12160 Montgomery Rd
Cincinnati OH 45249
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 30023848
Request Appointment Information
Awards & Recognitions
Medical Malpractice Cases
Medical Board Sanctions
Calcifying ghost cell odontogenic tumor (CGCOT) with predominance of clear cells: a case report with important diagnostic considerations. - Oral surgery, oral medicine, oral pathology and oral radiology
An 18-year-old female reported painful swelling in the left maxillary region 4 months after the extraction of tooth #15. Because incisional biopsy suggested ameloblastoma with clear-cell changes, segmental resection was performed. The microscopic examination of the excised tissue revealed histomorphologic diversity, with features of typical calcifying ghost cell odontogenic tumor (CGCOT) and a significant clear-cell component constituting more than 50% of the tumor mass without any features of malignancy. Clear cells were periodic acid-Schiff (PAS) positive and mucicarmine negative. CK19 was strongly positive in the solid tumor islands and variably positive in clear cells. A definitive diagnosis of CGCOT with predominance of clear cells was confirmed. Because both squamous metaplasia and clear-cell components were present in the ameloblastic follicles independent of each other, the presence of abundant calcifications favored the diagnosis of CGCOT with a clear-cell component over that of an ameloblastoma with clear-cell changes. The importance of identifying the histomorphologic features of the 2 entities, ameloblastoma and CGCOT, is highlighted. This appears to be the second case reported in the literature, to the best of our knowledge.Copyright Â© 2015 Elsevier Inc. All rights reserved.
A signaling-enhanced chimeric receptor to activate the ICOS pathway in T cells. - Journal of immunological methods
Activation of the inducible costimulator (ICOS) signaling pathway in T cells is difficult to assess with bioassays, because most T cell lines do not constitutively express ICOS. Additionally, engagement of ICOS by its natural ligand B7 related protein 1 (B7RP1) is insufficient to elicit ICOS signaling, but requires simultaneous costimulation of the T cell receptor (TCR) to be effective. Here we describe a genetically engineered human T cell line that expresses a chimeric receptor (ICOS-CD3) consisting of full-length human ICOS fused at its C-terminal end to the cytoplasmic domain of human CD3 zeta. When engaged by B7RP1, ICOS-CD3 initiated signaling independently of TCR costimulation and induced substantially more IL-2 secretion in Jurkat T cells compared to wildtype ICOS. We demonstrate that this signaling-enhanced chimeric receptor can be used in simple and sensitive bioassays to detect bioactive B7RP1, anti-B7RP1 drugs, and the presence of corresponding neutralizing anti-drug antibodies.Copyright Â© 2015 Elsevier B.V. All rights reserved.
Prevalence of oral cancer and pre-cancerous lesions and the association with numerous risk factors in North India: A hospital based study. - National journal of maxillofacial surgery
Oral cancer is one of the most common life-threatening diseases all over the world. Developing countries face several challenges to identify and remove potential risk factors. Chewing tobacco/pan masala is considered to be the most potent risk factor for oral precancerous lesions and oral cancer.To investigate the relative occurrence of different oral pre-cancerous lesions and oral cancer in North India and to identify the associated risk factors.A hospital-based study was conducted and 471 subjects were recruited in the study. The subjects comprised patients with squamous cell carcinoma (n = 85), oral submucous fibrosis (n = 240), leukoplakia (n = 32), lichen planus (n = 15), and controls (n = 99). Statistical analysis of the data was done using Chi-square and regression analysis.A strong correlation was observed between the presence of the chewing habit in all the oral precancerous lesions and oral cancer. Duration of the habit and intensity of habit ware also strongly correlated with the risk of oral precancerous lesions and oral cancer. Other factors such as alcohol and smoking were found to be less important in concern with oral cancer and precancerous lesions.
Potentially fatal supramylohyoid sublingual epidermoid cyst. - Journal of maxillofacial and oral surgery
A case of chronic and slow growing massive lateral neck swelling is presented which gradually resulted in dysphagia to an extent that patient reported in emergency room. Clinical findings were indicative of a cystic swelling or a massive lipoma. Temporary decompression of the lesion was achieved by partially aspirating the contents of the cyst. Nature of aspirate and its microscopic and biochemical analysis excluded lipoma, vascular malformation and salivary phenomenon. The diagnosis tapered to developmental lateral neck cysts. Magnetic Resonance Imaging (MRI) revealed a massive cystic lesion in the left floor of mouth extending to the right lingual aspect of mandible and posteriorly to impinge on the medial wall of pharynx. A combined intraoral and extraoral approach was used to expose and excise the lesion in toto. Final histological diagnosis of the pathology was epidermoid cyst.
A rare case of extraskeletal mesenchymal chondrosarcoma with dedifferentiation arising from the buccal space in a young male. - Journal of maxillofacial and oral surgery
Extraskeletal mesenchymal chondrosarcoma (EMCS) is a rare and aggressive pathological variant of chondrosarcoma arising from soft tissues of mainly the extremities, meninges/dura, trunk, and orbits. EMCS comprises only 2Â % of all soft tissue sarcomas and only 6Â % of them arise from soft tissue in the head and neck region. It usually affects in the second and third decade of life and is common in women. It runs a very rapid clinical course with distant metastases and has poor prognosis and survival rates. Histologically it has a dimorphic presentation of small round mesenchymal cells interspersed with foci of cartilaginous differentiation. Radiographically it appears as a soft tissue lobulated mass with various patterns of calcification. This is the first case of primary and recurrent EMCS originating in the buccal space with unusual features of dedifferentiation. The diagnostic challenges in this case were the inconclusive FNAC results, lack of radiographic evidence of characteristic calcifications and presence of areas of myxoid material and dedifferentiation on histopathology. The clinical, cytological, histological, immunohistochemical, radiographic, PET-CT findings and management with review of literature is presented. The diagnostic and management pitfalls of this extremely rare tumor are also discussed.
Neodymium:Yttrium aluminum garnet laser in the management of oral leukoplakia: A case series. - Contemporary clinical dentistry
Oral leukoplakia is a nonscrappable whitish patch described as a potentially malignant disorder with high prevalence in India. Besides medicinal treatment, neodymium: Yttrium aluminum garnet (Nd: YAG) laser is also used for the management of oral leukoplakia. This study evaluated the role of Nd: YAG laser in the management of oral leukoplakia and also investigated postoperative complications along with long-term prognosis of the disease.The study is a prospective cohort study conducted for 24 months (June 2011 to May 2013) in Lucknow.The study comprised of 42 patients, both male and female of Indian origin and diagnosed with oral leukoplakic lesions. Patients with biopsy proven squamous cell carcinoma and medically compromised are excluded from the study. All patients has undergone ablation of lesion by pulsed Nd: YAG laser and were followed after 24 h, 72 h, 1-week and then successively for 1, 3, 6 months and then 1(st) and 2(nd) postoperative years.Pain and slough were evaluated by Wicoxon rank test (P = 0.0001 statistically significant) which decreased from 24 h to 1-week and became nil in subsequent follow-ups. Similarly, McNemar's test (P = 0.001 statistically significant) was used for evaluation of burning sensation, paresthesia, infection and recurrences. Recurrence was noted in 2 patients but following the second application, there were no recurrences over the period of further follow-up. None of the patient suffered from an infection, paresthesia or anesthesia.Hence, Nd: YAG laser was found to be effective in ablating leukoplakia. It is convenient, economical with minimum complications and morbidities.
A study on oncogenic role of leptin and leptin receptor in oral squamous cell. - Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine
Leptin been mainly produced by adipose tissue and cancer cells is the most studied adipokine, amongst the several cytokines. Leptin is an antiapoptotic molecule and inducer of cancer stem cells as well as activates cell proliferation. Its oncogenic, mitogenic, proinflammatory and proangiogenic actions lead to its vital roles in tumourigenesis. Two common functional DNA polymorphisms in the genes of leptin G2548A (LEP) and leptin receptor A668G (LEPR) affect the amount of circulating cytokine-type hormone leptin with risk for development of oral squamous cell carcinoma (OSCC). The present study investigated whether these LEP and LEPR gene polymorphisms are affecting risk for OSCC by comparing the genotypes of patients with controls. A total of 306 OSCC and 228 controls participated in this study. We have determined the frequency of LEP (G2548A) and LEPR (A668G) gene polymorphisms in OSCC cases and controls by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). The incidence of leptin gene G2548A homozygous mutant AA polymorphism was significantly increased in the OSCC patients (pâ€‰=â€‰0.002, odds ratio (OR)â€‰=â€‰2.4, 95Â % confidence interval (CI)â€‰=â€‰1.37-4.22) when compared with controls, and leptin receptor A668G homozygous mutant GG polymorphism was significantly high in the OSCC patients as compared to controls (pâ€‰=â€‰0.000, ORâ€‰=â€‰3.8, 95Â % CIâ€‰=â€‰1.98-7.62). The polymorphism of homozygous mutant allele A of leptin gene and G allele of leptin receptor may be associated with increased risk for OSCC. The observations showed regular increase of supporting role of leptin in OSCC. The present study showed an association of AA genotype and A allele of LEP G2548A as well as GG genotype and G allele of LEPR A668G polymorphisms with increased risk for OSCC in north Indian patients. Moreover, the combination of both the polymorphisms may be involved in susceptibility and progression of OSCC.
Comparison of cell-based and non-cell-based assay platforms for the detection of clinically relevant anti-drug neutralizing antibodies for immunogenicity assessment of therapeutic proteins. - Journal of immunological methods
Anti-drug neutralizing antibodies (NAbs) formed due to unwanted immunogenicity of a therapeutic protein point towards a mature immune response. NAb detection is important in interpreting the therapeutic's efficacy and safety in vivo. In vitro cell-based NAb assays provide a physiological system for NAb detection, however are complex assays. Non-cell-based competitive ligand binding (CLB) approaches are also employed for NAb detection. Instead of cells, CLB assays use soluble receptor and conjugated reagents and are easier to perform, however have reduced physiological relevance. The aim of this study was to compare the performance of CLB assays to established cell-based assays to determine the former's ability to detect clinically relevant NAbs towards therapeutics that (i) acted as an agonist or (ii) acted as antagonists by binding to a target receptor. We performed a head-to-head comparison of the performance of cell-based and CLB NAb assays for erythropoietin (EPO) and two anti-receptor monoclonal antibodies (AMG-X and AMG 317). Clinically relevant NAb-positive samples identified previously by a cell-based assay were assessed in the corresponding CLB format(s). A panel of 12 engineered fully human anti-EPO monoclonal antibodies (MAbs) was tested in both EPO NAb assay formats. Our results showed that the CLB format was (i) capable of detecting human anti-EPO MAbs of differing neutralizing capabilities and affinities and (ii) provided similar results as the cell-based assay for detecting NAbs in patient samples. The cell-based and CLB assays also behaved comparably in detecting NAbs in clinical samples for AMG-X. In the case of anti-AMG 317 NAbs, the CLB format failed to detect NAbs in more than 50% of the tested samples. We conclude that assay sensitivity, drug tolerance and the selected assay matrix played an important role in the inability of AMG 317 CLB assays to detect clinically relevant NAbs.Copyright Â© 2015 Elsevier B.V. All rights reserved.
Examining the Specification Validity of the HEDIS Quality Measures for Substance Use Disorders. - Journal of substance abuse treatment
Accurate operationalization is a major challenge in developing quality measures for substance use disorder treatment. Specification validity is a term used to describe whether a quality measure is operationalized such that it captures the intended care processes and patients. This study assessed the specification validity of the 2009 Healthcare Effectiveness Data and Information Set (HEDISÂ®) substance use disorder initiation and engagement measures by examining whether encounters assumed to include relevant treatment have corroborating evidence in the clinical progress notes. The positive predictive values were excellent (>90%) for residential and outpatient records selected from addiction treatment programs but more modest for records generated in non-addiction settings, and were highly variable across facilities. Stakeholders using these measures to compare care quality should be mindful of the clinical composition of the data and determine if similar validation work has been conducted on the systems being evaluated.Published by Elsevier Inc.
Evaluation of exfoliative cytology in the diagnosis of oral premalignant and malignant lesions: A cytomorphometric analysis. - Dental research journal
Many oral squamous cell carcinomas (OSCCs) arise within regions that previously had premalignant lesion. Early diagnosis and prompt treatment of premalignant lesions offers the best hope of improving the prognosis in patients with OSCC. Exfoliative cytology is a simple and non-invasive diagnostic technique that could be used for early detection of oral premalignant and malignant lesions. This study was undertaken to evaluate the quantitative changes in nuclear area (NA), cytoplasmic area (CA) and nuclear-to-cytoplasmic ratio (NA/CA) in cytological buccal smears of oral leukoplakia with dysplasia (OLD) and OSCC patients while comparing with normal healthy mucosa.A quantitative study was conducted over 90 subjects including 30 cases each of OLD, OSCC and clinically normal oral mucosa. The smears obtained were stained with Papanicolaou (PAP) stain and cytomorphological assessment of the keratinocytes was carried out. The statistical tools included arithmetic mean, standard deviation, Chi-square test, analysis of variance, Tukey multiple comparison. P < 0.001 was considered as significant.The mean NA of keratinocytes in the normal mucosa was 65.47 Â± 4.77 Î¼m(2) while for OLD it was 107.97 Â± 5.44 Î¼m(2) and 139.02 Â± 8.10 Î¼m(2) for that of OSCC. The differences show a statistically significant increment in NA (P < 0.001). There was significant reduction (P < 0.001) in the CA of keratinocytes from OSCC when compared with those from smears of OLD and normal mucosa with the values of 1535.80 Â± 79.38 Î¼m(2), 1078.51 Â± 56.65 Î¼m(2) and 769.70 Â± 38.77 Î¼m(2) respectively. The NA/CA ratio in the smears from normal oral mucosa, OLD and OSCC showed a mean value of 0.043 Â± 0.004, 0.100 Â± 0.008, 0.181 Â± 0.015 respectively with a significant difference among the groups (P < 0.001).Evaluation of nuclear and CA of keratinocytes by cytomorphometry can serve as a useful adjunct in the diagnosis and prognosis of a dysplastic lesion which may lead to OSCC.
Map & Directions
12160 Montgomery Rd Cincinnati, OH 45249
8231 Cornell Rd Suite 320
8231 Cornell Rd Suite 320