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1.  Developing a Novel, Sustainable and Beneficial System for the Systematic Management of Hospital Wastes 
India is the 2nd most populated country in the world. Population of India is increasing at a tremendous rate. Proportionately, the numbers of people seeking health care are increasing. In that ratio the quantities of hospital wastes, in wider terms, healthcare wastes that are getting generated is also increasing. Current methods for the safe disposal of healthcare wastes are not able to cope up with the rate of generation of healthcare wastes and moreover are not eco-friendly at all. Due to this, the current rules and regulations regarding the safe disposal of healthcare wastes are getting violated, ultimately leading to improper management of healthcare wastes, posing a serious threat to the environment and to the community.
To develop a novel, sustainable and beneficial system for the systematic management of healthcare wastes utilizing the strategies of waste reduction, waste segregation and recycling of Non Hazardous Hospital Wastes (NHHWs).
Materials and Methods
Firstly a detailed study of the Healthcare Waste Management System (HCWMS) operational at the Jaslok Hospital and Research Centre was done. A pilot study was then performed. After that, data regarding the generation and management of healthcare wastes in the other healthcare settings was collected and analyzed. Considering all this, a novel, sustainable and beneficial template system for the systematic management of healthcare wastes was proposed. Lastly the possible positive impacts from the implementation of HCWMSs designed using proposed template HCWMS in significant numbers of healthcare establishments was gauged.
The healthcare waste management system operational at the Jaslok Hospital and Research Centre was found to be very efficient and provided vital inputs about developing the novel HCWMS. The pilot study was successfully completed generating significant revenue from the hospital’s own NHHWs while managing them in an eco-friendly way. The total healthcare waste generation in Maharashtra was approximately estimated at about 2,89,200kg/day of which about 43,380kg/day was Bio-Medical Wastes (BMWs) while about 2,45,820kg/day were the NHHWs. This stresses the need of implementing HCWMSs in Healthcare Establishments (HCEs) based on the proposed novel template of HCWMS.
The novel template system is proposed in a detailed manner under various heads in the form of a handbook which is scalable upwards or downwards as per the requirement of a HCE. The enormous economic and environmental positive impacts from the implementation of the HCWMSs based on the proposed HCWMS in significant numbers of HCEs were presented numerically, putting light on the necessity and tremendous potential of this field of research.
PMCID: PMC5071971  PMID: 27790471
Beneficial; Ecofriendly; Non hazardous healthcare wastes; Recycling; Sustainable
2.  Vorinostat and bortezomib as third-line therapy in patients with advanced non-small cell lung cancer: a Wisconsin Oncology Network Phase II study 
Investigational new drugs  2013;32(1):195-199.
The primary objective of this phase II trial was to evaluate the efficacy and tolerability of vorinostat and bortezomib as third-line therapy in advanced non-small cell lung cancer (NSCLC) patients.
Eligibility criteria included recurrent/metastatic NSCLC, having received 2 prior systemic regimens, and performance status 0–2. Patients took vorinostat 400 mg PO daily days 1–14 and bortezomib 1.3 mg/m2 IV day 1, 4, 8 and 11 in a 21-day cycle. Primary endpoint was 3-month progression free survival (3m-PFS), with a goal of at least 40 % of patients being free of progression at that time point. This study followed a two-stage minimax design.
Eighteen patients were enrolled in the first stage. All patients had two prior lines of treatment. Patients received a median of two treatment cycles (range: 1–6) on study. There were no anti-tumor responses; stable disease was observed in 5 patients (27.8 %). Median PFS was 1.5 months, 3m-PFS rate 11.1 %, and median overall survival 4.7 months. The most common grade 3/4 toxicities were thrombocytopenia and fatigue. Two patients who had baseline taxane-related grade 1 peripheral neuropathy developed grade 3 neuropathy. The study was closed at its first interim analysis for lack of efficacy.
Bortezomib and vorinostat displayed minimal anti-tumor activity as third-line therapy in NSCLC. We do not recommend this regimen for further investigation in unselected patients.
PMCID: PMC4310688  PMID: 23728919
Non-small cell lung cancer; Vorinostat; Bortezomib; Third-line
3.  Electronic brachytherapy as adjuvant therapy for early stage breast cancer: a retrospective analysis 
OncoTargets and therapy  2011;4:13-20.
This multicenter, retrospective study evaluated treatment and clinical outcomes of patients with early stage breast cancer who received adjuvant high-dose rate (HDR) electronic brachytherapy (EBT) treatment post-lumpectomy using the Axxent® EBT system. Dosimetric data from the EBT treatment plans were compared with those based on iridium-192 HDR brachytherapy.
Material and methods:
Medical records of 63 patients with early stage breast cancer (Tis, T1a, T1b, T1c, and T2) who were treated post-lumpectomy with EBT alone or in combination with external beam radiation therapy were reviewed. The prescribed EBT dose was 34 Gy (10 fractions over 5 days, 3.4 Gy each) to 1 cm from the balloon surface. Dosimetry data from 12 patients were compared with these of treatment plans using an iridium-192 source prepared for the same 12 patients.
The majority of patients (90.5%) were older than 50 years and had one or more risk factors for breast cancer (80.6%). Tumor sizes were 0.1 cm to 3.5 cm (mean 1.3 cm). Median follow-up was 7 months (1 to 18 months) post-EBT. Balloon applicators were implanted 0 to 85 days (mean 13.4 days) post-lumpectomy/re-excision. The most common adverse events were erythema, rash dermatitis, and pain or breast tenderness. No recurrences were reported. Dosimetric analyses demonstrated comparable target coverage, increased high-dose regions, and a significantly reduced dose to the ipsilateral breast and lungs as well as the heart with EBT as compared with the iridium-192 treatment plans.
This retrospective, multicenter study showed that postsurgical adjuvant radiation therapy for early stage breast cancer can be administered using the EBT system with similar toxicity outcomes to those reported with iridium-192 brachytherapy. EBT offers a convenient, portable, nonisotope alternative to HDR brachytherapy using iridium-192.
PMCID: PMC3084303  PMID: 21552411
electronic brachytherapy; breast cancer; radiation therapy
4.  Use of electronic brachytherapy to deliver postsurgical adjuvant radiation therapy for endometrial cancer: a retrospective multicenter study 
OncoTargets and therapy  2010;3:197-203.
This retrospective, multicenter study evaluated the feasibility and safety of high-dose rate electronic brachytherapy (EBT) as a postsurgical adjuvant radiation therapy for endometrial cancer.
Medical records were reviewed from 41 patients (age 40–89 years) with endometrial cancer (Federation of International Gynecology and Obstetrics stages IA–IIIC) treated at nine centers between April 2008 and October 2009. Treatment included intracavitary vaginal EBT alone (n = l6) at doses of 18.0–24.0 Gy in 3–4 fractions and EBT in combination with external beam radiation therapy (EBRT, n = 25) at a total radiation dose range of 40.0–80.4 Gy. Doses were prescribed to a depth of 5 mm from the applicator surface and to the upper third (n = 15) and the upper half (n = 26) of the vagina.
Median follow-up was 3.8 (range 0.5–12.0) months. All 41 patients received the intended dose of radiation as prescribed. Adverse events occurred in 13 of 41 patients and were mild to moderate (Grade 1–2), consisting primarily of vaginal mucositis, rectal mucosal irritation and discomfort, and temporary dysuria and diarrhea. There were no Grade 3 adverse events in the EBT-only treatment group. One patient, who was being treated with the combination of EBT and EBRT for recurrent endometrial cancer, had a Grade 3 adverse event. No recurrences have been reported to date.
Electronic brachytherapy provides a feasible treatment option for postoperative adjuvant vaginal brachytherapy as sole radiation therapy and in combination with EBRT for primary endometrial cancer. Early and late toxicities were mild to moderate.
PMCID: PMC2962306  PMID: 21049086
endometrial cancer; electronic brachytherapy; radiation therapy
5.  Phase I/II study of vinorelbine and exisulind as first-line treatment of advanced non-small cell lung cancer in patients at least 70 years old: a Wisconsin Oncology Network Study 
Exisulind is an apoptotic agent with preclinical activity in non-small cell lung cancer (NSCLC). Vinorelbine is safe and effective in older patients with advanced NSCLC. We assessed these agents together as palliative treatment for older patients with advanced NSCLC.
Chemotherapy-naïve patients ≥ 70 years old with stage IIIB-IV NSCLC and a performance status (PS) ≤ 2 were eligible. Primary endpoints were the maximum tolerated dose (MTD, phase I) and time-to-progression (TTP, phase II) of oral exisulind with 25 mg/m2/week of intravenous (IV) vinorelbine on a 28-day cycle. Patients with clinical benefit after six cycles of this combination received exisulind alone.
Fourteen phase I patients (median PS 1; median age 78 years) were enrolled. Dose-limiting toxicities included grade 3 constipation (one patient), grade 3 febrile neutropenia (one patient) and grade 3 diarrhea (one patient). The MTD of oral exisulind with 25 mg/m2/week of IV vinorelbine was 125 mg twice daily. Thirty phase II patients (median PS 1; median age 78 years) were enrolled. Grade ≥ 3 neutropenia occurred in 14/30 patients. Two patients experienced neutropenic fever. There were no complete responses, one partial response and 12 patients with stable disease as their best response. The objective response rate was 4.0% (95% CI: 0.1–20.4%). Phase II median TTP was 4.7 months (95% CI: 3.1 – 9.3 months) and median OS was 9.6 months (95% CI: 6.6 – 19.1 months).
This combination is safe, appears to have activity in the elderly with advanced NSCLC and a PS ≤ 2, and warrants further investigation.
PMCID: PMC2562273  PMID: 18758305
Elderly; exisulind; sulindac sulfone; non-small cell lung cancer; vinorelbine; phase I; phase II

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