Publications by authors named "Moni A Kuriakose"

Article Synopsis
  • The study investigates lymph node stromal cell cultures (LNSCs) from oral squamous cell carcinoma (OSCC) patients to understand tumor interactions for better treatment options.
  • Primary cultures were developed from both metastatic and non-metastatic patient nodes, confirming their purity and revealing a variety of cell types.
  • Transcriptomic and cytokine profiling showed different molecular alterations based on node status, with key insights into immune response and potential pathways for metastasis, highlighting the relevance of these models for future cancer research.
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Profiling studies using reverse transcription quantitative PCR (RT-qPCR) require reliable normalization to reference genes to accurately interpret the results. A stable reference gene panel was established to profile metastatic and non-metastatic lymph nodes in patients with oral squamous cell carcinoma. The stability of 18S ribosomal RNA (), ribosomal Protein Lateral Stalk Subunit P0 (), ribosomal Protein L27 (), TATA-box binding protein (), hypoxanthine phosphoribosyl-transferase 1 (), beta-actin (), glyceraldehyde-3-Phosphate Dehydrogenase () and vimentin () was evaluated, as reference genes for profiling patient-derived lymph node stromal cells (LNSCs; N=8; N0:6, N+:2) and lymph node tissues (Patients:14, Nodes=20; N0:7; N+:13).

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Objectives: Oral cancer is significantly high in India, and screening is an effective approach to downstage the disease. Educating Community Health Workers (CHWs) on early oral cancer detection is an effective step toward reducing the burden and serves as a first step toward facilitating the transfer of knowledge. Therefore, the purpose of this hands-on education was to equip CHWs with insight on the advanced diagnostics, preventive techniques, and innovations for the early detection of oral cancer.

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Background: The National Comprehensive Cancer Network (NCCN) guideline recommends consideration of weekly cisplatin as an alternative option for patients with head and neck cancer undergoing definitive chemoradiation. However, in a recent phase III trial (ConCERT), 20% of patients treated with weekly cisplatin could not receive a total of 200 mg/m, and the association of low adherence to weekly cisplatin and cancer control outcomes remains unclear. To fill this knowledge gap, we performed an observational cohort study of patients with head and neck cancer undergoing definitive chemoradiation with weekly cisplatin.

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Objective: The 2x2 factorial design is an effective method that allows for multiple comparisons, especially in the context of interactions between different interventions, without substantially increasing the required sample size. In view of the considerable preclinical evidence for Curcumin and Metformin in preventing the development and progression of head and neck squamous cell carcinoma (HNSCC), this study describes the protocol of the clinical trial towards applying the drug combination in prevention of second primary tumors.

Methods: We have applied the trial design to a large phase IIB/III double-blind, multi-centric, placebo-controlled, randomized clinical trial to determine the safety and efficacy of Metformin and Curcumin in the prevention of second primary tumours (SPT) of the aerodigestive tract following treatment of HNSCC (n=1,500) [Clinical Registry of India, CTRI/2018/03/012274].

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Objectives: The incidence of oral cancer is significantly high in South Asia and Southeast Asia. Organized screening is an effective approach to early detection. The aim of this systematic review and meta-analysis was to evaluate the reliability, diagnostic accuracy, and effectiveness of visual oral screening by community health workers (CHWs) in identifying oral cancer/oral potentially malignant disorders (OPMDs) in this region.

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Oral potentially malignant disorders (OPMDs) are precursors to over 80% of oral cancers. Hematoxylin and eosin (H&E) staining, followed by pathologist interpretation of tissue and cellular morphology, is the current gold standard for diagnosis. However, this method is qualitative, can result in errors during the multi-step diagnostic process, and results may have significant inter-observer variability.

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Objectives: The incidence of young-onset oral squamous cell carcinoma (OSCC) is growing, even among non-smokers/drinkers. The effects of adverse histopathological features on long-term oncologic outcomes between the young and old are controversial and confounded by significant heterogeneity. Few studies have evaluated the socio-economic impact of premature mortality from OSCC.

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Objectives: The aim of this pilot study is to identify the genetic factors that contribute to the response of metronomic chemotherapy in head and neck squamous cell carcinoma (HNSCC) patients using whole-exome sequencing (WES). This study would facilitate the identification of predictive biomarkers, which would enable personalized treatment strategies and improve treatment outcomes for patients with HNSCC.

Materials And Methods: We have selected patients with recurrent head and neck cancer who underwent metronomic chemotherapy.

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Objectives: Oral cancer is a leading cause of morbidity and mortality. Screening and mobile Health (mHealth)-based approach facilitates early detection remotely in a resource-limited settings. Recent advances in eHealth technology have enabled remote monitoring and triage to detect oral cancer in its early stages.

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The high prevalence of oral potentially-malignant disorders exhibits diverse severity and risk of malignant transformation, which mandates a Point-of-Care diagnostic tool. Low patient compliance for biopsies underscores the need for minimally-invasive diagnosis. Oral cytology, an apt method, is not clinically applicable due to a lack of definitive diagnostic criteria and subjective interpretation.

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Importance: Combined modality therapy, such as chemoradiotherapy, often results in significant morbidity among patients with head and neck cancer. Although the role of body mass index (BMI) varies based on cancer subtypes, its association with treatment response, tumor recurrence, and survival outcomes among patients with head and neck cancer remains unclear.

Objective: To evaluate the role of BMI in treatment response, tumor recurrence, and survival outcomes among patients with head and neck cancer undergoing chemoradiotherapy.

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Article Synopsis
  • The study investigates the lymphocyte-monocyte ratio (LMR) as a potential prognostic biomarker for survival outcomes in North American patients with head and neck cancer undergoing chemoradiation treatment.
  • Researchers analyzed data from 476 patients, revealing that lower LMR scores were linked to worse overall and cancer-specific survival, with higher LMR scores correlating with improved survival outcomes.
  • After properly adjusting for biases, they confirmed that a median LMR value of 3.8 could serve as a critical threshold, where patients with LMRs below this value had significantly lower chances of survival.
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There is near consensus that prophylactic lateral neck dissection has no role in the management of differentiated thyroid cancer, but the extent of lateral neck dissection in differentiated thyroid cancer remains controversial, especially whether level V should be addressed or not. There is lot of heterogeneity in reporting of the management of level V in papillary thyroid cancer. We at our Institute address the lateral neck positive papillary thyroid cancer with selective neck dissection involving levels II-IV, performing extended level IV dissection with inclusion of the triangular area delineated by the sternocleidomastoid muscle, the clavicle, and the perpendicular line drawn to the clavicle from the point where the horizontal line at the level of cricoid cuts the posterior border of sternocleidomastoid muscle.

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Unlabelled: The EGFR and TGFβ signaling pathways are important mediators of tumorigenesis, and cross-talk between them contributes to cancer progression and drug resistance. Therapies capable of simultaneously targeting EGFR and TGFβ could help improve patient outcomes across various cancer types. Here, we developed BCA101, an anti-EGFR IgG1 mAb linked to an extracellular domain of human TGFβRII.

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Oral Cancer is one of the most common causes of morbidity and mortality. Screening and mobile Health (mHealth) based approach facilitates remote early detection of Oral cancer in a resource-constrained settings. The emerging eHealth technology has aided specialist reach to rural areas enabling remote monitoring and triaging to downstage Oral cancer.

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Convolutional neural networks have demonstrated excellent performance in oral cancer detection and classification. However, the end-to-end learning strategy makes CNNs hard to interpret, and it can be challenging to fully understand the decision-making procedure. Additionally, reliability is also a significant challenge for CNN based approaches.

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Article Synopsis
  • Recent studies challenge the 10 pack-years smoking threshold previously used for risk assessment, leaving the actual threshold undefined.
  • A study focusing on head and neck cancer patients found that exceeding 22 pack-years of smoking is linked to worse overall survival and progression-free survival.
  • Analysis showed that heavy smokers (more than 22 pack-years) have a higher risk of distant failure, while no significant risk was found with the previously used 10 pack-years threshold.
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Oral cancer is usually preceded by oral potentially malignant disorders (OPMDs) and early detection can downstage the disease. The majority of OPMDs are asymptomatic in early stages and can be detected on routine oral examination. Though only a proportion of OPMDs may transform to oral squamous cell carcinoma (OSCC), they may serve as a surrogate clinical lesion to identify individuals at risk of developing OSCC.

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Article Synopsis
  • Cytology is a minimally invasive technique for cancer screening, particularly oral cancer, which is prevalent worldwide, and the study aims to create an automated tool for analyzing cytology images to identify abnormal cells.
  • The researchers used a large dataset of 2730 multi-channel, fluorescent microscopy images to train different segmentation and classification models, including U-Net and its modifications, to effectively separate and classify single epithelial cells from background noise like artifacts and blood cells.
  • Results showed that both U-Net and modified U-Net models performed well in segmenting the images, indicating their potential use in enhancing diagnostic accuracy in oral cancer screening.
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Significance: Oral cancer is one of the most prevalent cancers, especially in middle- and low-income countries such as India. Automatic segmentation of oral cancer images can improve the diagnostic workflow, which is a significant task in oral cancer image analysis. Despite the remarkable success of deep-learning networks in medical segmentation, they rarely provide uncertainty quantification for their output.

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Background: The technology enabled distributed model in Kerala is based on an innovative partnership model between Karkinos Healthcare and private health centers. The model is designed to address the barriers to cancer screening by generating demand and by bringing together the private health centers and service providers at various levels to create a network for continued care. This paper describes the implementation process and presents some preliminary findings.

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The immune cell niche associated with oral dysplastic lesion progression to carcinoma is poorly understood. We identified T regulatory cells (Treg), CD8+ effector T cells (Teff) and immune checkpoint molecules across oral dysplastic stages of oral potentially malignant disorders (OPMD). OPMD and oral squamous cell carcinoma (OSCC) tissue sections (N = 270) were analyzed by immunohistochemistry for Treg (CD4, CD25 and FoxP3), Teff (CD8) and immune checkpoint molecules (PD-1 and PD-L1).

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Early detection of oral cancer in low-resource settings necessitates a Point-of-Care screening tool that empowers Frontline-Health-Workers (FHW). This study was conducted to validate the accuracy of Convolutional-Neural-Network (CNN) enabled m(mobile)-Health device deployed with FHWs for delineation of suspicious oral lesions (malignant/potentially-malignant disorders). The effectiveness of the device was tested in tertiary-care hospitals and low-resource settings in India.

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Article Synopsis
  • This study aimed to determine the best hemoglobin (Hgb) threshold for predicting outcomes in head and neck cancer patients undergoing chemoradiation, identifying 11.4 as the critical level.
  • Among 496 patients analyzed, low Hgb levels (below 11.4) correlated with significantly worse overall survival (OS) and progression-free survival (PFS), especially in those with HPV-negative tumors.
  • The findings suggest that while low Hgb is a strong negative prognostic factor for patients with HPV-negative head and neck cancers, it does not significantly impact those with HPV-positive tumors.
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