benefit of integrating genomic data with clinical details to map out a tailored treatment plan to benefit individual patients.

JCO Global Oncology, 2021

The COVID-19 pandemic has caused unprecedented impact across the globe, severely affecting the na... more The COVID-19 pandemic has caused unprecedented impact across the globe, severely affecting the national health systems, as well as mobility and commuting. Several key health issues are inadvertently being overlooked, bearing impact on mortality and other outcomes, particularly for patients with cancer.

Journal of Oral Medicine and Oral Surgery, 2020

Dear Editor, Salivary diagnostics has taken a major leap in infectious disease diagnosis with the... more Dear Editor, Salivary diagnostics has taken a major leap in infectious disease diagnosis with the SARS-CoV-2 pandemic. The U.S. Food and Drug Administration (FDA) authorised the Rutgers University Clinical Genomics Laboratory and the Curative-Korva SARS-CoV-2 Assay (the Curative-Korva test) for diagnosis of SARS-Cov-2 in saliva samples [1,2]. Since then, the Covid-19 diagnosis has become easier and more accessible. Saliva has been the major vector in the spread of COVID-19. SARS-CoV-2 is excreted in the oral cavity and spreads via aerosols. The droplets origin from nasopharyngeal or oropharyngeal, which is associated with saliva. While, larger droplets contribute to viral transmission to subjects nearby, the longdistance transmission is possible with smaller droplets infected with air-suspended viral particles [3]. The collection of saliva is a non-invasive, safe, quick process and eliminates the fear of inadequate sampling. In large-scale testing, sample collection methods that are technique sensitive, requiring trained professionals and increased protection measures (like personal protective equipment) are challenging and hard on available resources. Such a scenario demands the use of more efficient and convenient methods. Furthermore, the ease of self Àadministration facilitates at home sample collection eliminating the need to travel to a collection centre, reducing the risk of exposure to the individual as well as the healthcare personnel. While the Food and Drug Administration (FDA) has approved the at home saliva collection kits, these samples still need laboratory processing that uses RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) technology for SARS-Cov2 detection [1,2]. Going one step ahead, SkillCell

Frontiers in Oncology, 2021

Head and neck squamous cell carcinomas (HNSCC) include heterogeneous group of tumors, classified ... more Head and neck squamous cell carcinomas (HNSCC) include heterogeneous group of tumors, classified according to their anatomical site. It is the sixth most prevalent cancer globally. Among South Asian countries, India accounts for 40% of HNC malignancies with significant morbidity and mortality. In the present study, we have performed exome sequencing and analysis of 51 Head and Neck squamous cell carcinoma samples. Besides known mutations in the oncogenes and tumour suppressors, we have identified novel gene signatures differentiating buccal, alveolar, and tongue cancers. Around 50% of the patients showed mutation in tumour suppressor genes TP53 and TP63. Apart from the known mutations, we report novel mutations in the genes AKT1, SPECC1, and LRP1B, which are linked with tumour progression and patient survival. A highly curated process was developed to identify survival signatures. 36 survival-related genes were identified based on the correlation of functional impact of variants ide...

Journal of Indian Speech Language & Hearing Association, 2020

Speech errors are commonly reported in the literature for postsurgical treatment in lingual carci... more Speech errors are commonly reported in the literature for postsurgical treatment in lingual carcinomas. The degree of errors relate to the extent of resection and reconstruction. Residual organ compensation is reported in partial glossectomy, while adjacent articulator compensation in total glossectomy. This case report describes an early atypical labial compensation for lingual sounds in a young female postpartial glossectomy and free flap reconstruction. Speech articulation errors were specific to distortion of tongue tip stops, laterals, and liquids. Bilabial flicker like movements were noted during the production of alveolar stops which subsequently developed into a bilabial compensatory articulation. This error indicates that compensation for the affected articulator function may begin at a very early postsurgical stage. The compensation needs to be identified and intervened at an early stage where facilitation must be sought as a modality for speech correction in smaller surgeries to achieve new or near normal speech.

Authorea

Background: Increasing the use of tobacco by the younger generation has increased in oral cavity ... more Background: Increasing the use of tobacco by the younger generation has increased in oral cavity tumours. Surgical treatment is radical and results in severe functional morbidity. Using computer-aided designing technology, surgical and rehabilitative planning can be better. We present here our concept of a biomechanical 3D tongue model and its clinical utility in the management of tongue tumours. Methods: Patients diagnosed with Carcinoma of Tongue were included. These patients underwent a pre-operative Magnetic Resonance Imaging (MRI) of the head and neck region at our center. These patients were informed about the use of a 3D biomechanical patient-specific model for treatment planning and execution. Using Materialise Mimics Innovation Suite 19 DICOM data was imported, visualized, edited and segmented. Flashforge 'Creator-pro'3D Printer was used for 3D Printing. Fused Deposition Modeling (FDM) technology was used to print the tumour and uninvolved tongue in two different colors for easy identification. These patients underwent surgery with the 3D model serving as a guide for margins. Results: Two patients with stage III squamous cell carcinoma of tongue underwent the surgery based on the plan evolved from the 3D model. All the surgical margins were clear. The model helped address the discordance between patient expectations and surgical outcomes. We found that the model aided the reconstructive surgeon to plan the flap volume better and this translated into better rehabilitative outcomes. Discussion and Conclusion: The 3D biomechanical tongue model is a novel concept and may aid in improving our overall treatment outcomes.

Journal of Oral Medicine and Oral Surgery, 2020

Oral Oncology, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2018

We describe 3 rare cases of metastatic renal cell carcinoma in the head and neck region. Our firs... more We describe 3 rare cases of metastatic renal cell carcinoma in the head and neck region. Our first case was a 72 years old male presented with profuse bleeding from the left ear. On examination, proliferative, pink, friable mass was present in the left external auditory canal. On eliciting the detailed history, it was found that patient had renal cell carcinoma in the left kidney four years back and underwent left radical nephrectomy. Patient underwent left lateral temporal bone resection with cul-de-sac closure. Histopathological examination of the specimen showed metastatic renal cell carcinoma. Our second case was a 64 years old male presented with complaints of growth in the oral cavity of 1 month duration. On examination, 5×3 cms proliferative growth was present in the hard palate. Biopsy from the growth in the hard palate showed metastatic renal cell carcinoma. Patient gave history of renal cell carcinoma in the past for which he did not receive treatment. Our third case was a...

Heliyon, 2019

Cutaneous squamous cell carcinoma is a common global cancer with Ultraviolet light recognized as ... more Cutaneous squamous cell carcinoma is a common global cancer with Ultraviolet light recognized as the most significant risk factor. The other definite or plausible risk factors include immunosuppression, infection with oncogenic viruses, exposure to toxins, chemicals, chronic inflammatory skin disease and a high body mass index. This case highlights the rarity of the pathology in terms of size, the subtle transition of verrucous hyperplasia to cutaneous squamous cell carcinoma over a period of time and the fallibility of the frozen section report in deciding the optimum resection margins. The initial innocuous presentation represented a diagnostic challenge as it can be mistaken for other benign entities. A correlation between the history, clinical presentation, tumor biology and the histopathological characteristics helped us to unlock the jigsaw puzzle of approaching a rare condition with a modification in the surgical approach.

Indian Journal of Surgical Oncology, 2017

The incidence of small differentiated thyroid carcinomas is increasing worldwide in the recent ye... more The incidence of small differentiated thyroid carcinomas is increasing worldwide in the recent years, especially tumours of size less than 2 cm in diameter. In this study, we have analysed the patterns of behaviour of small-sized thyroid carcinomas (<2 cm, T1 tumours) in comparison with largesized thyroid carcinomas. This is a retrospectively analysed data of patients with thyroid carcinoma. The following parameters were analysed: distribution with regard to age, sex and the presence of metastasis based on radioiodine scan. The following histopathological details were collected: maximal tumour diameter, extrathyroidal extension and lymphovascular invasion. Out of 152 patients, 39 patients were excluded due to the non-availability of complete details. Among the 113 patients of thyroid carcinomas, 43 patients (28%) were presented with small-sized tumours (measuring less than 2 cm). In smallsized thyroid tumours, 21.6% showed extrathyroidal extension. 2.7% of the small-sized thyroid carcinomas showed perineural invasion as compared to 6.3% of the large-sized thyroid carcinomas. Twenty percent of the small-sized thyroid carcinomas showed lymphovascular emboli. 51.2% of the small-sized thyroid carcinomas were presented with nodal metastasis as compared to 40% of the large-sized thyroid carcinomas. 57.5% of the small-sized thyroid carcinomas showed extracapsular extension as compared to 57.8% of the large-sized thyroid carcinomas. Despite small size, thyroid carcinomas have properties to behave aggressively as comparable to large-sized thyroid carcinomas. Taking the above facts into account, the small thyroid cancers should be treated with considerable caution as large thyroid cancers, especially since we have limited tools to predict the preoperative poor prognostic factors.

International Journal of Head and Neck Surgery, 2014

Background: Vascular complications are seen in 2 to 13% of cases with internal carotid artery (IC... more Background: Vascular complications are seen in 2 to 13% of cases with internal carotid artery (ICA) injuries with or without reconstruction. The hypoglossal and vagus appeared most vulnerable for permanent paralysis due to traction or resection. Mortality with surgical excision of carotid body tumor (CBT) has become negligible with newer vascular surgical techniques and the morbidity has fallen to minimal 2.56%. Case report: We report a case of 24-year-old female with symptomatic CBT excision with external carotid artery (ECA) ligation. She developed asymptomatic infarction of the occipital lobe. All the cranial nerves were intact with a follow-up uneventful for the past 2 years. Conclusion: Minimizing complications in CBT surgery include an accurate preoperative imaging assessment of the tumor with comorbidities and evidence-based mana gement.

Indian Journal of Otolaryngology and Head & Neck Surgery, 2009

The role of vitamin A in the maintenance of epithelial integrity is well known. Several animal st... more The role of vitamin A in the maintenance of epithelial integrity is well known. Several animal studies have dealt with the induction of cholesteatoma in vitamin A defi ciency states and prevention and treatment of otitis media with vitamin A treatment. We treated fi ve patients of cholesteatoma with vitamin A oral supplements and no other treatment and found signifi cant resolution of cholesteatoma in four patients. Though this may not be an explanation in every case of cholesteatoma, our study highlights that there is a subset of patients with vitamin A defi cient cholesteatoma who could substantially benefi t from intervention with this wonderful vital amine.

Journal of Cancer Research and Therapeutics, 2010

Angiogenesis plays a key role in the initiation of growth and metastatic process in cancers. The ... more Angiogenesis plays a key role in the initiation of growth and metastatic process in cancers. The angiogenic switch may be one of the earliest events in conferring a metastatic potential to the tumor. Further evolution in this multi-step cascade is controlled by the positive and negative regulators of angiogenesis. Recent advances in molecular biology have given a better insight into the mechanisms governing head neck cancer with promising data elaborating the role of angiogenesis. Metastasis to neck nodes is a very important determinant of prognosis, and is more frequently encountered than distant metastasis in head and neck cancers. Systematic PUBMED search of English-language literature of studies involving humans between 1990 and 2008 using the Mesh terms 'pathologic neovascularization', 'head and neck neoplasms', 'lymphatic metastasis' was performed. Quality assessment of selected studies included clinical pertinence, publication in peer reviewed journals, adequate number of enrolled patients. The present article reviews the utility value of various angiogenic parameters and markers that have been utilized to predict regional metastasis including micro vessel density, positive and negative regulators of angiogenesis, and genetic markers for angiogenesis. Although there seems promising preclinical and clinical evidence paving way for novel diagnostic and therapeutic interventions, the implicit role of angiogenesis in metastatic head and neck cancers needs further substantiation.

Indian Journal of Surgical Oncology, 2016

Carotid body tumours are rare and mostly benign neoplasm. They are slow growing but can evade or ... more Carotid body tumours are rare and mostly benign neoplasm. They are slow growing but can evade or exert pressure on neighbouring important neurovascular structures. Hence, surgical resection remains the treatment modality of choice for large tumours partially or completely encasing the carotid arteries. But the surgical resection of these tumours with minimum morbidity is challenging because of their highly vascular nature. Earlier literature has dealt with various aspects of management of carotid body tumours including classification, morbidity, work-up, embolisation and extent of resection. However, the options in techniques of dissection for carotid body tumours have not been elaborated much. Here, we describe a stepwise dissection technique of carotid body tumours from the internal carotid towards the external carotid artery. This surgical technique, named as Bthe internal to external (INT-EX) technique^, provides better control of bleeding during the surgery, ease of dissection and lesser post-operative morbidity.

bioRxiv, 2021

India is at the 3rd position worldwide in terms of publication of scientific literature. However,... more India is at the 3rd position worldwide in terms of publication of scientific literature. However, in terms of productivity, it has been consistently failing to transform the research knowledge into industrial output. This study compares India with the leading countries to understand its lacuna in terms of R&D policy and outputs. Although scientific publications are regarded as the output of basic research, patent applications serve as a better indicator of the applied research. This paper assesses the important determinants for patent filings of a nation. It also focuses on the role of academia and industry collaboration in R&D and the productivity of a nation. We found that the higher the GERD (total Gross Domestic Expenditure of R&D) and the R&D personnel in a nation, the higher the patent filings of the nation. Moreover, we show that academia-industrial collaboration plays a key role in transforming basic research into real-world applications, as we illustrate the government’s ro...

Medical Hypotheses, 2020

Majority of patients infected with the COVID 19 virus display a mild to moderate course of diseas... more Majority of patients infected with the COVID 19 virus display a mild to moderate course of disease and spontaneously recover at 14-20 days. However, about 15% of patients progress to severe stages and 2.5% of these patients succumb to this illness. Most patients with severe disease belong to the elderly age group (< 65 years of age) and have multiple associated co-morbidities. The immune responses induced by the COVID 19 virus, during the incubation and non-severe stages, requires the early initiation of a specific adaptive immune response to eliminate the virus and prevent the progress to severe stages. In patients with a dysfunctional bridge adaptive immunity, the innate immune response becomes exaggerated due to the lack of feedback from the adaptive immune cells. The resultant cytokine storm is responsible for the severe lung injury leading to acute respiratory distress syndrome seen in COVID 19 patients. Mesenchymal stem cells are known to suppress overactive immune responses as well as bring about tissue regeneration and repair. This immuno-modulatory effect of MSCs could hold potential to manage a patient with severe symptoms of COVID 19 infection due to a dysfunctional adaptive immune system.

Medical Hypotheses, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.