Gynecological laparoscopic surgeries in the era of COVID-19 pandemic: a prospective study

( Sushmita Saha ),( Kallol Kumar Roy ),( Rinchen Zangmo ),( Anamika Das ),( Juhi Bharti ),( Rakhi Rai ),( Archana Kumari ),( Gayatri Suresh ),( Nilofar Noor ),( Perumal Vanamail ) 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.4

Objective The novel coronavirus pandemic led to the suspension of elective surgeries and the diversion of resources and manpower towards pandemic control. However, gynecological emergencies and malignancies must be addressed despite the restricted resources and the need for protective measures against COVID-19. This study aimed to determine the types of gynecological surgeries performed, difficulties encountered, and their outcomes in the setting of the pandemic. Methods We performed a prospective cohort study over 6 months at a single tertiary center, including 60 women with gynecological complaints, categorized as emergencies and semi-emergencies, who underwent further surgery. Their surgical outcomes were measured through various parameters. Results We found that 68.3% were emergency cases, while the rest were classified as semi-emergencies. Fibroid and adenomyosis with failed medical management (48.3%), followed by cervical intraepithelial neoplasia (10%), and malignancies (10%) accounted for the semi-emergency cases, while ruptured ectopic pregnancies (13.3%) and torsion and ovarian cysts (18.4%) comprised the emergency cases. The decision to incision time between emergency and semi-emergency cases varied widely due to the safety prerequisites during the pandemic, ranging from 1 hour in emergency cases to 48 hours in semi-emergency cases. In addition, we studied the ease of preoperative preparation, patient satisfaction, and the average number of personnel available to run the operation theaters at these times. No serious perioperative adverse events were observed in the present study. Conclusion In conclusion, gynecological surgeries could continue to be safely performed with all precautions in place against COVID-19 infection and related morbidities.

Modal analysis of FG sandwich doubly curved shell structure

Sushmita Dash,Kulmani Mehar,Nitin Sharma,Trupti R. Mahapatra,Subrata K. Panda 국제구조공학회 2018 Structural Engineering and Mechanics, An Int'l Jou Vol.68 No.6

The modal frequency responses of functionally graded (FG) sandwich doubly curved shell panels are investigated using a higher-order finite element formulation. The system of equations of the panel structure derived using Hamilton’s principle for the evaluation of natural frequencies. The present shell panel model is discretised using the isoparametric Lagrangian element (nine nodes and nine degrees of freedom per node). An in-house MATLAB code is prepared using higher-order kinematics in association with the finite element scheme for the calculation of modal values. The stability of the opted numerical vibration frequency solutions for the various shell geometries i.e., single and doubly curved FG sandwich structure are proven via the convergence test. Further, close conformance of the finite element frequency solutions for the FG sandwich structures is found when compared with the published theoretical predictions (numerical, analytical and 3D elasticity solutions). Subsequently, appropriate numerical examples are solved pertaining to various design factors (curvature ratio, core-face thickness ratio, aspect ratio, support conditions, power-law index and sandwich symmetry type) those have the significant influence on the free vibration modal data of the FG sandwich curved structure.

Impact of Treatment Time on Chemoradiotherapy in Locally Advanced Cervical Carcinoma

Pathy, Sushmita,Kumar, Lalit,Pandey, Ravindra Mohan,Upadhyay, Ashish,Roy, Soumyajit,Dadhwal, Vatsla,Madan, Renu,Chander, Subhash Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.12

Background: Adverse effects of treatment prolongation beyond 8 weeks with radiotherapy for cervical cancer have been established. Clinical data also show that cisplatin increases the biologically effective dose of radiotherapy. However, there are no data on the effect of overall treatment time in patients with locally advanced cervical cancer treated with concomitant chemo-radiotherapy (CCRT) in an Indian population. The present study concerned the feasibility of concurrent chemotherapy and interspacing brachytherapy during the course of external radiotherapy to reduce the overall treatment time and compare the normal tissue toxicity and loco-regional control with a conventional schedule. Materials and Methods: Between January 2009 and March 2012 fifty patients registered in the Gynaecologic Oncology Clinic of Institute Rotary Cancer Hospital with locally advanced cervical cancer (FIGO stage IIB-IIIB) were enrolled. The patients were randomly allocated to treatment arms based on a computer generated random number. Arm I (n=25) treatment consisted of irradiation of the whole pelvis to a dose of 50 Gy in 27 fractions, and weekly cisplatin $40mg/m^2$. High dose rate intra-cavitary brachytherapy (HDR-ICBT) was performed after one week of completion of external beam radiotherapy (EBRT). The prescribed dose for each session was 7Gy to point A for three insertions at one week intervals. Arm II (n=25) treatment consisted of irradiation of the whole pelvis to a dose of 50 Gy in 27 fractions. Mention HDR-ICBT ICRT was performed after 40Gy and 7Gy was delivered to point A for three insertions (days 23, 30, 37) at one week intervals. Cisplatin $20mg/m^2/day$ was administered from D1-5 and D24-28. Overall treatment time was taken from first day of EBRT to last day of HDR brachytherapy. The overall loco-regional response rate (ORR) was determined at 3 and 6 months. Results: A total of 46 patients completed the planned treatment. The overall treatment times in arm I and arm II were $65{\pm}12$ and $48{\pm}4$ days, respectively (p=0.001). At three and six months of follow-up the ORR for arm I was 96% while that for arm II was 88%. No statistically significant difference was apparent between the two arms. The overall rate of grade ${\geq}3$ toxicity was numerically higher in arm I (n=7) than in arm II (n=4) though statistical significance was not reached. None of the predefined prognostic factors like age, performance status, baseline haemoglobin level, tumour size, lymph node involvement, stage or histopathological subtype showed any impact on outcome. Conclusions: In the setting of concurrent chemoradiotherapy a shorter treatment schedule of 48 days may be feasible by interspacing brachytherapy during external irradiation. The response rates and toxicities were comparable.

Comments on - Neoadjuvant Chemo-radiation with IMRT in Resectable and Borderline Resectable Pancreatic Cancer

Pathy, Sushmita,Francis, Antony George,Roy, Soumyajit Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.13

Equilibrium and kinetic studies for removal of malachite green from aqueous solution by a low cost activated carbon

Uma,Yogesh C. Sharma,Sushmita Banerjee 한국공업화학회 2013 Journal of Industrial and Engineering Chemistry Vol.19 No.4

A low cost activated carbon was synthesized from coconut coir and was applied for the removal of malachite green (MG) from its aqueous solutions. Characterization of the adsorbent was carried out and BET surface area of the adsorbent was found to be 205.27 m2/g. The process of removal of MG was better governed by second order kinetics with a rate constant of 0.21 g mgˉ1 minˉ1 at 323 K. The coefficient of mass transfer was found to be 3.70 x10ˉ5 cm sˉ1. The value of DG8 was found to be negative indicating feasibility and spontaneity of the adsorption process.

Comparative Evaluation of Two-dimensional Radiography and Three Dimensional Computed Tomography Based Dose-volume Parameters for High-dose-rate Intracavitary Brachytherapy of Cervical Cancer: A Prospective Study

Madan, Renu,Pathy, Sushmita,Subramani, Vellaiyan,Sharma, Seema,Mohanti, Bidhu Kalyan,Chander, Subhash,Thulkar, Sanjay,Kumar, Lalit,Dadhwal, Vatsla Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.11

Background: Dosimetric comparison of two dimensional (2D) radiography and three-dimensional computed tomography (3D-CT) based dose distributions with high-dose-rate (HDR) intracavitry radiotherapy (ICRT) for carcinoma cervix, in terms of target coverage and doses to bladder and rectum. Materials and Methods: Sixty four sessions of HDR ICRT were performed in 22 patients. External beam radiotherapy to pelvis at a dose of 50 Gray in 27 fractions followed by HDR ICRT, 21 Grays to point A in 3 sessions, one week apart was planned. All patients underwent 2D-orthogonal and 3D-CT simulation for each session. Treatment plans were generated using 2D-orthogonal images and dose prescription was made at point A. 3D plans were generated using 3D-CT images after delineating target volume and organs at risk. Comparative evaluation of 2D and 3D treatment planning was made for each session in terms of target coverage (dose received by 90%, 95% and 100% of the target volume: D90, D95 and D100 respectively) and doses to bladder and rectum: ICRU-38 bladder and rectum point dose in 2D planning and dose to 0.1cc, 1cc, 2cc, 5cc, and 10cc of bladder and rectum in 3D planning. Results: Mean doses received by 100% and 90% of the target volume were $4.24{\pm}0.63$ and $4.9{\pm}0.56$ Gy respectively. Doses received by 0.1cc, 1cc and 2cc volume of bladder were $2.88{\pm}0.72$, $2.5{\pm}0.65$ and $2.2{\pm}0.57$ times more than the ICRU bladder reference point. Similarly, doses received by 0.1cc, 1cc and 2cc of rectum were $1.80{\pm}0.5$, $1.48{\pm}0.41$ and $1.35{\pm}0.37$ times higher than ICRU rectal reference point. Conclusions: Dosimetric comparative evaluation of 2D and 3D CT based treatment planning for the same brachytherapy session demonstrates underestimation of OAR doses and overestimation of target coverage in 2D treatment planning.

Silencing growth hormone receptor inhibits estrogen receptor negative breast cancer through ATP-binding cassette subfamily G member 2

Arunkumar Arumugam,Ramadevi Subramani,Sushmita Bose Nandy,Daniel Terreros,Alok Kumar Dwivedi,Edward Saltzstein,Rajkumar Lakshmanaswamy 생화학분자생물학회 2019 Experimental and molecular medicine Vol.51 No.-

Growth hormone receptor (GHR) plays a vital role in breast cancer chemoresistance and metastasis but the mechanism is not fully understood. We determined if GHR could be a potential therapeutic target for estrogen receptor negative (ER−ve) breast cancer, which are highly chemoresistant and metastatic. GHR was stably knocked down in ER-ve breast cancer cells and its effect on cell proliferation, metastatic behavior, and chemosensitivity to docetaxel (DT) was assessed. Microarray analysis was performed to identify potential GHR downstream targets involved in chemoresistance. GHR and ATP-binding cassette sub-family G member 2 (ABCG2) overexpression and knockdown studies were performed to investigate the mechanism of GHR-induced chemoresistance. Patient-derived xenografts was used to study the effect of GHR and ABCG2. Immunohistochemical data was used to determine the correlation between GHR, pAKT, pmTOR, and ABCG2 expressions. GHR silencing drastically reduced the chemoresistant and metastatic behavior of ER-ve breast cancer cells and also inhibited AKT/mTOR pathway. In contrast, activation, or overexpression of GHR increased chemoresistance and metastasis by increasing the expression and promoter activity, of ABCG2. Inhibition of JAK2/STAT5 signaling repressed GHR-induced ABCG2 promoter activity and expression. Further, ABCG2 knockdown significantly increased the chemosensitivity. Finally, patient-derived xenograft studies revealed the role of GHR in chemoresistance. Overall, these findings demonstrate that targeting GHR could be a novel therapeutic approach to overcome chemoresistance and associated metastasis in aggressive ER-ve breast cancers.

Ruthenium doped carbon aerogel with CO2 surface activation for enhanced electrochemical capacitance

Ashish Singh,D.K. Kohli,Sushmita Bhartiya,Rashmi Singh,M.K. Singh,P.K. Gupta 한국물리학회 2017 Current Applied Physics Vol.17 No.6

With the aim of enhancement of electrochemical capacitance, CO2 activation of carbon aerogel (CA) prepared by polycondensation of resorcinol with formaldehyde was performed to obtain activated carbon aerogel (ACA) having improved surface area properties. Ruthenium oxide nano-particles were loaded by impregnation method for utilizing pseudo-capacitive property of ruthenium oxide (RuO2) and the effect of activation treatment was studied. RuO2 loading of 20% by weight was accomplished in CA and ACA to synthesize RuO2 doped carbon aerogel (CA/RuO2) and activated carbon aerogel (ACA/RuO2). While the specific capacitance of carbon aerogel improved from 95 to 153 F/g on activation, RuO2 loading further led to enhancement in capacitance and specific capacitance of 308 F/g was obtained for ACA/ RuO2. The studies being important for Ru economy, showed the influence of surface area enhancement of base matrix in achieving high specific capacitance.

Mechanism of Lipid Induced Insulin Resistance: An Overview

Samir Bhattacharya,Rakesh Kundu,Suman Dasgupta,Sushmita Bhattacharya 대한내분비학회 2012 Endocrinology and metabolism Vol.27 No.1

Type 2 diabetes (T2D) is rapidly spreading throughout the world. It’s an insidious disease and still treated in an indirect manner without having specific drug target. In majority cases T2D is treated with drugs that address type 1 diabetes, majority of drugs aim to increase insulin release although the root cause for T2D is not the dearth of insulin release, it occurs in the later stage of disease development. T2D silently progressed in the patient; it begins with insulin resistance that takes place due to the loss of insulin sensitivity. Though insulin resistance is the centre of pathogenesis, our treatment of the disease has not yet addressed it. It is now a fact that insulin resistance is manifested by lipid and fatty acids (FAs) play a critical role in blunting insulin sensitivity. Our understanding is still poor in deciphering how lipid impose insulin insensitivity, majority of workers suggest it is because of insulin signaling defects which implements insulin function in inhibiting glucose to the cell from circulation. Number of long chain saturated FA has been shown to produce insulin signaling defects. However, we really need further investigation to find specific target(s) for FA induced damage. In addition to these information, a new dimension of T2D is getting attractive is fetuin-A/α2-Heremans-Schmid Glycoprotein,a secretary protein from liver. Its gene locus has been identified as T2D susceptible. Fetuin-A’s excess expression occurs by FA and it disrupts adipocyte function. It has been shown to be associated with T2D especially in obesity. In this review, we briefly discuss the present status on the mechanistic understanding of lipid induced insulin resistance that leads to T2D. More we understand the mechanism; opportunity to fight the battle with T2D will be increasing. Since, this field is now vast; we covered a few major events.

Head and neck extra nodal NHL (HNENL) - Treatment Outcome and Pattern of failure - A Single Institution Experience

Giridhar, Prashanth,Mallick, Supriya,Bhasker, Suman,Pathy, Sushmita,Mohanti, Bidhu Kalyan,Biswas, Ahitagni,Sharma, Atul Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.15

Background: Extra nodal lymphoma (ENL) constitutes about 33 % of all non-Hodgkin's lymphoma. 18-28% develops in the head and neck region. A multimodality treatment with multi-agent chemotherapy (CT) and radiotherapy (RT) is considered optimum. Materials and Methods: We retrieved the treatment charts of patients of HNENL treated in our institute from 2001-2012. The charts were reviewed and the demographic, treatment details and outcome of HNENL patients were retrieved using predesigned pro-forma. Results: We retrieved data of 75consecutive patients HNENL. Median age was 47years (Range: 8-76 years). Of the 75 patients 51 were male and 24 were female. 55patients were evaluable. The patient and tumor characteristics are summarized in Table 1. All patients were staged comprehensively with contrast enhanced computed tomography of head, neck, thorax, abdomen, pelvis and bone marrow aspiration and biopsy 66 patients received a combination multi-agent CT with CHOP being the commonest regimen. 42 patients received 4 or lesser number of cycles of chemotherapy whereas 24received more than 4 cycles chemotherapy. Post radiotherapy, 41 out of 42 patients had a complete response at 3 months. Only 21patients had a complete response after chemotherapy. All patients received radiation (mostly involved field radiation) as a part of the treatment. The median radiation dose was 45 Gray (Range: 36 Gray-50 Gray). The radiation was planned by 2D fluoro simulation based technique in 37cases and by 3 Dimensional conformal radiation therapy (3DCRT) in 36 cases. Two patients were planned by the intensity modulated radiation therapy (IMRT) technique. IMRT was planned for one thyroid and one nasal cavity primary. 5 patients experienced relapse after a median follow up of 19 months. The median survival was not reached. The estimated two and three year survival were 92.9% (95%CI- 68.6- 95.35) and 88% (95%CI- 60.82 - 92.66) respectively. Univariate analysis revealed higher stage and poorer baseline performance status to be significantly associated with worse progression free survival. 5 patients progressed (relapse or primary disease progression) after treatment. Of the 5 patients, two patients were primary orbital NHL, two patients had NHL nasal cavity and one was NHL thyroid. Conclusions: Combined modality treatment in HNENL confers excellent disease control with acceptable side effects.