Papers by ASHWANI KUMAR MISHRA
Spinal Cord Series and Cases, 2021
Study design Descriptive retrospective. Objectives To evaluate the burden of respiratory morbidit... more Study design Descriptive retrospective. Objectives To evaluate the burden of respiratory morbidity in terms of ventilator dependence (VD) days and length of stay in neurotrauma ICU (NICU) and hospital, and to determine mortality in patients with traumatic cervical spinal cord injury (CSCI) in a low middle-income country (LMIC).
Indian journal of psychological medicine
The study aimed to assess the efficacy of providing brief intervention (BI) for women tobacco use... more The study aimed to assess the efficacy of providing brief intervention (BI) for women tobacco users in a community-based setting. In this open-labeled randomized study, a representative sample of women (n = 100) from a community in East Delhi were screened using Alcohol, Smoking and Substance Involvement Screening Test. Eligible women were randomized to BI or simple advice (SA) arms. At baseline, they were assessed for tobacco use characteristics and severity of nicotine dependence using Fagerstrom's test for nicotine dependence. Intervention in the form of a single session of BI or SA to quit tobacco was provided at baseline. All participants were assessed at 1 week and 3 months following intervention. The principal outcome was self-reported abstinence from tobacco use at 3 months follow-up. The mean age of the sample was 43 years (standard deviation = 13). Most women were married (80%), housewives (69%), illiterate (61%), socioeconomically disadvantaged and were smokeless toba...
The Lancet Psychiatry, 2015
Journal of Nervous & Mental Disease, 2014
The current study assessed the estimated rate of depression and associated risk factors among sur... more The current study assessed the estimated rate of depression and associated risk factors among survivors 8 months after the 2008 Wenchuan earthquake in China. A stratified random sample of 1514 participants was recruited from all temporary camp communities in a county town 45 km away from the epicenter. The estimated rate of depression was 35.7%. The severity of depressive symptoms was significantly associated with female sex, perceived livelihood security, loss of a family member, residential house damage or collapse, and not living in an urban area, whereas married status is a protector against depressive symptoms. The results suggest that community-based effective, sustainable, and culturally sensitive interventions and services are warranted and should be directed to the groups at high risk for mental health problems.
BMC Medical Research Methodology, 2020
BackgroundShannon’s index is one of the measures of biodiversity, which is intended to quantify b... more BackgroundShannon’s index is one of the measures of biodiversity, which is intended to quantify both richness and evenness of the species/individuals in the ecosystem or community. However, application of Shannon’s index in the field of substance use among the street children has not been done till date.MethodsThis paper is concerned with methods of estimating Shannon’s diversity index (SDI), which can be used to capture the variation in the population due to certain characteristics. Under the consideration that the probability of abundance, based on certain characteristics in the population, is a random phenomenon, we derive a Bayesian estimate in connection with Shannon’s information measure and their properties (mean and variance), by using a probability matching prior, through simulation and compared it with those of the classical estimates of Shannon. The theoretical framework has been applied to the primary survey data of substance use among the street children in Delhi, colle...
Indian Journal of Otolaryngology and Head & Neck Surgery, 2021
Speech-language therapists along with affected individuals face various challenges for accomplish... more Speech-language therapists along with affected individuals face various challenges for accomplishing the rehabilitation services. In the current COVID19 pandemic scenario, telerehabilitation has emerged as a substitute to the traditional face-to-face therapy, and is the only option possible in some cases. To subjectively assess the feasibility & acceptability of telerehabilitation provided by speech-language pathologist to patients of speech and language disorders. This qualitative study includes 20 patients suffering from disorders of fluency, voice, swallowing and neurogenic disorders. The participants included were undergoing face-to-face therapy at our institute. After the completion of face-to-face session series, telerehabilitation services were provided through a video calling app. The outcomes of teletherapy were assessed subjectively using a structured questionnaire on 11 parameters using a Likert scale. Of the included 20 patients, after completion of teletherapy, four patients chose the physical interaction as the preferred mode of therapy while 16 chose teletherapy as the preferred mode. Except three clients who rated their overall satisfaction as '3', others rated as '4' or '5'.The therapists were satisfied with the outcomes in 17 cases, and were pleased with the overall progress of all the clients (rated 4 or 5). Telerehabilitation is a reliable method to deliver speech and language services at community level, on long-term basis, as is proven by the high satisfaction scores among the clients as well as the service providers.
Smart Computational Intelligence in Biomedical and Health Informatics, 2021
Background: The variation of the lipid profile by sex in patients with coronary artery disease (C... more Background: The variation of the lipid profile by sex in patients with coronary artery disease (CAD) is well known. However, when the sample size is small, it is difficult to establish this association. Objectives: The present study uses the Bayesian paradigm to understand the association between sex and lipid profile in patients with coronary artery disease and compares the results with classical approaches. Methods: The study is based on a secondary analysis of CAD patients' data (n = 1045) from NHANES (2015-2016), older than 50 years for which lipid profile measurements were available. The clinical diagnosis of CAD was positive in 91 individuals and negative in 945. The comparison of differences in lipid profiles by sex was performed under the classical paradigm (independent sample t-test and Wilcoxon Rank Sum Test) and Bayesian. Results: CAD-positive men were younger (54-80 years) than women (57-80 years). Lipid parameters (total cholesterol, LDL, direct HDL, non-HDL) differed significantly according to sex, under both classical and Bayesian paradigms; except triglycerides and two proportions (TC: HDL, LDL: HDL). However, the Bayesian paradigm has suggested differences even for triglycerides and two sex ratios. Conclusions: The present study demonstrates the application of Bayesian t test in the case of a small sample size. This clearly suggests that even when the sample size is small, the Bayesian paradigm closely approximates our prior knowledge of the lipid profile as a risk factor for the development of CAD. The Bayesian paradigm revealed the importance of clinical parameters (triglycerides, TC: HDL and LDL: HDL), which remained hidden under the classical t-test and the non-parametric Wilcoxon Rank Sum Test.
Biomedical Research Journal, 2016
Endogenous and exogenous hormones influence breast cancer risk including estrogen biosynthesis pa... more Endogenous and exogenous hormones influence breast cancer risk including estrogen biosynthesis pathway, vitamin D receptor pathway, and the androgen receptor pathway. Genes involved in these pathways are CYP17, which encodes an enzyme involved in estradiol and testosterone synthesis, androgen receptor (AR), which binds testosterone and DHT and regulates breast cell growth and the vitamin D receptor (VDR), which binds vitamin D and down-regulates breast growth.The current study was proposed to determine whether polymorphisms in the CAG repeat in exon 1 of AR, MspAI T > C substitution of CYP17, and ApaI, TaqI, poly-A repeat in the VDR gene contribute to breast cancer risk. Logistic regression models were used to evaluate individual and joint contributions of genotypes to breast cancer risk.Seventy (70) breast cancer patients and eighty healthy women (80) were recruited for the study. PCR based RFLP and fragment analysis assays were used to determine genotypes of hormone metabolizing genes. Considering CYP17 A2 allele, VDR Poly-(A) L, and AR ≥ 20 CAG repeats as high risk alleles, a multigenic model of breast cancer susceptibility was developed to identify women who carry a combination of alleles to put them at relatively higher risk to develop breast cancer. All the high-risk genotypes were positively associated with risk. The risk among women carrying three high-risk alleles was OR:4.68 [95% confidence interval (CI), 0.77-28.0; p for trend = 0.10] compared with those who carried none. The conditional logistic regression analysis revealed that the heterozygous TC genotype for CYP17 and AR1AR2 of AR, imparted significantly fourfold risk for the breast cancer risk, in comparison to the referent genotype TT and AR1AR1 [adjusted ORs:3.705(1.236,11.106), p = 0.019] and [4.391(1.324,14.557), p = 0.016], respectively. Gene X Gene interaction showed that the combinations TC*AA, TC*Aa, TC*aa and CC*Aa imparted significantly four to fifteen fold more risk for the breast cancer [(4.377 (1.159, 16.520), p = 0.029); 4.041(1.092, 14.956), p = 0.036); (15.071(0.975, 232.81), p = 0.052); (4.151(1.053, 16.371), p = 0.042), respectively)]. Genes involved in hormone synthesis and metabolizing pathway may play a role in breast cancer development as supported by the multigenic model of breast cancer susceptibility.
Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine, 2017
Urothelial cancer patients are prone to recurrence, and there is no marker to predict which cases... more Urothelial cancer patients are prone to recurrence, and there is no marker to predict which cases become refractory to the immunotherapy given to these patients. Tumour behaviour is decided by the dynamics between the pro- and anti-tumorigenic cytokines. In this study, 27 cytokines were estimated in serum and urine of 72 urothelial cancer patients and 42 healthy volunteer controls. Serum cytokines IL-1RA, IL-4 and RANTES were in significantly higher concentration in serum of patients compared to controls, while IL-2 was significantly less in concentration. Patients were found to have significantly high concentrations of 12 urinary cytokines (IL-2, IL-4, IL-8, IL-10, GM-CSF, IFN-γ, IP-10, MIP-1a, PDGF, MIP-1b, RANTES and VEGF) in comparison to healthy controls. Serum VEGF and urinary IL-1ra, IL-4, IL-10, GM-CSF, IP-10, MIP-1a and MIP-1b concentrations were found significantly higher in concentration in high-grade tumours compared to low-grade tumours. There was no difference in eithe...
Indian Journal of Psychological Medicine, 2016
Background: Cannabis continues to be the most commonly used illicit psychoactive substance global... more Background: Cannabis continues to be the most commonly used illicit psychoactive substance globally. The National Survey in India conducted in the year 2004 also reported it to be the most commonly used illicit substance in the country. Furthermore, it was reported to be the second most commonly used psychoactive substance by the treatment seekers at de-addiction centers in the country. Objectives: To assess time trends of cannabis use among treatment-seeking individuals at government de-addiction centers across India over a period of 7 years. Materials and Methods: The study utilized data collected through Drug Abuse Monitoring System across India. The data of treatment seekers from de-addiction centers established under the Drug De-addiction Program, Ministry of Health and Family Welfare, Government of India and supported by the Ministry of Social Justice and Empowerment, Government of India (122 in number) across the country were analyzed. Results: A total of 107,469 individuals sought treatment from government de-addiction centers over the 7 years (2007-2013) period. With the exception of an aberration for the year 2012, there has been a steady decline in the proportion of treatment seekers who are not current cannabis users. A significantly greater proportion (Chi-square: 586.30, df: 1, P < 0.001) of individuals with current cannabis use alone or along with tobacco (20.4%) tend to have a co-morbid psychiatric disorder as compared to treatment seekers with current use of substances other than cannabis (6.1%). Conclusions: It is important to focus on cannabis in clinical service delivery and research in the country.
BMC Public Health, 2015
Background: Patients with Post kala-azar dermal leishmaniasis (PKDL) are considered a reservoir o... more Background: Patients with Post kala-azar dermal leishmaniasis (PKDL) are considered a reservoir of Leishmania donovani. It is imperative to identify and treat them early for control of visceral leishmaniasis (VL), a current priority in the Indian subcontinent. We explored trends in clinico-epidemiological features of PKDL cases over last two decades, for improving management of the disease. Methods: Clinically suspected cases were diagnosed with rK39 strip test followed by parasitological confirmation by microscopy and/or PCR/qPCR in skin tissue/slit aspirates. Patients were treated with antimonials till 2008 and subsequently with miltefosine. Results: The study indicated higher incidence of PKDL cases in areas of high endemicity for VL, with 20 % cases reporting no history of VL. Approximately 26 % cases of PKDL were initially misdiagnosed at primary health centers. Duration between onset of PKDL and diagnosis was above 12 months in 80 % cases. Diagnostic sensitivity was 32-36 % with microscopy and 96-100 % with PCR/qPCR. Compliance to treatment was over 85 % with miltefosine while 15 % with antimonials. Relapse rate with miltefosine was up to 13.2 %. Conclusions: PKDL patients tend to delay reporting and are often misdiagnosed. Confirmatory diagnosis using minimally invasive skin slit aspirate samples would help overcome such issues. There was a paradigm shift in compliance with miltefosine; however, increasing relapse rate indicated the need for newer therapies with oral formulations.
Indian journal of medical ethics, 2014
This study was aimed at assessing the retracted medical literature on mental disorders. Another a... more This study was aimed at assessing the retracted medical literature on mental disorders. Another aim was to test the hypothesis that the weak research infrastructure in certain countries and the rising pressure to publish in Asia due to the progress of science in that continent may have contributed to the increase in the number of retractions. A bibliometric search was carried out using the PubMed database. The data were analysed using SPSS version 21. The retraction rate for articles on mental disorders (number of retracted articles per 100,000 published articles on mental disorders) varied from a low of 3.56 (for 2005) to a high of 49.25 (for 2012). Of the 38 articles for which the reasons for retraction could be accessed, 10 (26.31%) were retracted for fraud. Overall, 0.0138% of all articles on the biomedical sciences were retracted. Of the articles on mental disorders, 0.0095% were retracted. There was a disproportionately greater number of retractions in the case of articles ori...
World Journal of Surgical Oncology, 2010
Background: Considerably little is known about the biological role and clinical significance of a... more Background: Considerably little is known about the biological role and clinical significance of androgen receptor expression in breast cancer. The objectives of this study were to characterize AR-CAG repeat genotypes in a cohort of women with breast cancer and to determine the influence of AR on response to neoadjuvant chemotherapy and clinical outcome. Materials and methods: Genotyping of the AR CAG repeat region was done on 70 patients and 80 healthy agedmatched female controls. To assess response to NACT, tissue samples from 30 LABC cases were evaluated quantitatively by real time for AR mRNA expression. The clinical response was correlated with both the pre and post chemotherapy AR expression. The CAG alleles did not show differences between cases and controls when the mean of short, long and average length of both CAG alleles was considered. However, analysis when done defining short allele as CAGn < 20 (AR1) and the long as CAGn ≥ 20 (AR2), risk was found associated with AR2 allele with marginal significance (P = 0.09). Stratification by age of onset, FH, stage, grade ER and AR status failed to reveal any association with breast cancer risk. Genotype carriers with ≥20 CAGn showed decrease of AR mRNA expression although significance could not be established (P = 0.47). Tumours in responders had the higher AR mRNA expression levels in pre neo-adjuvant chemotherapy condition (p < 0.02) which got reduced after neoadjuvant chemotherapy and the difference was found to be significant (P = 0.014). Conclusions: Although, expansion of the CAGn in the AR gene doesn't show any major effect on breast cancer risk, patients with positive AR expression, pre neoadjuvant chemotherapy, were found to be good responders and a decrease in mRNA level of AR gene related to the chemotherapy-induced apoptosis could serve as an important independent predictor of response to NACT.
World Journal of Surgical Oncology, 2011
Background: Sentinel lymph node biopsy (SLNB) is now considered a standard of care in early breas... more Background: Sentinel lymph node biopsy (SLNB) is now considered a standard of care in early breast cancers with N0 axillae; however, its role in locally advanced breast cancer (LABC) after neo-adjuvant chemotherapy (NACT) is still being debated. The present study assessed the feasibility, efficacy and accuracy of sentinel lymph node biopsy (SLNB) using "dye alone" (methylene blue) method in patients with LABC following NACT. Materials and methods: Thirty, biopsy proven cases of LABC that had received three cycles of neo-adjuvant chemotherapy (cyclophosphamide, adriamycin, 5-fluorouracil) were subjected to SLNB (using methylene blue dye) followed by complete axillary lymph node dissection (levels I-III). The sentinel node(s) was/were and the axilla were individually assessed histologically. The SLN accuracy parameters were calculated employing standard definitions. The SLN identification rate in the present study was 100%. The sensitivity of SLNB was 86.6% while the accuracy was 93.3%, which were comparable with other studies done using dual lymphatic mapping method. The SLN was found at level I in all cases and no untoward reaction to methylene blue dye was observed. Conclusions: This study confirms that SLNB using methylene blue dye as a sole mapping agent is reasonably safe and almost as accurate as dual agent mapping method. It is likely that in the near future, SLNB may become the standard of care and provide a less morbid alternative to routine axillary lymph node dissection even in patients with LABC that have received NACT.
PLoS ONE, 2012
Betel Quid (BQ) chewing independently contributes to oral, hepatic and esophageal carcinomas. Str... more Betel Quid (BQ) chewing independently contributes to oral, hepatic and esophageal carcinomas. Strong association of breast cancer risk with BQ chewing in Northeast Indian population has been reported where this habit is prodigal. We investigated genomic alterations in breast cancer patients with and without BQ chewing exposure. Twenty six BQ chewers (BQC) and 17 non BQ chewer (NBQC) breast cancer patients from Northeast India were analyzed for genomic alterations and pathway networks using SNP array and IPA. BQC tumors showed significantly (P,0.01) higher total number of alterations, as compared with NBQC tumors, 48617% versus 32625 respectively. Incidence of gain in fragile sites in BQC tumors were significantly (P,0.001) higher as compared with NBQC tumors, 34 versus 23% respectively. Two chromosomal regions (7q33 and 21q22.13) were significantly (p,0.05) associated with BQC tumors while two regions (19p13.3-19p12 and 20q11.22) were significantly associated with NBQC tumors. GO terms oxidoreductase and aldo-keto reductase activity in BQC tumors in contrast to G-protein coupled receptor protein signaling pathway and cell surface receptor linked signal transduction in NBQC tumors were enriched in DAVID. One network ''Drug Metabolism, Molecular Transport, Nucleic Acid Metabolism'' including genes AKR1B1, AKR1B10, ETS2 etc in BQC and two networks ''Molecular Transport, Nucleic Acid Metabolism, Small Molecule Biochemistry'' and ''Cellular Development, Embryonic Development, Organismal Development'' including genes RPN2, EMR3, VAV1, NNAT and MUC16 etc were seen in NBQC. Common alterations (.30%) were seen in 27 regions. Three networks were significant in common regions with key roles of PTK2, RPN2, EMR3, VAV1, NNAT, MUC16, MYC and YWHAZ genes. These data show that breast cancer arising by environmental carcinogens exemplifies genetic alterations differing from those observed in the non exposed ones. A number of genetic changes are shared in both tumor groups considered as crucial in breast cancer progression.
The Journal of Clinical Psychiatry, 2013
To the Editor: With reference to the recent article by Sanchez-Gistau et al, 1 we wish to discuss... more To the Editor: With reference to the recent article by Sanchez-Gistau et al, 1 we wish to discuss a few methodological issues and concerns not previously discussed regarding the study limitations. Our first issue regards the suitability of some instruments (Positive and Negative Syndrome Scale [PANSS], [Hamilton Depression Rating Scale [HDRS]) for the study sample (aged 9-17 years) in view of their questionable or unknown validity in child and adolescent populations. The authors have not commented on this; however, the cross-referenced parent study indicates that adult scales were used for adolescent patients to act as a baseline comparison in their longitudinal cohort study. 2 However, in the absence of validity, their use in a younger population at least for the purpose of present study does not seem to be justifiable. Instead, the assessments might have been done using the Kiddie-PANSS 3 for psychotic symptoms, Children's Depression Rating Scale 4 for depressive symptoms, or other age-appropriate instruments. An additional limitation is that the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) was simply translated into Spanish and not validated further for use. Second, there were only 3 assessments in total, viz, baseline, 1-year, and 2-year (T 0 , T 1 , and T 2), which appear to be too infrequent for a study with suicidality as a primary outcome. The intervening 1-year period was accounted for by only a single question ("Have you attempted suicide since the last visit?"). The use of repeated measures (eg, 3-or 6-monthly) and corroboration from family members or clinical records might have increased the robustness.
Archives of Toxicology, 2001
We investigated the eect of the GSTM1 and GSTT1 null genotypes, and GSTP1 313 A/G polymorphism on... more We investigated the eect of the GSTM1 and GSTT1 null genotypes, and GSTP1 313 A/G polymorphism on bladder cancer susceptibility in a case control study of 121 bladder cancer patients, and 121 age-and sex-matched controls of the Turkish population. The adjusted odds ratio for age, sex, and smoking status is 1.94 [95% con®dence intervals (CI) 1.15±3.26] for the GSTM1 null genotype, and 1.75 (95% CI 1.03±2.99) for the GSTP1 313 A/G or G/G genotypes. GSTT1 was shown not to be associated with bladder cancer. Combination of the two high-risk genotypes, GSTM1 null and GSTP1 313 A/G or G/G, revealed that the risk increases to 3.91-fold (95% CI 1.88±8.13) compared with the combination of the low-risk genotypes of these loci. In individuals with the combined risk factors of cigarette smoking and the GSTM1 null genotype, the risk of bladder cancer is 2.81 times (95% CI 1.23±6.35) that of persons who both carry the GSTM1-present genotype and do not smoke. Similarly, the risk is 2.38-fold (95% CI 1.12±4.95) for the combined GSTP1 313 A/G and G/ G genotypes and smoking. These ®ndings support the role for the GSTM1 null and the GSTP1 313 AG or GG genotypes in the development of bladder cancer. Furthermore, gene-gene (GSTM1-GSTP1) and gene-environment (GSTM1-smoking, GSTP1-smoking) interactions increase this risk substantially.
Annals of Oncology, 2010
Background: Breast cancer is an extraordinarily hormone-dependent tumor. This study was to evalua... more Background: Breast cancer is an extraordinarily hormone-dependent tumor. This study was to evaluate androgen receptor (AR) status and its significance in breast cancer in Chinese women. Methods: Three hundred and thirty-five consecutive cases of invasive ductal breast carcinoma, 34 ductal carcinoma in situ (DCIS), and 82 DCIS adjacent to invasive tissues were involved in this study. The expression of AR was analyzed by immunohistochemistry and compared with patient outcome, and its implications were evaluated in five molecular subgroups of invasive ductal carcinoma (IDC) and in DCIS lesions. Results: AR expression was related to that of estrogen receptor (P < 0.001) and progesterone receptor (P = 0.035) but not correlated with the other conventional parameters. AR retained independent prognostic significance (hazard ratio 0.309, 95% confidence interval, 0.192-0.496; P < 0.001). The majority (61.0%) of basal-like breast cancers showed loss of AR expression (P < 0.001), which had poor prognosis. The percentage of AR-positive cases was significantly higher in DCIS adjacent to IDC group than in pure DCIS and IDC groups (93.9%, 79.4%, and 72.5%; P = 0.046 and P < 0.001, respectively). Conclusions: Our data suggest that AR may provide another specific definition of breast cancer subtypes and reveal a potential role in DCIS progression. These findings may help develop new therapies.
Cancer Detection and Prevention, 2009
Background: Vitamin D (1,25-dihydroxyVitamin D 3 ) has shown experimentally anticarcinogenic effe... more Background: Vitamin D (1,25-dihydroxyVitamin D 3 ) has shown experimentally anticarcinogenic effects and is thought to protect against breast cancer. The actions of Vitamin D are mediated via the Vitamin D receptor (VDR), and the polymorphisms at 3′UTR region of this gene ...
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Papers by ASHWANI KUMAR MISHRA