Preethi George - Academia.edu (original) (raw)

Papers by Preethi George

Journal of Cytology, 2021

Context: Differentiating NSCLC as either adeno or squamous type and identification of Epidermal G... more Context: Differentiating NSCLC as either adeno or squamous type and identification of Epidermal Growth Factor Receptor (EGFR) mutations is clinically relevant for lung cancer patients for selecting treatment. Thyroid transcription factor-1 (TTF-1) and p63 were demonstrated as useful markers for histologic typing of lung cancer. Mutation and overexpression of EGFR has been reported in a subset of non-small cell lung cancers. If these markers can be validated for the differential diagnosis of adenocarcinoma in a sputum sample itself, it will be highly beneficial for lung cancer patients. Aims: To evaluate whether immunocytochemical expression of TTF-1, p63, and EGFR proteins in sputum samples can be used for differential diagnosis of lung adenocarcinoma by comparing with that of the corresponding tissue samples. Settings and Design: Ninety sputum samples and matched tissue samples were used for the study. Subjects and Methods: Monolayered smears and cell blocks of sputum and the corresponding tissue samples were immunostained with the standard ABC method. The expression patterns of these markers were analyzed statistically and compared with clinic-pathological parameters. Statistical Analysis Used: Chi-square test and paired t-test. Results: The p63 protein had a positive expression in 73.9% of SCC whereas TTF1 had positive expression in 75.8% of ADC. The EGFR expression was positive in 27 cases of adenocarcinoma, 21 cases of SCC and 19 cases of NSCLC. Conclusions: Immunocytochemistry of the aforementioned antibodies in sputum samples can be used as supplementary evidence for the subtyping of NSCLC.

Introduction: Heterogeneity is a common phenomenon in cancer survival. Cancer survival probabilit... more Introduction: Heterogeneity is a common phenomenon in cancer survival. Cancer survival probability varies hugely with respect to the prognostic factors. When the patients have long- term survival and the studied population is a mixture of susceptible individuals, who may experience the event of interest, and non-susceptible individuals, who will never experience it and are heterogeneous, mixture cure rate model is the alternate method.Methods: For illustration, breast cancer patients registered during 2006 followed-up till 2014was considered, and further followed-up till 2016 was considered for validation. Kaplan-Meier (K-M) method, mixture distribution (MD) models and mixture cure rate (MCR) models were used for estimating the probabilities. Anderson-Darling Statistics, Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC) and Kullback-Leibler survival (KLS) divergence were used for model identification.Results: The mixing proportion was estimated as 0.52 for the...

Epidemiologic Methods, 2021

Objectives: In time to event analysis, the risk for an event is usually estimated using Cox propo... more Objectives: In time to event analysis, the risk for an event is usually estimated using Cox proportional hazards (CPH) model. But CPH model has the limitation of biased estimate due to unobserved hidden heterogeneity among the covariates, which can be tackled using frailty models. The best models were usually being identified using Akaike information criteria (AIC). Apart from AIC, the present study aimed to assess predictability of risk models using survival concordance measure. Methods: CPH model and frailty models were used to estimate the risk for breast cancer patient survival, and the frailty variable was assumed to follow gamma distribution. Schoenfeld global test was used to check the proportionality assumption. Survival concordance, AIC and simulation studies were used to identify the significance of frailty. Results: From the univariate analysis it was observed that for the covariate age, the frailty has a significant role (θ = 2.758, p-value: 0.0004) and the corresponding...

Indian Journal of Palliative Care, 2020

Background: Quality of life questionnaire (QLQ) OG25 is the questionnaire used for measuring qual... more Background: Quality of life questionnaire (QLQ) OG25 is the questionnaire used for measuring quality of life (QOL) of patients with esophago-gastric junction (OG) cancers. QLQ-OG 25 is a disease-specific tool to capture the QOL parameters of patients with OG junction cancers. OG 25 was developed by the European Organization for the Research and Treatment of Cancer (EORTC) using inspiration from their questionnaires for carcinoma stomach (STO22) and carcinoma esophagus (OES18). It is usually used along with QLQ-C30, which is a general tool applicable for all cancers. This questionnaire is in the English language. In order to use this questionnaire in a non-English speaking population, the English questionnaire has to be initially translated to the local languages. Malayalam is the language spoken by 38.5 million people residing in the South Indian state, Kerala, India. We have translated and validated the QLQ-OG 25 to Malayalam language in an attempt of enabling it to be used for future studies at this geographic region. Methods: The translation was done by the standard protocol adopted by EORTC. QLQ-C30 and QLQ-OG25 questionnaires were then filled in by patients with OG junction cancers. These patients had cancers of various subsites of the OG junction and were at different stages of treatment, at the time of interview. The interview was done twice, at an interval ranging from 48 h to 1 week between the two interviews. Results: A total of 46 patients with OG junction tumors at varying stages of treatment completed the questionnaire. There were no missing data. The average time to finish the interview was 12.12 min. The Cronbach's alpha, which signifies the internal consistency of the questionnaire, was found to be >0.7 in all the domains studied, except in cognitive function. The intraclass correlation coefficients varied from 0.63 to 0.93. Conclusion: The Malayalam translation of the QOL tool QLQ-OG25 has been found to be an acceptable and valid tool in assessing the QOL parameters of patients with OG junction cancers.

Indian Journal of Palliative Care, 2019

Background: Malayalam is the language spoken by 38.5 million people worldwide. There is no specif... more Background: Malayalam is the language spoken by 38.5 million people worldwide. There is no specific instrument to measure stoma-related quality of life (QOL) in Malayalam language. Aim: This study was designed to translate and validate the city of hope QOL (COH-QOL) Ostomy Questionnaire, which is a robust tool developed in English language. Materials and Methods: The instrument was translated to Malayalam, abiding by internationally accepted translation methodology. Trained interviewer ( first author) administered the questionnaire to patients with stoma, who were visiting the stoma clinic. The reliability of the subscales and the total scores were established by calculating correlation coefficients. Convergent and divergent validity were evaluated by calculating Pearson's correlations of each item with its own scale and other scales. Results: Cronbach's alpha coefficients for all subscales were 0.70 or more. Similarly, split-half coefficients also were more than 0.70, which were acceptable. All subscales met the minimum acceptable standards of convergent and discriminant validity. Discriminant validity of all scores was less than convergent validity which suggests that there was no overlap between various constructs in measuring the same traits. The validation study of Malayalam translation of COH stoma questionnaire has shown that the tool is valid and reliable. Conclusion: The validation study of Malayalam translation of City of Hope Stoma questionnaire has shown the tool is valid and reliable.

Journal of Cytology, 2019

Context: Despite sputum cytology being accepted as a simple and noninvasive diagnostic method for... more Context: Despite sputum cytology being accepted as a simple and noninvasive diagnostic method for lung cancer, the clinical usefulness of sputum for evaluation of prognosis is yet to be explored. Validation of some of the markers in sputum for prognosis prediction will be highly useful for selective therapy. Aims: This study was aimed to evaluate a reliable panel of immunocytochemical markers for their significance to predict survival. Materials and Methods: We have analyzed the expression of p53, p16, galectin-3, and epidermal growth factor receptor (EGFR) proteins in sputum samples processed in a mucolytic agent/cellblock and compared the same with that of the corresponding tissue samples. Results: Overexpression of p16 and EGFR was found to have a better survival benefit, whereas positive p53 and galectin-3 expressions had shorter period of survival. Expression patterns of all these four proteins were more or less similar in smears, cellblocks of sputum, and tissue samples except for slight changes in staining intensity which was not found to be statistically significant. No significant difference was found in the association of these proteins with survival pattern between sputum and tissue samples. Conclusion: This is the first report of immunocytochemistry of a panel of markers on cells exfoliated in sputum samples which suggests that analysis of immunocytochemical markers in sputum samples can be attempted as a cost-effective and reliable predictor of prognosis and survival. Accumulation of mutated p53, overexpression of galectin-3, and lower expression of p16 and EGFR proteins were found to predict poor prognosis for lung cancer.

Indian Journal of Surgical Oncology, 2019

The study aims at the prediction of optimal cytoreduction (OCR) in patients undergoing interval c... more The study aims at the prediction of optimal cytoreduction (OCR) in patients undergoing interval cytoreduction (ICR) in advanced epithelial ovarian cancer (AEOC) based on CT imaging and CA 125 values and assessing the survival pattern of these patients after ICR. This is a prospective observational study of patients with stage III C ovarian cancer who underwent ICR in our institution after neoadjuvant chemotherapy (NACT). All consecutive patients operated from April 2016 to October 2017 were included in the study. From their medical records, their demographic details and clinical variables were recorded. The CA 125 value and CT scan findings before and after chemotherapy were documented. A Bristow's predictive score (BS) was calculated based on the radiological parameters. After ICR, the outcome of the surgery was documented. Optimal cytoreduction (OCR) was defined as no gross residual disease after surgery. The surgical outcome was correlated with the CA 125 difference pre and post chemotherapy and Bristow's predictive score pre and post chemotherapy. The patients were followed up and their survival at 6 and 12 months was assessed. Univariate and multivariate analysis was done to identify factors predicting OCR. 51 patients were included in the study. Age group of the women ranged from 31 to 74 years with a mean of 52 years. Majority of the patients (70.6%) were postmenopausal. Of the 51 women, OCR could be achieved in 31 patients (60.8%). Post-chemotherapy, 36 patients had elevated CA125 above baseline of which 50% attained OCR. Forty six patients had CA 125 response post chemotherapy of which 67.4% attained OCR. Forty five patients had reduction in Bristow Score compared to the pre chemo values of which 64.4% attained OCR which was not found to be statistically significant. Overall survival was 100% survival at 6 months and 92.8% at 12 months in those who achieved OCR. Those with residual disease 0.1-1 cm had survival of 74.1% at 6 and 12 months. Those with residual disease > 1 cm had a survival of 50% at 6 and 12 months. CA125 response has a significant role in predicting OCR while CT evaluation using the BS was not useful in predicting OCR during ICR for AEOC.

Cancer Epidemiology, 2019

Asian Pacific journal of cancer prevention : APJCP, Jun 25, 2017

Background: Cancer is emerging as a major cause of morbidity and mortality in low and middle-inco... more Background: Cancer is emerging as a major cause of morbidity and mortality in low and middle-income countries. Cancer registry figures help for planning and delivery of health services. This paper provided the first results of cancer incidence and mortality [Crude (CR) and age-standardized (ASR)] rates (world-standard population) of Trivandrum district, South India and compared with other registries under the network of National Cancer Registry Programme (NCRP), Government of India. Materials and Methods: Trivandrum district cancer registry encompasses a population of 3.3 million, compiles data from nearly 75 sources (hospitals and diagnostic laboratories) and included under the NCRP in 2012. During 2012-2014, registry recorded 15,649 incident cases and 5667 deaths. Proportion of microscopic diagnosis was 85% and ‘Death certificate only’ was 8%. Results: Total cancer incidence (CRs) rates were 161 and 154 (ASR: 142.2 and 126) and mortality rates were 66 and 49 (ASR: 54 and 37) per 1...

World Journal of Surgical Medical and Radiation Oncology, Aug 11, 2012

Introduction: Maxillectomy is required for the tumors arising in maxillary sinus, hard palate, up... more Introduction: Maxillectomy is required for the tumors arising in maxillary sinus, hard palate, upper alveolus or lateral aspect of the nasal cavity. The purpose of this paper is to present the experience in young adults undergoing maxillectomy for malignancy. Aims & Objectives: To study the histopathological profile and primary site distribution of the malignant tumors in young adults undergoing maxillectomy and also to study the factors influencing the survival after primary and salvage maxillectomy for malignancy. Materials & Methods: A retrospective analysis of young adults (18- 45 years) who underwent maxillectomy for carcinoma of the upper alveolus, maxillary sinus, hard palate or nasal cavity treated at a Cancer Center between 2002-2006. Results: Hard palate & Upper alveolus were found to be the commonest site of tumor in the young patients. Squamous cell carcinoma was the major histological diagnosis. On multivariate analysis male patients and patients in 35- 45 year age group had a significantly better survival compared to females and patients < 35 years. The node positive cases had a significant poor survival compared to node negative cases and those treated with total maxillectomy showed a significantly better survival rate. Conclusion: The patients in whom maxillectomy was done as a primary modality of treatment had better survival compared to salvage surgery patients although it was not significant statistically. The nodal status of these patients was a statistically significant factor adversely influencing the disease free survival.

Diagnostic cytopathology, Jan 16, 2015

Lung cancer claims highest rate of cancer related mortality worldwide, mainly due to late diagnos... more Lung cancer claims highest rate of cancer related mortality worldwide, mainly due to late diagnosis and distant metastasis. Sputum cytology is the simplest, non-invasive and cost effective technique but it has low sensitivity due to lack of robust processing methods to retrieve all the diagnostic materials clogged in mucus, inflammatory exudates and blood. This study have compared conventional pick and smear method of sputum processing with samples prepared by homogenization methods using N-acetyl-l-cysteine, Dithiothreitol (DTT), CytoRich red solution and cell blocks (CBs) with respect to screening time, quality of staining, cellularity, smear background, nuclear and cytoplasmic morphology preservation, and diagnostic efficacy. The significance of CB prepared from homogenised samples for immunocytochemistry, protein extraction, Genomic DNA and RNA extraction were also evaluated on a cohort 3,185 samples. The significance of the morphological features in each of the techniques was s...

Oral Oncology Supplement, 2009

chemical crosslink. The oral-cancer hamster model also revealed the self-assembled nanoparticles ... more chemical crosslink. The oral-cancer hamster model also revealed the self-assembled nanoparticles reduced the hepatic uptake. The biosafety, bio-distribution, and kinetics of the nanoparticles was performed. The nanoparticles were significantly cleared from the liver and kidneys after one week. In conclusion, by recombining the desired targeting moiety and various functional nanoparticles through self-assembly, this new modularly designed platform has the capability of enhancing the efficiency of targeted diagnosis and therapies for a wide spectrum of biomedical applications. The technology also encouraged the establishment of a clinical targeting contrast library by modular design concept.

Asian Pacific journal of cancer prevention : APJCP

The association between an exposure of interest (risk factor) and a disease may be confounded by ... more The association between an exposure of interest (risk factor) and a disease may be confounded by the action of other separate factors as well as by interactions between risk factors exerting an impact. Crude measures of effect may be misleading in such situations. Levels of the potential confounding factor could be estimated using stratified analysis. Uniformity of the stratum-specific effect estimates can be assessed by performing chi-square tests for heterogeneity. If the effect is uniform across strata, we can calculate a pooled adjusted summary estimate of the effect using the Mantel-Haenzel (M-H) method. Confidence intervals for the adjusted estimate and the M-H chi-square test are calculated to assess the significance. If the effect is not uniform (presence of interaction), we report stratum-specific estimates, confidence intervals and chi-square for each estimate. In the present paper, assessment of the level of confounding and interaction between risk factors are illustrated...

Asian Pacific journal of cancer prevention : APJCP, 2010

Bioactive components of many foods added during cooking have potential antioxidant, anti-inflamma... more Bioactive components of many foods added during cooking have potential antioxidant, anti-inflammatory, antimicrobial, antibacterial and chemopreventive properties. However, epidemiologic studies generally do not collect detailed information on these items, which include spices, chilies, coconuts, garlic, onions, and oils. Since India has some of the highest spice consumption in the world, we developed a computer-based food preparer questionnaire to estimate per capita consumption of 19 spices, chilies, coconuts, garlic, onions, and 13 cooking oils among 3,625 participants in the India Health Study, a multicenter pilot study in three regions of India. We observed notable regional differences in consumption of spices, chilies, coconut, garlic, and onions. In Trivandrum, over 95 percent of the participants consumed 12 different spices, while in New Delhi and Mumbai, 95 percent of participants consumed only four and five spices, respectively. Cooking oil use also varied, as ghee was mos...