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Papers by Namrata Punit Awasthi

Indian Journal of Clinical Biochemistry

z ratio (NLR) were recorded. Patients were followed up until recovery with discharge or death. Pa... more z ratio (NLR) were recorded. Patients were followed up until recovery with discharge or death. Parameters from 54 mild (MCOV-19), 46 severe (SCOV-19) and 30 HC were analysed. mHLA-DR revealed significant and graded down regulation in MCOV-19 and SCOV-19 as compared to HC whereas IDI was lowest in HC with increasing values in MCOV-19 and SCOV-19. For diagnostic discrimination of MCOV-19 and SCOV-19, IDI revealed highest AUC (0.99). All three immune parameters revealed significant difference between survivors (n = 78) and non-survivors (n = 22). mHLA-DR < 7010 and IDI > 12 had significant association with mortality. Four best performing parameters to identify patients with SCOV-19 at higher risk of mortality were IDI, NLR, ALC and PCT. mHLA-DR and IDI, in addition to NLR and ALC at admission and during hospital stay can be utilized for patient triaging, monitoring, early intervention, and mortality prediction. IDI reported for the first time in this study, appears most promising. Immune monitoring of 'in hospital' cases may provide optimized treatment options.

<p>Supplemental material, Supplementary_Material for Clinicopathological parameters influen... more <p>Supplemental material, Supplementary_Material for Clinicopathological parameters influencing inhibitor development in patients with hemophilia A receiving on-demand therapy by Sanya Arshad, Anshima Singh, Namrata Punit Awasthi, Swati Kumari and Nuzhat Husain in Therapeutic Advances in Hematology</p

Background: Aspergillus has a ubiquitous distribution in nature, aspergillous fungal balls are mo... more Background: Aspergillus has a ubiquitous distribution in nature, aspergillous fungal balls are more common and are referred to as aspergillomas. The present study was conducted to study the cases of aspergiloma in study population. Materials & Methods: It included 35 cases of pulmonary aspergillosis. The hematological and radiological investigations were done in all patients. The lesions were classified as cavitatory and non-cavitatory lesions. The number, location, site, shape, nature of the inner lining and thickness of the wall, communication with the bronchial tree or vasculature and surrounding parenchyma were recorded. Results: Out of 35 patients, males were 22 and females were 13. The difference was significant (P-0.05). 28 patients had hemoptysis and 7 had not. Accompanying features in hemoptysis patients were cough (22), short breadth (7), chest pain (8), fever (12), loss of apetite & weight (9), right heart failure (2) and gasping state (1). Accompnaying features in patien...

Background: Spectrum of alcoholic liver disease ranges from steatosis to steatohepatitis (alcohol... more Background: Spectrum of alcoholic liver disease ranges from steatosis to steatohepatitis (alcoholic steatohepatitis) to cirrhosis. The present study was conducted to study the similarities and differences in biochemical and histologic features between NASH and ASH. Materials & Methods: It included 40 patients of ASH and 40 patients of NASH. The morphologic criteria for including cases in ASH and NASH were degree of steatosis, ballooning, portal and lobular inflammation with or without fibrosis. Clinical, biochemical and histological features were compared in both groups. Results: Bilirubin level in AST patients was 5.46 mg% and in NASH group was 2.37 mg%. The difference was significant (P<0.05). AST level in ASH group was 90.4 IU/ml and 72.2 IU/ml in NASH group. ALT was significantly higher in NASH group as compared to ASH group (104.6 IU/ml vs 76.8 IU/ml). SAP level was also significantly higher in NASH group as compared to ASH group (202.7 IU/ml vs 116 IU/ml). Comparison of ste...

Egyptian Journal of Radiology and Nuclear Medicine, 2022

Background Mammography is the primary imaging modality for diagnosing breast cancer in women more... more Background Mammography is the primary imaging modality for diagnosing breast cancer in women more than 40 years of age. Digital breast tomosynthesis (DBT), when supplemented with digital mammography (DM), is useful for increasing the sensitivity and improving BIRADS characterization by removing the overlapping effect. Ultrasonography (US), when combined with the above combination, further increases the sensitivity and diagnostic confidence. Since most of the research regarding tomosynthesis has been in screening settings, we wanted to quantify its role in diagnostic mammography. The purpose of this study was to assess the performance of DM alone vs. DM combined with DBT vs. DM plus DBT and ultrasound in diagnosing malignant breast neoplasms with the gold standard being histopathology or cytology. Results A prospective study of 1228 breasts undergoing diagnostic or screening mammograms was undertaken at our institute. Patients underwent 2 views DM, single view DBT and US. BIRADS cate...

Transfusion and Apheresis Science, 2021

The acquisition of factor VIII inhibitors poses major management challenges for haemophilia A (HA... more The acquisition of factor VIII inhibitors poses major management challenges for haemophilia A (HA) patients. Most (Factor VIII) inhibitors are immunoglobulin G4 (IgG4) and G1 (IgG1) subclasses, with IgG4 being the most prevalent. The Nijmegen Bethesda Assay (NBA) was used to quantify inhibitors. However, the requirement for a large sample volume, accompanying costs, and required technical expertise complicate NBA, particularly in developing countries. ELISA-based screening proved to be more viable in a resource-constrained scenario. This study aimed to standardise and evaluate an in-house IgG4 ELISA for the detection of haemophilia A inhibitors. This study enrolled thirty HA patients with inhibitors, thirty three HA without inhibitors, and 33 healthy controls. Standardisation of in-house IgG4 ELISA was performed. The checkerboard method was employed to optimise plasma-derived Factor VIII concentrations (HEMOFIL M Baxalta US Inc.), sample dilutions, and anti-human IgG4-HRP conjugate (Southern Biotechnology, USA). The samples were evaluated three times, and the mean optical density (OD) was used to determine the cutoff. Using a cutoff OD (mean±2SD) of 0.502 in our in-house ELISA, we could differentiate healthy controls and HA without inhibitors from HA with inhibitors with 93.3 % sensitivity, 97.0 % specificity, 97 % NPV, and 93.3 % PPV, respectively. However, the accuracy was 95.83 %. The two-way mixed-effects model, interclass correlation (ICC) derived by Cronbach's Alpha was 0.912 (p = 0.001) and close to perfect agreement. IgG4 ELISA is an effective method for detecting neutralising or functionally significant FVIII inhibitors, particularly in resource-constrained settings, following which patients may be referred to referral laboratories for quantification of inhibitors.

Journal of cancer research and therapeutics, 2017

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy, recognized... more Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy, recognized as a distinct entity in the WHO 2008 classification of hematolymphoid neoplasm. Described for the first time in 1994 as CD4+ cutaneous lymphoma with high expression of CD56, BPDCN has been known previously with various names such as blastic natural killer (NK) leukemia/lymphoma, agranular CD4+ CD56+ hematodermic neoplasm, and agranular CD4+ NK cell leukemia. This disease usually presents with cutaneous involvement as the first manifestation, with subsequent or simultaneous spread to bone marrow and peripheral blood. Leukemia as the first presenting symptom without any cutaneous involvement is a rare finding and can masquerade as acute undifferentiated leukemia. We present here such a case of a 59-year-old male who presented as leukemia without any cutaneous lesion but subsequently developed a scalp nodule.

NTRODUCTION Ameloblastoma is a rare, benign or cancerous tumor of odontogenic epithelium (amelobl... more NTRODUCTION Ameloblastoma is a rare, benign or cancerous tumor of odontogenic epithelium (ameloblasts, or outside portion, of the teeth during development) much more commonly appearing in the lower jaw than the upper jaw. It was recognized in 1827 by Cusack. This type of odontogenic neoplasm was designated as an adamantinoma in 1885 by the French physician Louis-Charles Malassez. It was finally renamed to the modern name ameloblastoma in 1930 by Ivey and Churchill. 1

Annals of Applied Bio-Sciences, 2015

Background: Considerable variation has been noted in the age at onset and bleeding pattern in Cas... more Background: Considerable variation has been noted in the age at onset and bleeding pattern in Cases with Hemophilia A (CWH) of severe type. Mechanisms seem multifactorial with co-inheritance of Factor V Leiden mutation (FVL) with severe Hemophilia A (HA) being one of them. There is evidence that carrier ship of FVL mutation in CWH might confer an evolutionary selective advantage leading to a milder clinical phenotype. The authors hypothesized that FVL mutation may be more prevalent in CWH. The present study was undertaken to determine the prevalence of FVL mutation in CWH and evaluate the phenotypic effect of this co-inheritance on clinical severity of hemophilia. Methods: A total of 100 CWH were recruited for this study. Detailed clinical history regarding the age at onset, type, frequency and site of bleeding was taken. Coagulation work up including Factor VIII (FVIII) assay and von willebrand factor antigen (VWFAg) were done. FVL mutation and intron 22 inversion mutation were stu...

Indian Journal of Pathology and Oncology, 2020

The WHO 2016 update on lymphoid neoplasms incorporates criteria independent of tissue architectur... more The WHO 2016 update on lymphoid neoplasms incorporates criteria independent of tissue architecture in the diagnosis and subclassification of non-Hodgkin lymphoma. Thus, lymphoid neoplasms with characteristic immunophenotypes and/or cytomorphology could be classified with FNA material with appropriate use of ancillary methods. We analysed the efficacy of cytomorphology and cell block immunocytochemistry (CB-ICC) in in diagnostic workup of non-Hodgkin lymphoma diagnosis on FNA material. 65 clinically suspected cases of lymphoma presenting with lymphnode enlargements were analysed. FNAC and CB-ICC were performed and compared with the subsequent biopsy. The sensitivity, specificity, PPV and NPV of CBICC in the diagnosis of NHL were 84.6%, 75%, 95.6%, and 42.8%, respectively in our study. We also observed that use of CB-ICC can have significant logistic implications in patient management in terms of reducing the turnaround time to diagnosis and improving the accuracy in diagnosis on FNAC. ICC on cell blocks can easily be done on FNA material and is a very useful adjunct to FNAC in establishing the diagnosis in a suspected case of NHL especially when a biopsy is not available.

Journal of Nepal Medical Association, 2014

We report the cytological findings of a sacro-coccygeal chordoma in a 53 year male diagnosed preo... more We report the cytological findings of a sacro-coccygeal chordoma in a 53 year male diagnosed preoperatively by guided fine needle aspiration cytology. The smears shows characteristic Physalliphorous cells in a metachromatic background of myxoid material entrapping cords of cuboidal cells. Differential diagnosis in cytology include conventional and myxoid chondrosarcoma, myxoid liposarcoma, myxoid malignant fibrous histiocytoma, metastatic mucinous carcinoma and myxo-papillary ependymoma. The distinguishing features between these neoplasms are discussed. Preoperative diagnosis of chordoma permits optimum planned surgery. Keywords: chordoma; myxoid; sacral.

Journal of Cardiovascular Medicine and Surgery, 2018

Therapeutic Advances in Hematology, 2018

Background: Development of inhibitors to transfused factor VIII in patients with hemophilia A con... more Background: Development of inhibitors to transfused factor VIII in patients with hemophilia A continues to be a challenge for professionals involved in hemophilia care. The majority of patients in India receive ‘on-demand’ rather than prophylactic therapy. The present study was done to assess the prevalence of factor VIII inhibitors in patients with hemophilia A (PWHA) receiving ‘on-demand’ therapy in a North Indian population and to study the clinicopathological parameters influencing the development of inhibitors. Methods: The study group comprised of 300 PWHA. Detailed clinical parameters, treatment history, bleeding profile including family history were recorded. Diagnosis of hemophilia A was confirmed by relevant coagulation tests. Inhibitors were screened using mixing based studies followed by quantification by Bethesda assay and Nijmegen modified Bethesda assay. Samples were collected from five cities in North India where a free supply of factor VIII was available and effecti...

Medical hypotheses, 2018

γH2AX assay has been used for DNA damage assessment at higher doses of radiation exposure. Its ex... more γH2AX assay has been used for DNA damage assessment at higher doses of radiation exposure. Its expression has not been studied in cases with diagnostic low dose radiation exposure. Concerns have been raised about the after-effects of radiation in diagnostic procedures like Computed Tomography (CT) scan, Angiography etc especially when such scans are repeated within short span of time. The purpose of the present study was to assess immediate DNA damage after exposure to low level of ionizing radiation by the flow cytometric method of gamma-H2AX. Study sample includes total 60, cases and controls with two groups Group I-Normal controls (n = 15); Group II-Low dose, further divided in three groups: Group IIA-single CT scan (n = 15); Group IIB-Multiple CT scans (n = 15); and Group IIC-angiography single exposure (n = 15). For Low dose group blood was collected within 1 h after exposure in EDTA vaccutainers and immediately kept on ice. Lymphocytes were isolated and were fixed in 80% chill...

Journal of Applied Hematology, 2018

INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon disease. Many cases go und... more INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon disease. Many cases go undiagnosed as high index of clinical suspicion is required for its detection. This study was performed to detect the presence of PNH defect by flow cytometric immunophenotyping (FCMI) in patients with suspected PNH disease and evaluate their clinical and laboratory profile. MATERIALS AND METHODS: In this retrospective study, a total of 136 patients with suspected PNH who fulfilled the inclusion criteria for the study were evaluated for PNH defect by FCMI using monoclonal antibodies against CD55 and CD59 on red blood cell, granulocytes, and monocytes. RESULTS: Forty-eight (35.3%) of 136 patients evaluated had a PNH defect. Nineteen (39.5%) of these 48 patients had classical PNH (hemolytic type). The remaining 29 patients had PNH Clone in association with aplastic anemia. The clinical and laboratory data of these 19 patients with classical PNH were analyzed in this retrospective study. The median age was 34 years (range: 19–65 years). Thrombotic events were observed in 3 (16%) of the 19 cases (one each with Budd–Chiari syndrome, cerebral venous thrombosis, and abdominal vein thrombosis). The flow cytometric data of these patients were further analyzed for the presence of and size of PNH clone on erythrocytes, granulocytes, and monocytes. PNH clone was detected in 84% of erythrocytes, 76.9 % of monocytes and in 100% granulocytes. CONCLUSION: Classical PNH is not rare in India as previously thought. A high index of clinical suspicions and evaluation by FCMI is necessary for its detection. CD59 is a better marker for identification of PNH clone than CD55 in all three cell types.

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...

Journal of Cancer Research and Therapeutics, 2017

Journal of Cancer Research and Therapeutics, 2015

Gliosarcoma is an uncommon high-grade tumor which constitutes about 2% of all glioblastomas. Thes... more Gliosarcoma is an uncommon high-grade tumor which constitutes about 2% of all glioblastomas. These tumors have the histological hallmark of a biphasic pattern of high-grade glial and sarcomatous components. The histogenesis of these tumors is controversial. We report a case of primary gliosarcoma in an adult male with leiomyomatous differentiation and discuss the histogenesis as it appears in our case. Primary gliosarcomas of the brain are clinically challenging with a poor clinical outcome.