Sunesh Kumar

AIIMS Bhopal All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

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Publications (104)123.22 Total impact

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    ABSTRACT: The aim of this prospective randomized study was to evaluate the efficacy of estrogen in preventing intrauterine adhesions following hysteroscopic septal resection and to investigate its effect on reproductive outcome. After hysteroscopic septal resection, 90 women received either estrogen or placebo (n = 45 per group) for 30 days. A second-look hysteroscopy was performed after 2 months. All pregnancies occurring during the study period were recorded. Adhesions developed in three of 43 (6.9%) patients in the control group compared to none in the estrogen group. This difference was not statistically significant (P = 0.24). Regarding reproductive outcome, the differences between the two groups were also not significant. Estrogen treatment was not found to prevent intrauterine adhesions or improve reproductive outcome after hysteroscopic septal resection.
    Journal of Obstetrics and Gynaecology Research 02/2014; · 0.84 Impact Factor
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    ABSTRACT: Cardiovascular emergencies especially aortic dissections are rare in pregnancy. We report a case of Stanford Type A aortic dissection at 33 weeks of pregnancy presenting in shock. Rapid multidisciplinary approach and special obstetric considerations led to a successful outcome in this case.
    Case reports in vascular medicine. 01/2014; 2014:278036.
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    ABSTRACT: The purpose of this study was to evaluate the role of dehydroepiandrosterone (DHEA) on the number and quality of oocytes and embryos in poor responders undergoing IVF cycles. A total of 50 patients with a history of poor ovarian response in the previous cycle(s) were enrolled in a prospective cohort study. They were treated with oral micronized DHEA 25 mg three times a day for 4 months. Oocyte and embryo number and quality were recorded before and after treatment. The results were analysed using Student’s paired t-test. After treatment with DHEA, a significant increase in number of mature follicles was seen in the post treatment period (⩽35 years P < 0.001; ⩾36 years P = 0.002). There were significant increases in numbers of oocytes retrieved, fertilization rates and, consequently, the total number of embryos available. More embryos were vitrified among patients ⩽35 years (P < 0.001) post treatment, and clinical pregnancy rate in this group was 26.7%. DHEA treatment resulted in a higher number of oocytes retrieved, oocytes fertilized, embryos overall and of grade-I embryos. It can help in increasing pregnancy rate in poor responders.
    Reproductive biomedicine online 01/2014; · 2.68 Impact Factor
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    ABSTRACT: Serous ovarian cancer (SOC) is a significant cause of morbidity and mortality in females with poor prognosis because of advanced stage at presentation. Recently, neoadjuvant chemotherapy (NACT) is being used for management of advanced SOC, but role of tissue biomarkers in prognostication following NACT is not well established. The study was conducted on advanced stage SOC patients (n = 100) that were treated either conventionally (n = 50) or with NACT (n = 50), followed by surgery. In order to evaluate the expression of tissue biomarkers (p53, MIB1, estrogen and progesterone receptors, Her-2/neu, E-cadherin, and Bcl2), immunohistochemistry and semiquantitative scoring were done following morphological examination. Following NACT, significant differences in tumor histomorphology were observed as compared to the native neoplasms. MIB 1 was significantly lower in cases treated with NACT and survival outcome was significantly better in cases with low MIB 1. ER expression was associated with poor overall survival. No other marker displayed any significant difference in expression or correlation with survival between the two groups. Immunophenotype of SOC does not differ significantly in samples from cases treated with NACT, compared to upfront surgically treated cases. The proliferating capacity of the residual tumor cells is less, depicted by low mean MIB1 LI. MIB 1 and ER inversely correlate with survival.
    BioMed Research International 01/2014; 2014:401245. · 2.71 Impact Factor
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    ABSTRACT: To evaluate the toxicity and clinical outcome in patients with locally advanced cervical cancer (LACC) treated with whole pelvic conventional radiation therapy (WP-CRT) versus intensity modulated radiation therapy (WP-IMRT). Between January 2010 and January 2012, 44 patients with International Federation of Gynecology and Obstetrics (FIGO 2009) stage IIB-IIIB squamous cell carcinoma of the cervix were randomized to receive 50.4 Gy in 28 fractions delivered via either WP-CRT or WP-IMRT with concurrent weekly cisplatin 40 mg/m(2). Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events, version 3.0, and late toxicity was graded according to the Radiation Therapy Oncology Group system. The primary and secondary endpoints were acute gastrointestinal toxicity and disease-free survival, respectively. Of 44 patients, 22 patients received WP-CRT and 22 received WP-IMRT. In the WP-CRT arm, 13 patients had stage IIB disease and 9 had stage IIIB disease; in the IMRT arm, 12 patients had stage IIB disease and 10 had stage IIIB disease. The median follow-up time in the WP-CRT arm was 21.7 months (range, 10.7-37.4 months), and in the WP-IMRT arm it was 21.6 months (range, 7.7-34.4 months). At 27 months, disease-free survival was 79.4% in the WP-CRT group versus 60% in the WP-IMRT group (P=.651), and overall survival was 76% in the WP-CRT group versus 85.7% in the WP-IMRT group (P=.645). Patients in the WP-IMRT arm experienced significantly fewer grade ≥2 acute gastrointestinal toxicities (31.8% vs 63.6%, P=.034) and grade ≥3 gastrointestinal toxicities (4.5% vs 27.3%, P=.047) than did patients receiving WP-CRT and had less chronic gastrointestinal toxicity (13.6% vs 50%, P=.011). WP-IMRT is associated with significantly less toxicity compared with WP-CRT and has a comparable clinical outcome. Further studies with larger sample sizes and longer follow-up times are warranted to justify its use in routine clinical practice.
    International journal of radiation oncology, biology, physics 11/2013; 87(3):542-8. · 4.59 Impact Factor
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    ABSTRACT: In epithelial ovarian cancer (EOC), the cancer antigen 125 (CA-125) has been conventionally used to help in diagnosis and assessment of response to treatment. Currently, YKL-40 (Tyrosine-Lysine-Leucine-40) and circulating cell-free DNA are being evaluated for possession of similar ability. In this study, we aimed to assess the ability of a repertoire of potential biomarkers in detecting and assessing therapeutic response, in advanced EOC. Blood levels of CA-125, YKL-40, total cell-free DNA (CFDNA), cell-free nuclear DNA (CFnDNA), and cell-free mitochondrial DNA (CFmDNA) levels were measured in 100 untreated patients of advanced EOC from November 2009 to June 2011, and again on treatment completion from the 20 patients who appeared for follow-up analysis. Significantly, higher proportion of untreated patients had serum CA-125 >3 times upper limit of normal (ULN) (90.0 %; P < 0.0001) and plasma YKL-40 >ULN (77.0 %; P < 0.0001), both of which significantly decreased, Posttherapy. posttherapy, CFDNA (P < 0.0001), and CFnDNA (P < 0.0001) levels significantly decreased as compared to pretreatment levels. Positive and significant correlations existed between pretherapy CFDNA and CFnDNA [Spearman rho (ρ) = 1.000; P < 0.0001], and also with CFmDNA (ρ = 0.301; P = 0.002), separately between CFnDNA and CFmDNA (ρ = 0.303; P = 0.002), as well as between plasma YKL-40 and patient age (ρ = 0.353; (P < 0.0001). On treatment completion, CFDNA and CFnDNA levels showed positive and significant correlation (ρ = 1.000; P < 0.0001). Therefore serum CA-125 and plasma YKL-40 aid detection and assessment of therapeutic response, in advanced EOC. CFDNA and CFnDNA help in estimating extent of therapeutic response in advanced EOC.
    Molecular and Cellular Biochemistry 10/2013; · 2.33 Impact Factor
  • International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 10/2013; · 1.41 Impact Factor
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    ABSTRACT: Abstract Aim: The aim of this study was to evaluate the role of dehydroepiandrosterone (DHEA) supplementation on the ovarian reserve markers in infertile patients who were poor responders in previous in vitro fertilization (IVF) cycles. Study design: A prospective clinical trial was conducted on 30 patients with history of poor response in previous IVF cycles. These patients were treated with DHEA, (Tab Eema-D, Corona Remedies Pvt Ltd., Ahmedabad, Gujurat, India) 25 mg thrice a day for four months. Ovarian stimulation was done using the previous protocol. Clinical parameters were measured before and treatment with DHEA. Results were analysed using Student's "t" paired test. Results: DHEA resulted in a significant increase (p < 0.05) in the serum Antimullerian hormone in all age groups (35, 36-38 and >38 years). Peak estradiol level on the day of human chorionic gonadotrophin administration also increased significantly (p < 0.05). A significant decrease (p < 0.05) was noted in Day 2 follicle-stimulating hormone (FSH) in all age groups. There was no statistically significant difference in the antral follicle count (AFC). Pregnancy rate was 16.7% after treatment. Thus, DHEA has a significant effect in improving the ovarian reserve in poor responders with previously failed IVF cycles. It can help in enhancing clinical pregnancy rate in these patients.
    Gynecological Endocrinology 09/2013; · 1.30 Impact Factor
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    ABSTRACT: To evaluate the efficacy of intraperitoneal bupivacaine to reduce post operative pain after diagnostic minilaparoscopy in patients with infertility. A prospective randomized study was performed. The study group consisted of 104 women with infertility undergoing diagnostic minilaparoscopy. At the end of the procedure, the treatment group (Group A) was given 10 mL of intraperitoneal 0.25 % bupivacaine (100 mg) and the control group (Group B) given 10 mL of intraperitoneal saline. Post operative pain was recorded with the use of a visual analog scale with scores ranging from 1 to 10 at 2, 4, 6 and 8 h intervals after the surgery. Additional analgesics given to the patients in the post operative period and any other side effects were noted. The treatment group had significantly lower pain scores at 2, 4, 6 and 8 h after the procedure (P < 0.05). The need for post operative analgesics also was significantly lower in the treatment group (P = 0.007). Post operative intraperitoneal bupivacaine administration is beneficial for patients undergoing diagnostic minilaparoscopy. It can significantly decrease post operative pain for up to 8 h and reduce the need for additional analgesics.
    Archives of Gynecology 08/2013; · 0.91 Impact Factor
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    ABSTRACT: Familial hypercholesterolemia is a rare disorder characterized by high cholesterol levels and early cardiovascular disease. Early detection and treatment with statins and other hypolipidemic agents are effective in heterozygous patients. Low-density lipoprotein apheresis and liver transplantation are treatment options in homozygous familial hypercholesterolemia. We report a case of a 27-year-old pregnant woman with familial hypercholesterolemia who presented with breathlessness and swelling in the joints. She had been taking statins previously, which were stopped and she had been put on low-lipid and low-residue diet to reduce the risk of acute coronary event and sudden intrauterine death. She was found to have dilated cardiomyopathy with 25% ejection fraction. At 36 weeks of gestation, we carried out cesarean section in view of poor biophysical profile. Familial hypercholesterolemia is a very rare disorder with only a few cases reported in the published work during pregnancy. Statins are contraindicated during pregnancy and diet modification remains the mainstay of therapy.
    Journal of Obstetrics and Gynaecology Research 07/2013; · 0.84 Impact Factor
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    ABSTRACT: To study the outcome of pregnancy in women with idiopathic thrombocytopenic purpura. A retrospective analysis of 30 pregnancies in 26 women with idiopathic thrombocytopenic purpura was carried out at a tertiary hospital in India. The courses of the disease, maternal and perinatal outcome in these pregnancies were studied. Mean age of pregnant women with idiopathic thrombocytopenic purpura was 27.3 years and 61.5 % was primigravidae. Out of 26 patients with idiopathic thrombocytopenic purpura, 16 were already diagnosed while the other 10 were diagnosed during pregnancy. The incidence of bleeding episodes in antenatal period, severe thrombocytopenia and hemorrhagic complications at the time of delivery was 30, 37 and 11.1 %, respectively. Oral steroids were required in 40 % of pregnancies. Two patients received intravenous immunoglobulin therapy. Severe thrombocytopenia at the time of delivery was more commonly seen in women in whom ITP was diagnosed during pregnancy as compared to those in whom ITP was diagnosed prior to pregnancy (P = 0.04). Severe thrombocytopenia was seen in 18.5 % of neonates and intracranial hemorrhage was detected in 1 neonate. There were no still births or maternal mortality. Pregnancy outcome in patients with idiopathic thrombocytopenic purpura is generally good.
    Archives of Gynecology 07/2013; · 0.91 Impact Factor
  • Indian journal of endocrinology and metabolism. 05/2013; 17(3):540-1.
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    ABSTRACT: OBJECTIVES: There are limited options for patients with recurrent or metastatic cervical carcinoma who are either refractory to or ineligible for systemic chemotherapy. We conducted a clinical study to evaluate the role of gefitinib, an epidermal growth factor receptor tyrosine kinase inhibitor, in such patients. METHODS: Eligible patients were enrolled into the study and were treated with gefitinib at a dose of 250 mg/day orally until disease progression, development of intolerable adverse effects, or withdrawal of consent. The primary end point of the study was progression-free survival. The secondary end points were stable disease, overall survival, and toxicity. RESULTS: From January 2008 to June 2011, a total of 20 patients were enrolled. Median age was 52 years and median disease-free interval was 15 months. Twelve patients presented with locoregional recurrence, 2 patients presented with distant metastases, and 6 patients presented with both locoregional recurrence and distant metastasis. Median duration of gefitinib therapy was 4 months. One patient had complete response, 1 patient had partial response, 4 patients had stable disease, and 14 patients had progressive disease. The median progression-free survival and overall survival were 4 months and 5 months, respectively. Only 1 patient had severe drug-related toxicity. CONCLUSIONS: Gefitinib is safe and seems to be effective in recurrent or metastatic cervical carcinoma. Further studies are warranted to identify the subgroup of patients, based on epidermal growth factor receptor mutations, who are more likely to benefit.
    International Journal of Gynecological Cancer 03/2013; · 1.94 Impact Factor
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    ABSTRACT: BACKGROUND: A retrospective analysis of the records of all the patients of pulmonary arterial hypertension with pregnancy at AIIMS, New Delhi, India, to study maternal and perinatal outcome and to compare outcome between severe and mild pulmonary arterial hypertension. MATERIALS AND METHODS: A retrospective analysis was carried out of 30 pregnancies in women with pulmonary arterial hypertension (PAH) who delivered at ≥28 weeks of gestation from July 2006 through July 2012 at a tertiary care center in India. Pulmonary artery blood pressure (PABP) during the first trimester of pregnancy or before pregnancy was considered to define PABP as severe or mild, with severe cases having systolic PABP >50 mmHg on echocardiography. RESULTS: Out of 30 patients, 14 patients had severe PAH and 16 patients had mild PAH. Women with severe PAH had a significantly higher incidence of preterm delivery (11 vs. 3, P < 0.05), small for gestational age infants (10 vs. 2, P < 0.05) and cardiac complications (6 vs. 1, P < 0.05) compared to women with mild PAH. There was maternal mortality in a patient with Eisenmenger syndrome. In women with severe PAH and mild PAH, PABP increased in later pregnancy from 63.14 ± 7.6 to 71.57 ± 7.9 mmHg (P < 0.05) and from 40.37 ± 3.6 to 41.69 ± 4.1 mmHg (P < 0.05), respectively. CONCLUSIONS: Pregnancy in women with severe PAH is associated with higher maternal morbidity and adverse fetal outcome compared to pregnancy in women with mild PAH.
    Archives of Gynecology 02/2013; · 0.91 Impact Factor
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    ABSTRACT: BACKGROUND: A retrospective analysis of the records of all the patients of heart disease with pregnancy at AIIMS, New Delhi, India, to find out the maternal and fetal outcome. MATERIALS AND METHODS: A retrospective analysis was carried out of 100 pregnancies in women with heart disease who delivered at ≥28 weeks of gestation from July 2009 through August 2012. RESULTS: Cardiac disease was found to complicate 3.8 % of pregnancies. Rheumatic heart disease (n = 64, 64 %) was the predominant cardiac disease. Congenital heart disease was found to complicate 36 pregnancies (n = 36, 36 %).Cardiac complications were seen in 32 (32 %) and fetal complications in 18 (18 %) pregnancies. Fewer cardiac and postpartum complications were present in NYHA class I/II patients compared to NYHA III/IV patients (P < 0.05). Pregnancy outcome was better in rheumatic heart disease patients who had undergone cardiac intervention prior to pregnancy (n = 29, 45.2 %) compared to those whose heart disease remained uncorrected (n = 35, 54.8 %) but the difference was not statistically significant. There was one maternal mortality in a patient with Eisenmenger syndrome. Two of the newborns of the 17 women who had received anticoagulants had features of warfarin embryopathy. CONCLUSION: Pregnancy in women in NYHA class III/IV is associated with significantly higher maternal morbidity and cardiac interventions before pregnancy, when indicated may improve pregnancy outcome.
    Archives of Gynecology 02/2013; · 0.91 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate role of dose dense neo-adjuvant chemotherapy (NACT) prior to standard concurrent chemo-radiation (CCRT) in locally advanced cervical cancer. METHODS: Between June 2010 and December 2011, 28 patients (median age - 51 years, range, 35 to 67 years) with locally advanced cervical cancer received NACT using paclitaxel (60mg/m(2)) and carboplatin (AUC-2) weekly for 6 doses. After a mean interval of 15 days (range 7-23 days), patients then received definitive radiation and concomitant weekly infusion of cisplatin (40mg/m(2) for 6 doses). Response to concurrent chemo-radiation and toxicity were end points. RESULTS: Following NACT, 67.8% of patients responded; complete (CR) - 2(7.1%), Partial (PR)-17(60.7%), stable 7(25.0%) and 2 patients (7.1%) progressed. 24 of 28 patients received CCRT; 23 / 24 achieved CR. 22 of 23 complete responders continues to be in CR at a median follow-up of 12 months (range, 7 to 24 months). Grade III/IV neutropenia was the main hematological toxicity- seen in 28.5% and 29% of patients, respectively during NACT and CCRT. CONCLUSIONS: Neoadjuvant chemotherapy with dose dense weekly paclitaxel and carboplatin followed by standard CCRT is a feasible approach and is associated with a high response rate in locally advanced cervical cancer.
    Gynecologic Oncology 01/2013; · 3.93 Impact Factor
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    ABSTRACT: Ovarian stromal tumor with minor sex cord elements is a rare tumor. It is composed of predominantly fibrothecomatous tumor with scattered minor sex cord elements in less than 10% of the tumor area. These tumors may be hormonally active and predispose to carcinoma endometrium. A case of ovarian fibroma-thecoma with minor sex cord elements in which coexistent endometrial carcinoma was also discovered is being reported. Though thecoma may be a predisposing factor for endometrial cancer, meticulous histopathological examination of the ovary may reveal additional sources of estrogen like granulosa cell aggregates as in our patient. Such patients would require long-term follow-up to detect any recurrence of granulosa cell tumor.
    Indian journal of medical and paediatric oncology 01/2013; 34(1):44-6.
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    ABSTRACT: Pelvic floor dysfunction and prolapse affect 50 % of women past middle age. Failure to recognize the complex set of pelvic floor defects in individuals leads to most post-surgical failures. Imaging has so far not had an established role in the investigation of prolapse. The present study is an attempt to define the role of magnetic resonance imaging in POP. Thirty patients with clinically graded stage III/IV prolapse underwent routine physical examination and grading of POP in the Department of Obstetrics and Gynaecology, AIIMS. Dynamic MR evaluation with TRUFISP configuration was done and organ prolapse was measured through the hiatal line (HMO classification). The agreement of MRI, physical examination and intra-operative examination was analyzed using kappa as the test of agreement. Twenty-eight subjects with grade III and 2 subjects with grade IV prolapse were enrolled. The mean age was 52.8 and the mean parity was 3.63. On MRI, 19 patients were found to have grade III prolapse, 4 had grade IV prolapse and the rest had grade I and II prolapse. There was poor agreement of MRI with clinical examination in anterior and middle compartments (k 0.161, k 0.144). The agreement between MRI and Intra-operative findings was 0.369, 0.422 for anterior and posterior compartments. Kappa was 0.085 for rectocele and 0.710 for enteroceles. The agreement was better for posterior compartment and enterocele. MRI detected 5 out of 8 enteroceles intra-operatively. The study demonstrates that while dynamic MRI does not confer any additional advantage in the diagnosis of anterior and middle compartment defects, the diagnosis of enteroceles, which may be missed clinically, is efficiently made on dynamic MRI imaging. Additionally, MRI can differentiate enterocele from a high rectocele which can further classify the surgery needed. There is also a need to standardize the protocol and the role of MR imaging in POP.
    Archives of Gynecology 06/2012; 286(4):953-8. · 0.91 Impact Factor
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    ABSTRACT: To compare findings with 2-deoxy-2-((18)F)fluoro-D-glucose positron emission tomography combined with computed tomography ((18)F-FDG-PET/CT) with findings obtained using ultrasound (US), magnetic resonance imaging (MRI), and CT in patients with proven tubercular tubo-ovarian masses. Seventeen patients with proven tubercular tubo-ovarian masses underwent (18)F-FDG-PET/CT imaging and the findings were compared with US (for all patients), MRI (for 9 patients), CT (for 4 patients), and laparotomy or laparoscopic findings (for 14 patients). Eleven patients (64.7%) had unilateral tubo-ovarian masses, with activity in 6 masses (35.3%); 4 patients (23.5%) had bilateral tubo-ovarian masses, with activity in all masses; and 2 patients (11.76%) had unilateral space-occupying lesions, with activity in 1 lesion. The detection rates of tubo-ovarian masses with (18)F-FDG-PET/CT were similar to, but the characterization of adnexal masses was less than, those obtained with CT or MRI. Finally, (18)F-FDG-PET/CT was equally accurate as laparoscopy or laparotomy in detecting the presence, laterality, and activity of tubo-ovarian masses. Imaging with (18)F-FDG-PET/CT is noninvasive and appears to be clinically useful for the diagnosis of tubercular tubo-ovarian masses.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 05/2012; 118(2):123-8. · 1.41 Impact Factor
  • European journal of obstetrics, gynecology, and reproductive biology 04/2012; 163(2):240-1. · 1.97 Impact Factor

Publication Stats

367 Citations
123.22 Total Impact Points

Institutions

  • 2008–2013
    • AIIMS Bhopal All India Institute of Medical Sciences
      Bhopal, Madhya Pradesh, India
  • 2003–2012
    • All India Institute of Medical Sciences
      • Department of Obstetrics and Gynaecology
      New Delhi, NCT, India