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Papers by Ajith Vettuparambil

Research paper thumbnail of Swiss cheese disease: A rare case of juvenile papillomatosis of the breast mimicking carcinoma in a young female

Indian Journal of Pathology and Microbiology

Research paper thumbnail of The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines

Abdominal Imaging, 2012

Imaging of acute pancreatitis requires not only an understanding of the disease subtypes and the ... more Imaging of acute pancreatitis requires not only an understanding of the disease subtypes and the myriad of associated complications but also familiarity with the appropriate radiologic nomenclature as defined by the Atlanta symposium in 1992 and, more recently, by the Acute Pancreatitis Classification Working Group in 2008. The accurate description of the radiological findings plays a critical role in the evaluation and management of patients with acute pancreatitis, particularly those with severe disease. There have been increasing efforts to develop uniformity in the use of terminology used to define the radiologic findings in acute pancreatitis, in particular, the terminology for fluid collections, a common area of inconsistency and confusion. Terms such as ''acute peripancreatic fluid collections,'' ''acute post-necrotic fluid collections,'' ''pseudocyst,'' and ''walled-off pancreatic necrosis'' are now recommended as they describe the evolution of fluid collections in patients with both interstitial and necrotizing pancreatitis and nonspecific terms such as ''pancreatic abscess'' and ''phlegmon'' are being abandoned. In this review we illustrate, with case examples, the standardized terminology used in the radiological and clinical description of acute pancreatitis, its severity, and complications with an emphasis on the role of ultrasound, computed tomography and magnetic resonance imaging. Different management options of the associated complications are also discussed. The use of standardized terminology will hopefully improve the communication between radiologists, gastroenterologists, and surgeons to facilitate treatment planning and will lead to enhanced outcomes for patients with acute pancreatitis as well as create uniformity for enrollment into research studies.

Research paper thumbnail of Psoriasis can markedly impair the quality of life of patients irrespective of severity: Results of a hospital-based cross-sectional study

Muller Journal of Medical Sciences and Research, 2016

Background and Objectives: There are conflicting opinions in previous studies whether the quality... more Background and Objectives: There are conflicting opinions in previous studies whether the quality of life (QoL) of patients with psoriasis is affected by its severity. The aim of the study was to assess the QoL of patients with psoriasis attending a tertiary care teaching hospital in central Kerala, India; and to find out if severity of psoriasis as measured by psoriasis area severity index (PASI) affects the QoL. Materials and Methods: We did a cross-sectional study of 49 patients with psoriasis. QoL was assessed using the Malayalam version of the Dermatology Life Quality Index (DLQI). PASI was used to calculate the clinical severity of the disease. We calculated Spearman′s rank correlation coefficient between these two scores. Results: Thirty-three (67.3%) patients had marked (moderate or above) impact on overall QoL. Among the various domains of the QoL, symptoms and feeling were found to be affected most, followed by work and school and daily activities. There was no significant correlation between PASI and the overall DLQI (Spearman r = 0.131, P = 0.37), though the domain of leisure activities showed moderately significant positive correlation (Spearman r = 0.037; P = 0.03) with PASI. Conclusion: Psoriasis markedly affects the QoL of the sufferers, especially in the domains of symptoms and feeling, work, and school as well as daily activities. This study does not provide evidence that impairment of QoL is related to severity of psoriasis.

Research paper thumbnail of Are the Risk Factors of Breast Cancer among Women in Kerala different from around the globe, Need for a detailed analysis : Prospective review from a tertiary care centre Kerala

Introduction: The incidence of breast cancer is increasing worldwide. This study aimed to assess ... more Introduction: The incidence of breast cancer is increasing worldwide. This study aimed to assess the risk factors of breast cancer in patients reporting at our tertiary care institute with an endeavour to reduce the incidence, mortality and morbidity due to the disease, having the knowledge that risk factors may vary according to different parts of the country.Methods: A case control study was conducted in the Department of General Surgery, Government Medical College, Thrissur among 165 histologically proven female breast cancer patients (cases) and 165 females with no evidence of carcinoma breast (age matched controls). Screening was done by both clinical examination and imaging wherever necessary from April 1st  2013 to March 31st  2014. A private interview was set up for all cases and controls using a structured proforma for collecting data regarding risk factors. Both t- test and chi square test were used for analysis.Results: Mean age of the study population was 52 ye...

Research paper thumbnail of Thirty-day surgical outcome among patients who had undergone emergency laparotomy in a tertiary care teaching hospital: An audit of 151 cases

Muller Journal of Medical Sciences and Research

Research paper thumbnail of Flap Fixation as a Technique for Reducing Seroma Formation in Patients Undergoing Modified Radical Mastectomy: an Institutional Experience

Indian Journal of Surgical Oncology

Research paper thumbnail of Epidemiology, Pathological Characteristics and Estrogen and Progesterone Receptor Status of Operated Cases of Female Breast Cancer: A Retrospective Review of 266 Cases from Kerala

Indian journal of surgical oncology, 2015

Breast cancer is presently the most common cancer among women in Kerala, in Southern India. The o... more Breast cancer is presently the most common cancer among women in Kerala, in Southern India. The objectives of this study were to analyze the epidemiology and pathological characteristics of female breast carcinoma in Kerala. 266 patients who were diagnosed with operable breast cancer between April 2009 and June 2010 were studied. Various pathological characteristics including stage, grade, axillary lymph nodal status, tumor size, and estrogen and progesterone receptor status were studied. Estrogen and progesterone receptor status were evaluated by immunohistochemistry. Chi-square test and frequency tables were used for statistical analysis. The mean age at presentation was 50 years. 48.9 % of the patients were premenopausal. 53.76 % had grade II tumors. Positive axillary lymph nodes were found in 70.3 % patients, and 68 % presented with stage II disease. 54.13 % were ER positive and 62 % were PR positive. The relatively young age at diagnosis, late presentation of the disease, and l...

Research paper thumbnail of Epidemiology, Pathological Characteristics and Estrogen and Progesterone Receptor Status of Operated Cases of Female Breast Cancer: A Retrospective Review of 266 Cases from Kerala

Indian Journal of Surgical Oncology, 2015

Breast cancer is presently the most common cancer among women in Kerala, in Southern India. The o... more Breast cancer is presently the most common cancer among women in Kerala, in Southern India. The objectives of this study were to analyze the epidemiology and pathological characteristics of female breast carcinoma in Kerala. 266 patients who were diagnosed with operable breast cancer between April 2009 and June 2010 were studied. Various pathological characteristics including stage, grade, axillary lymph nodal status, tumor size, and estrogen and progesterone receptor status were studied. Estrogen and progesterone receptor status were evaluated by immunohistochemistry. Chi-square test and frequency tables were used for statistical analysis. The mean age at presentation was 50 years. 48.9 % of the patients were premenopausal. 53.76 % had grade II tumors. Positive axillary lymph nodes were found in 70.3 % patients, and 68 % presented with stage II disease. 54.13 % were ER positive and 62 % were PR positive. The relatively young age at diagnosis, late presentation of the disease, and lower estrogen and progesterone receptor expression compared to patients from the West point toward the need for better breast cancer awareness and screening programmes in Kerala.

Research paper thumbnail of Hormone-receptor expression and survival patterns in operated cases of female invasive ductal breast carcinoma in Kerala: a retrospective cohort study

World journal of surgical oncology, Jan 23, 2015

Though breast cancer is the most common cancer among women in Kerala, India, epidemiological data... more Though breast cancer is the most common cancer among women in Kerala, India, epidemiological data on breast cancer in the state is largely lacking. The objectives of this study were to analyze the survival pattern of female breast carcinoma in this region of the country and to compare the differences in survival with different hormone-receptor expressions. One hundred eighty-nine female breast cancer patients who were operated between 1 August 2008 and 3 July 2009 were followed up over telephone to obtain data on five-year survival. Grade, stage of the disease, and hormone-receptor (HR) status were obtained from treatment records. Logistic regression and the Kaplan-Meier survival analysis were used for statistical analysis. The mean age of the study population was 49.07 (SD, 10.35) years. A majority of the patients had estrogen receptor (ER)+/progesterone receptor (PR) + tumors (n = 103, 54.5%), followed by 72 (38.1%) ER-/PR-, 10 (5.3%) ER-/PR+, and 4 (2.1%) ER+/PR-. Stage of the di...

Research paper thumbnail of Psoriasis can markedly impair the quality of life of patients irrespective of severity: Results of a hospital-based cross-sectional study

Background and Objectives: There are conflicting opinions in previous studies whether the quality... more Background and Objectives: There are conflicting opinions in previous studies whether the quality of life (QoL) of patients with psoriasis
is affected by its severity. The aim of the study was to assess the QoL of patients with psoriasis attending a tertiary care teaching
hospital in central Kerala, India; and to find out if severity of psoriasis as measured by psoriasis area severity index (PASI) affects the
QoL. Materials and Methods: We did a cross-sectional study of 49 patients with psoriasis. QoL was assessed using the Malayalam
version of the Dermatology Life Quality Index (DLQI). PASI was used to calculate the clinical severity of the disease. We calculated
Spearman’s rank correlation coefficient between these two scores. Results: Thirty-three (67.3%) patients had marked (moderate or
above) impact on overall QoL. Among the various domains of the QoL, symptoms and feeling were found to be affected most, followed
by work and school and daily activities. There was no significant correlation between PASI and the overall DLQI (Spearman r = 0.131,
P = 0.37), though the domain of leisure activities showed moderately significant positive correlation (Spearman r = 0.037; P = 0.03)
with PASI. Conclusion: Psoriasis markedly affects the QoL of the sufferers, especially in the domains of symptoms and feeling, work,
and school as well as daily activities. This study does not provide evidence that impairment of QoL is related to severity of psoriasis.

Research paper thumbnail of Swiss cheese disease: A rare case of juvenile papillomatosis of the breast mimicking carcinoma in a young female

Indian Journal of Pathology and Microbiology

Research paper thumbnail of The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines

Abdominal Imaging, 2012

Imaging of acute pancreatitis requires not only an understanding of the disease subtypes and the ... more Imaging of acute pancreatitis requires not only an understanding of the disease subtypes and the myriad of associated complications but also familiarity with the appropriate radiologic nomenclature as defined by the Atlanta symposium in 1992 and, more recently, by the Acute Pancreatitis Classification Working Group in 2008. The accurate description of the radiological findings plays a critical role in the evaluation and management of patients with acute pancreatitis, particularly those with severe disease. There have been increasing efforts to develop uniformity in the use of terminology used to define the radiologic findings in acute pancreatitis, in particular, the terminology for fluid collections, a common area of inconsistency and confusion. Terms such as ''acute peripancreatic fluid collections,'' ''acute post-necrotic fluid collections,'' ''pseudocyst,'' and ''walled-off pancreatic necrosis'' are now recommended as they describe the evolution of fluid collections in patients with both interstitial and necrotizing pancreatitis and nonspecific terms such as ''pancreatic abscess'' and ''phlegmon'' are being abandoned. In this review we illustrate, with case examples, the standardized terminology used in the radiological and clinical description of acute pancreatitis, its severity, and complications with an emphasis on the role of ultrasound, computed tomography and magnetic resonance imaging. Different management options of the associated complications are also discussed. The use of standardized terminology will hopefully improve the communication between radiologists, gastroenterologists, and surgeons to facilitate treatment planning and will lead to enhanced outcomes for patients with acute pancreatitis as well as create uniformity for enrollment into research studies.

Research paper thumbnail of Psoriasis can markedly impair the quality of life of patients irrespective of severity: Results of a hospital-based cross-sectional study

Muller Journal of Medical Sciences and Research, 2016

Background and Objectives: There are conflicting opinions in previous studies whether the quality... more Background and Objectives: There are conflicting opinions in previous studies whether the quality of life (QoL) of patients with psoriasis is affected by its severity. The aim of the study was to assess the QoL of patients with psoriasis attending a tertiary care teaching hospital in central Kerala, India; and to find out if severity of psoriasis as measured by psoriasis area severity index (PASI) affects the QoL. Materials and Methods: We did a cross-sectional study of 49 patients with psoriasis. QoL was assessed using the Malayalam version of the Dermatology Life Quality Index (DLQI). PASI was used to calculate the clinical severity of the disease. We calculated Spearman′s rank correlation coefficient between these two scores. Results: Thirty-three (67.3%) patients had marked (moderate or above) impact on overall QoL. Among the various domains of the QoL, symptoms and feeling were found to be affected most, followed by work and school and daily activities. There was no significant correlation between PASI and the overall DLQI (Spearman r = 0.131, P = 0.37), though the domain of leisure activities showed moderately significant positive correlation (Spearman r = 0.037; P = 0.03) with PASI. Conclusion: Psoriasis markedly affects the QoL of the sufferers, especially in the domains of symptoms and feeling, work, and school as well as daily activities. This study does not provide evidence that impairment of QoL is related to severity of psoriasis.

Research paper thumbnail of Are the Risk Factors of Breast Cancer among Women in Kerala different from around the globe, Need for a detailed analysis : Prospective review from a tertiary care centre Kerala

Introduction: The incidence of breast cancer is increasing worldwide. This study aimed to assess ... more Introduction: The incidence of breast cancer is increasing worldwide. This study aimed to assess the risk factors of breast cancer in patients reporting at our tertiary care institute with an endeavour to reduce the incidence, mortality and morbidity due to the disease, having the knowledge that risk factors may vary according to different parts of the country.Methods: A case control study was conducted in the Department of General Surgery, Government Medical College, Thrissur among 165 histologically proven female breast cancer patients (cases) and 165 females with no evidence of carcinoma breast (age matched controls). Screening was done by both clinical examination and imaging wherever necessary from April 1st  2013 to March 31st  2014. A private interview was set up for all cases and controls using a structured proforma for collecting data regarding risk factors. Both t- test and chi square test were used for analysis.Results: Mean age of the study population was 52 ye...

Research paper thumbnail of Thirty-day surgical outcome among patients who had undergone emergency laparotomy in a tertiary care teaching hospital: An audit of 151 cases

Muller Journal of Medical Sciences and Research

Research paper thumbnail of Flap Fixation as a Technique for Reducing Seroma Formation in Patients Undergoing Modified Radical Mastectomy: an Institutional Experience

Indian Journal of Surgical Oncology

Research paper thumbnail of Epidemiology, Pathological Characteristics and Estrogen and Progesterone Receptor Status of Operated Cases of Female Breast Cancer: A Retrospective Review of 266 Cases from Kerala

Indian journal of surgical oncology, 2015

Breast cancer is presently the most common cancer among women in Kerala, in Southern India. The o... more Breast cancer is presently the most common cancer among women in Kerala, in Southern India. The objectives of this study were to analyze the epidemiology and pathological characteristics of female breast carcinoma in Kerala. 266 patients who were diagnosed with operable breast cancer between April 2009 and June 2010 were studied. Various pathological characteristics including stage, grade, axillary lymph nodal status, tumor size, and estrogen and progesterone receptor status were studied. Estrogen and progesterone receptor status were evaluated by immunohistochemistry. Chi-square test and frequency tables were used for statistical analysis. The mean age at presentation was 50 years. 48.9 % of the patients were premenopausal. 53.76 % had grade II tumors. Positive axillary lymph nodes were found in 70.3 % patients, and 68 % presented with stage II disease. 54.13 % were ER positive and 62 % were PR positive. The relatively young age at diagnosis, late presentation of the disease, and l...

Research paper thumbnail of Epidemiology, Pathological Characteristics and Estrogen and Progesterone Receptor Status of Operated Cases of Female Breast Cancer: A Retrospective Review of 266 Cases from Kerala

Indian Journal of Surgical Oncology, 2015

Breast cancer is presently the most common cancer among women in Kerala, in Southern India. The o... more Breast cancer is presently the most common cancer among women in Kerala, in Southern India. The objectives of this study were to analyze the epidemiology and pathological characteristics of female breast carcinoma in Kerala. 266 patients who were diagnosed with operable breast cancer between April 2009 and June 2010 were studied. Various pathological characteristics including stage, grade, axillary lymph nodal status, tumor size, and estrogen and progesterone receptor status were studied. Estrogen and progesterone receptor status were evaluated by immunohistochemistry. Chi-square test and frequency tables were used for statistical analysis. The mean age at presentation was 50 years. 48.9 % of the patients were premenopausal. 53.76 % had grade II tumors. Positive axillary lymph nodes were found in 70.3 % patients, and 68 % presented with stage II disease. 54.13 % were ER positive and 62 % were PR positive. The relatively young age at diagnosis, late presentation of the disease, and lower estrogen and progesterone receptor expression compared to patients from the West point toward the need for better breast cancer awareness and screening programmes in Kerala.

Research paper thumbnail of Hormone-receptor expression and survival patterns in operated cases of female invasive ductal breast carcinoma in Kerala: a retrospective cohort study

World journal of surgical oncology, Jan 23, 2015

Though breast cancer is the most common cancer among women in Kerala, India, epidemiological data... more Though breast cancer is the most common cancer among women in Kerala, India, epidemiological data on breast cancer in the state is largely lacking. The objectives of this study were to analyze the survival pattern of female breast carcinoma in this region of the country and to compare the differences in survival with different hormone-receptor expressions. One hundred eighty-nine female breast cancer patients who were operated between 1 August 2008 and 3 July 2009 were followed up over telephone to obtain data on five-year survival. Grade, stage of the disease, and hormone-receptor (HR) status were obtained from treatment records. Logistic regression and the Kaplan-Meier survival analysis were used for statistical analysis. The mean age of the study population was 49.07 (SD, 10.35) years. A majority of the patients had estrogen receptor (ER)+/progesterone receptor (PR) + tumors (n = 103, 54.5%), followed by 72 (38.1%) ER-/PR-, 10 (5.3%) ER-/PR+, and 4 (2.1%) ER+/PR-. Stage of the di...

Research paper thumbnail of Psoriasis can markedly impair the quality of life of patients irrespective of severity: Results of a hospital-based cross-sectional study

Background and Objectives: There are conflicting opinions in previous studies whether the quality... more Background and Objectives: There are conflicting opinions in previous studies whether the quality of life (QoL) of patients with psoriasis
is affected by its severity. The aim of the study was to assess the QoL of patients with psoriasis attending a tertiary care teaching
hospital in central Kerala, India; and to find out if severity of psoriasis as measured by psoriasis area severity index (PASI) affects the
QoL. Materials and Methods: We did a cross-sectional study of 49 patients with psoriasis. QoL was assessed using the Malayalam
version of the Dermatology Life Quality Index (DLQI). PASI was used to calculate the clinical severity of the disease. We calculated
Spearman’s rank correlation coefficient between these two scores. Results: Thirty-three (67.3%) patients had marked (moderate or
above) impact on overall QoL. Among the various domains of the QoL, symptoms and feeling were found to be affected most, followed
by work and school and daily activities. There was no significant correlation between PASI and the overall DLQI (Spearman r = 0.131,
P = 0.37), though the domain of leisure activities showed moderately significant positive correlation (Spearman r = 0.037; P = 0.03)
with PASI. Conclusion: Psoriasis markedly affects the QoL of the sufferers, especially in the domains of symptoms and feeling, work,
and school as well as daily activities. This study does not provide evidence that impairment of QoL is related to severity of psoriasis.