Qualification: 
MSc
sheejamolvs@aims.amrita.edu

Sheejamol V. S. currently serves as Senior Lecturer in the Department of Biostatistics, School of Medicine, Kochi. 

Sheejamol V. S. joined as Sr. Lecturer in the Department of Biostatistics at Amrita School of Medicine in July 2017. She completed her M. Sc. Biostatistics and B. Sc. Mathematics from Mahatma Gandhi University Kottayam. She has 10 years teaching and research experience in the area of statistics in medical research.  She had worked as lecturer in biostatistics at Amrita School of Medicine from February 2011 – October 2014 and lecturer in statistics at P.K. Das Institute of Medical Sciences, Ottapalam, Palakkad from October 2014 to January 2017. She had done her post graduate research projects at Regional Cancer Centre Thiruvananthapuram, in the topics of Survival Analysis under the department of Epidemiology and Biostatistics.

Seminars / Workshops Attended

  • Participate on the Dissemination Program of ICMR-DBT National Guidelines for Stem Cell Research 2017 conducted at Amrita Institute of Medical Sciences, Kochi,Kerala on February 22, 2018
  • Participate on the ‘Dissemination Program of National Ethical Guidelines for Biomedical and Health Research Involving Human Participants and National Ethical Guidelines for Biomedical Research Involving Children 2017’ conducted at Amrita Institute of Medical Sciences, Kochi,Kerala on February 22, 2018
  • Workshop on ‘ Qualitatitive Data and Analysis Methods’, conducted at Amrita Institute of Medical Sciences and Research Centre, Kochi. on 21st to 23rd August 2014.
  • Short Courses in ‘Clinical Trials & Meta Analysis’, March 24-28,2014 : BRTC, Christian Medical College, Bagayam, Vellore, India
  • ‘International Conference on Epidemiology: Special Focus to Modeling Infectious and Chronic Disease Data using Time Series and Spatial Data Analysis’ conducted at Department of Statistics & Biostatistics, St. Thomas College Pala from 16th to 18th, August 2012.
  • Seminar on ‘New Trends in Applied Statistical Methodology’ and Annual conference of the Kerala Statistical Association conducted at Nirmala College Muvattupuzha on 25th to 27th February 2010. 
  • UGC Sponsored Two Day National Seminar on ‘Biostatistics: Applications of Stochastic Process in Medicine’ conducted at MES College Nedumkandam on 2nd to 3rd February 2009.
  • UGC Sponsored Workshop on ‘Modern Applied Statistical Methods in Statistical Softwares’ conducted at Nirmala College Muvattupuzha on 24th to 26th February 2009.
  • National Workshop on Biosciences’ conducted at Mar Augusthinose College, Ramapuram on 16th to 18th December 2008.

Publications

Publication Type: Journal Article

Year of Publication Title

2020

N. Rajrattans Akali, Rahul, B., Sheejamol V. S., Deepak Balasubramanian, Iyer, S., and Thankappan, K., “Prior chemoradiotherapy and pathological perineural invasion predict the survival outcomes of salvage surgery in head and neck squamous cell carcinoma.”, Head Neck, 2020.[Abstract]


BACKGROUND: The purpose of the study was to evaluate the oncological outcomes of salvage surgery in squamous cell carcinoma of the head and neck (SCCHN).

METHODS: This is a retrospective analysis of all patients of SCCHN with recurrence or second primary, post-treatment, who underwent salvage surgery. The outcomes were analyzed in terms of overall survival, overall survival postsalvage surgery and disease-free survival (DFS) postsalvage surgery. Clinical and pathological predictors were considered.

RESULTS: Two hundred and forty-one patients were included. The mean follow-up was 56.33 months. Five-year survival OS from date of initial diagnosis of the tumor was 61.2%. The 5-year OS survival after salvage surgery was 47.1%. Five-year DFS after salvage surgery was 28.1%. Prior chemoradiotherapy and pathological perineural invasion were independent predictors on multivariate analysis.

CONCLUSIONS: Survival outcomes after appropriate salvage treatment are good. Prior chemoradiotherapy and perineural invasion on salvage pathology are predictors of poorer outcomes.

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2016

C. G. Prameela, Ravind, R., Mon, P. S. Renil, Sheejamol V. S., and Dinesh, M., “Radiation dose to dysphagia aspiration-related structures and its effect on swallowing: Comparison of three-dimensional conformal radiotherapy and intensity-modulated radiation therapy plans.”, J Cancer Res Ther, vol. 12, no. 2, pp. 845-51, 2016.[Abstract]


CONTEXT: Radiotherapy techniques have improved over years but have also raised concerns over subsequent acute and late effects. One such complication, dysphagia, has led to much interest and optimization in treatment delivery.

AIMS: The aim of this study was to compare radiation dose to dysphagia aspiration related structures (DARS) in intensity modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT), and assess its relation to post-treatment swallowing status, in patients of carcinoma of the anterior two thirds of tongue.

MATERIALS AND METHODS: Treatment plans of patients treated with IMRT and 3DCRT, from November 2011 to December 2012, were retrieved. Swallowing structures were contoured. Dose volume histograms were generated. Constraint doses were considered based on the statistical derivations. Swallowing status was evaluated based on University of Washington Head- and Neck-related Quality-of-Life questions addressing swallowing.

STATISTICAL ANALYSIS USED: IBM SPSS Statistics 20 Windows (SPSS Inc., Chicago, IL, USA) was used. Mann-Whitney U-test, Spearman's rho correlation coefficient, and receiver operating curves were used.

RESULTS: Definitive statistical and subjective correlations were found to exist between doses of swallowing structures, especially the constrictor muscles, the base of the tongue and larynx. Probable mean dose constraints derived statistically clinically corroborates with the swallowing status of patients. IMRT had statistically significant advantage over 3DCRT, in terms of V30 (P - 0.051), V50 (P - 0.002), V60 (P - 0.002), and D80 (P - 0.023) for swallowing structures taken together.

CONCLUSION: Our study is probably one of the few studies predicting possible mean dose constraints for superior constrictor, the base of the tongue and larynx. Further prospective studies are required to confirm these and to improve the swallowing quality.

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2016

C. G. Prameela, Ravind, R., Gurram, B. C., Sheejamol V. S., and Dinesh, M., “Prognostic Factors in Primary Vaginal Cancer: A Single Institute Experience and Review of Literature.”, J Obstet Gynaecol India, vol. 66, no. 5, pp. 363-71, 2016.[Abstract]


<p><b>BACKGROUND: </b>Primary vaginal carcinoma is rare, accounting for 1-2 % of all gynecological malignancies. Being rare, most observations are based on retrospective and comparative analyses. This study was aimed to retrospectively analyze the prognostic factors and its relevance in the outcomes of primary vaginal cancers.</p><p><b>MATERIALS: </b>Medical records of all cases of primary vaginal cancers, presented to Department of Oncology, from 2004 to 2012, at a tertiary care center in southern India, were retrieved from electronic medical records, and were analyzed.</p><p><b>RESULTS: </b>The total number of cases was 32. Median age at presentation was 64.28 years. Squamous histology accounted for 84.4 %, with the rest being adenocarcinoma. Surgery was offered for five (15.6 %), and concurrent chemotherapy for 14 (43.8 %) patients. Three patients had only surgery. All others received radiotherapy. Twenty received external beam radiation (EBRT) and vaginal brachytherapy (VBT); seven only EBRT and two, adjuvant radiation. Five patients had residual disease; two, stage III, and three stage IV. Median follow-up was 55.83 months. Twelve patients were alive at last follow-up (37.5 %), while 14 were dead (43.8 %-8 of disease and 6 of other causes). Six patients were lost to follow-up (18.8 %). Twenty patients were disease free. Seven had recurrence, three loco-regional and four distant. Median overall survival (OS) was 86.1 months, disease-free survival (DFS) 90.17 months, and disease-specific survival (DSS) 97.13 months. When well and moderately differentiated tumors were taken together, the 5-year OS, DFS, and DSS rates were, 56.6, 64.3, and 82.3 %. For poorly differentiated tumors, median OS, DFS, and DSS were, 20.9, 14.6, and 20.9 months, with statistically significant advantage for better grade tumors, for DSS (p 0.050). Better 5-year OS, DFS, and DSS rates were observed for stage I + II group, with 54.9, 79.8, and 78.9 %, compared with advanced stage where the same were 54.8, 38.2, and 68.6 % (DFS-p 0.003, DSS-p 0.009). Grade and stage of tumor had statistically significant predictive value over the outcomes, while tumor size showed a significant trend. Patients treated with combination of EBRT and VBT fared well.</p><p><b>CONCLUSION: </b>Our study could conclude that grade of differentiation was a significant predictor of poor survival as was stage of disease. Combination of VBT and external beam radiotherapy provides good DFS.</p>

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2016

M. Pandey, Vidhyadharan, S., Puthalath, U., Veeraraghavan, R., Sheejamol V. S., Prasad, C., Iyer, S., and Thankappan, K., “Macroscopic technique for the evaluation of oral tongue tumour thickness: a reliable intraoperative method.”, Int J Oral Maxillofac Surg, vol. 45, no. 8, pp. 933-7, 2016.[Abstract]


<p>There is no reliable method to assess tumour thickness preoperatively or intraoperatively in cases of oral tongue squamous cell carcinoma (SCC). The purpose of this study was to evaluate the efficacy of a macroscopic technique to measure tumour thickness. This was a prospective study of 51 consecutive patients with T1/T2 primary SCC of the oral tongue. All patients underwent primary resection with ipsilateral neck dissection. Thickness measurements were obtained using Vernier calipers on the fresh specimen. The technique was correlated with the microscopic evaluation statistically using (1) Pearson's correlation coefficient, (2) intra-class correlation, and (3) Bland-Altman plot with 95% confidence intervals. On comparing the macroscopic technique to the microscopic evaluation, Pearson's correlation (r) was 0.915 (P<0.001). The inter-rater reliability using the intra-class correlation coefficient was 0.955. The Bland-Altman plot to test the agreement between the techniques showed the average difference between macroscopic thickness and microscopic thickness (bias) to be -0.421, with 95% limits of agreement of -3.166 and 2.82. There was a significant correlation and agreement between the macroscopic and microscopic measures of tumour thickness. The macroscopic technique could be used as a reliable tool to measure tumour thickness intraoperatively, prior to neck dissection. </p>

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2016

J. M. Kanthi, Sumathy, S., Sreedhar, S., Rajammal, B., Usha, M. G., and Sheejamol V. S., “Comparative Study of Cesarean Myomectomy with Abdominal Myomectomy in Terms of Blood Loss in Single Fibroid”, Journal of Obstetrics and Gynecology of India, vol. 66, pp. 287-291, 2016.[Abstract]


Objective: In this study, we evaluate the safety and feasibility of cesarean myomectomy and compare this procedure with abdominal myomectomy in single fibroid, in terms of blood loss and postoperative complications. Methods: Thirty-three patients who underwent cesarean myomectomy from June 2006 to 2012 in Amrita Institute of Medical Sciences, were included in the study. Almost an equal number of patients who underwent abdominal myomectomy (32) in the same period were included. Women are divided into two groups: group 1—cesarean myomectomy, group 2—abdominal myomectomy. Results: Mean age of the women was comparable; mean gestational age in group 1 was 37.97 +/− 1.57 weeks; and 60 % were primiparous. Hemoglobin (Hb) drop postoperatively was compared between the groups, and there was no significant difference. Though there was statistically significant difference among the groups regarding the size of fibroids, the main outcome measure of the study, the Hb drop was comparable between group 1 and 2. There is statistically significant difference in the Hb difference with increasing mean diameter of the fibroids. As the size increases, Hb drop also increases indicating the increasing blood loss. The measures used to reduce blood loss such as vasopressin instillation and stepwise devascularization influence the blood loss, and P value shows borderline significance. There was no difference in Hb drop among the groups according to the type of fibroids. But more subserous fibroids were removed in group 1, whereas more intramural fibroids were removed in group 2. Conclusion: Cesarean myomectomy can be safely done in single fibroids and is comparable to abdominal myomectomy in terms of blood loss. © 2015 Federation of Obstetric & Gynecological Societies of India

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2015

B. Parameswar Pillai, ,, Kumar, H., Jayakumar, R. Vilasam, Alur, V. Chandra, and Sheejamol V. S., “The prevalence of metabolic syndrome in polycystic ovary syndrome in a South Indian population and the use of neck circumference in defining metabolic syndrome”, International Journal of Diabetes in Developing Countries, vol. 35, pp. 469–475, 2015.[Abstract]


Polycystic ovary syndrome (PCOS) is a common endocrine disorder in young women with a high prevalence of insulin resistance (IR) and metabolic syndrome (MetS). The prevalence of MetS differs based on the defining criteria used. Neck circumference (NC) has been proposed as a surrogate marker of MetS which is simple and easy to perform in the outpatient setting. The aim of the study was to estimate the prevalence of metabolic syndrome in women with PCOS and to study the use of NC in defining metabolic syndrome. This was a prospective observational cross-sectional study involving 121 PCOS patients over a period of 2 years. The prevalence of metabolic syndrome was estimated using the modified Adult Treatment Panel (ATP) III criteria as well as the International Diabetes Federation (IDF) criteria. The Pearson correlation coefficient was used to find the degree of correlation between NC and waist circumference (WC). The Receiver operating characteristic (ROC) curves of NC were used to predict the metabolic syndrome. The independent sample t test and the Mann-Whitney U test were used for comparing the average NC and WC between the groups of patients with and without MetS. The prevalence of MetS was found to be 30.6 {%} using the modified ATP III criteria and 52 {%} using the IDF criteria. There is a statistically significant positive correlation between NC and WC (rþinspace}=þinspace}0.758, pþinspace}<þinspace}0.001). The mean NC is higher in patients who have MetS by both criteria (pþinspace}<þinspace}0.001). Based on ROC curve analysis, the NC cutoff of 33.5 cm detected MetS (by IDF criteria) with a sensitivity of 60.3 {%} and a specificity of 70.7 {%} (area under ROC curveþinspace}=þinspace}0.70, pþinspace}<þinspace}0.001) and the NC cutoff of 33.87 cm detected MetS (by ATP III criteria) with a sensitivity of 73 {%} and a specificity of 69 {%} (area under ROC curveþinspace}=þinspace}0.722 pþinspace}<þinspace}0.001). The IDF criteria identified a higher number of PCOS subjects with MetS compared to the ATP III criteria. NC correlated very well with MetS as well as WC, and this could replace the waist circumference to define MetS in the future.

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2014

C. G. Prameela, Ravind, R., M. Nair, H., Mon, P. S. Renil, Sheejamol V. S., and Makuny, D., “P0107 Dose to dysphagia aspiration-related structures and its effect on swallowing: Comparison of 3D CRT and IMRT plans”, European Journal of Cancer, vol. 50, pp. e38 - e39, 2014.[Abstract]


Background Advances in radiotherapy techniques have improved clinical outcomes, but have also lead to concerns over subsequent acute and late effects. Dysphagia is one such complication that has garnered much attention. This retrospective study, conducted at a tertiary cancer care centre, aimed to analyse swallowing profiles of patients with cancer of anterior two-thirds of tongue, who had undergone surgery and had received adjuvant radiation using either IMRT or 3D CRT, as a surrogate of dose received by dysphagia aspiration-related structures (DARS). Methods The treatment plans of patients treated using IMRT and 3D CRT, from November 2011 to December 2012, were retrieved from the planning system. The swallowing structures (DARS), namely superior, middle and inferior constrictors, base of tongue, larynx with supraglottis, and length of oesophagus, included in treatment volume with cricopharyngeous muscle, were contoured according to RTOG guidelines. Dose volume histograms were generated for these. Constraint doses were statistically derived. University of Washington Head-and-Neck-related Quality-of-Life questions addressing swallowing was used to evaluate swallowing status of patients. Findings A statistically significant subjective correlation was found to exist between doses of swallowing structures, especially the constrictor muscles, base of tongue, and the larynx. Statistically derived probable mean dose-constraints correlated clinically with swallowing status of patients. IMRT had a statistically significant advantage over 3D CRT, in terms of V30 (p=0.051), V50 (p=0.002), V60 (p=0.002), and D80 (p=0.023) for the swallowing structures taken together. The probable limiting dose for dysphagia was 63Gy for the superior constrictor and base of tongue, and 55Gy for the larynx. Interpretation Our study predicted possible mean dose constraints for the superior constrictor, base of tongue, and larynx. Further prospective studies are required to confirm these findings. Dysphagia-optimised IMRT is needed to improve swallowing status and quality of life in these patients.

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2014

P. CG, Ravind, R., P Zaheeruddin, M., Jose, W. M., Sheejamol V. S., and Dinesh, M., “Hyponatremia: Is there an association with disease profile in head and neck malignancies? Audit from a tertiary cancer care centre”, Journal of Cancer Research and Therapeutics, vol. 10, 2014.[Abstract]


Aim An increased incidence of hyponatremia was noticed among patients with head and neck malignancies on external beam radiation therapy. Hence, we have retrospectively assessed the incidence and patterns of hyponatremia and also the factors that might influence hyponatremia, in patients with head and neck malignancies, as an institutional audit. Materials and Methods Patients with head and neck cancers treated with radical intent from January 2011 to December 2012 were analysed. Data from electronic medical records were retrieved. Patients were grouped, based on their sodium status while on treatment, into group I (hyponatremic) and group II (eunatremic). Each of these groups were sub-grouped as A and B based on treatment interruptions. Univariate and multivariate analysis of individual variables were done.Results Study group included 271 patients. 68.3% of patients had developed hyponatremia. Age greater than 50 years was a significant factor in the development of hyponatremia in multivariate analysis (p- 0.018). Advanced stage was associated with a greater proportion of patients developing hyponatremia (p-<0.001). Surgery prior to radiation (univariate - p-0.009; multivariate - p-0.005) and concurrent chemotherapy (univariate - p-<0.001; multivariate - p-<0.001) significantly increased the risk of developing hyponatremia. Hyponatremia prior to initiating radiation also carried significant risk of developing hyponatremia on radiation (univariate - p-<0.001; multivariate - p-<0.001). Incidence of interruptions to radiation treatment was higher in patients having hyponatremia(p-0.002). Conclusion Hyponatremia was significantly associated with age, stage of disease, post-operative status, chemoradiation and with initial hyponatremia albeit correction prior to radiation

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2014

N. U. C. Sumithra, Lakshmi, R. L., N. Menon, L., Subhakumari, K. N., and Sheejamol V. S., “Evaluation of Oxidative Stress and hsCRP in Polycystic Ovarian Syndrome in a Tertiary Care Hospital”, Indian Journal of Clinical Biochemistry, 2014.[Abstract]


PCOS is a heterogeneous endocrine disorder with diverse clinical presentation. Oxidative stress plays a key role in the pathophysiology of this disease. Serumhigh sensitive C-reactive protein (hsCRP), a marker of chronic low grade inflammation, is indicative of future development of cardiovascular disease. Our aim is to evaluate the oxidant status and hsCRP levels in PCOS. The study involved 61 cases and 61 controls in the age group of 18-40 years diagnosed with PCOS. Erythrocyte malondialdehyde (MDA), superoxide dismutase (SOD), serum hsCRP, gonadotrophins, thyroid stimulating hormone, prolactin, glycemic status and lipid profile were estimated. Erythrocyte MDA (p &lt; 0.001), SOD (p = 0.007) and serum hsCRP (p &lt; 0.001) were significantly elevated in PCOS patients than controls. Oxidative stress is present in women with PCOS along with elevated hsCRP. © 2014 Association of Clinical Biochemists of India.

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2013

R. Anupama, Kuriakose, S., Vijaykumar, D. K., Pavithran, K., Jojo, A., Indu, R. N., and Sheejamol V. S., “Carcinosarcoma of the Uterus-A Single Institution Retrospective Analysis of the Management and Outcome and a Brief Review of Literature”, Indian Journal of Surgical Oncology, vol. 4, pp. 222-228, 2013.[Abstract]


Uterine carcinosarcomas are highly aggressive tumors of the uterus associated with a poor prognosis. Though initially classified as sarcomas, now these tumors are classified as carcinomas. The management approach of carcinosarcomas has also changed from those used for high grade sarcomas to that used for managing high grade endometrial carcinomas. The purpose of our study was to analyze the management and outcome of patients with uterine carcinosarcomas treated at our institution and also to attempt a brief review regarding the management of uterine carcinosarcomas. We did a retrospective analysis of all patients with a diagnosis of carcinosarcoma of the uterus treated at our Institution from January 2005 till December 2010. All Patients with a pathological diagnosis of carcinosacrcoma or malignant mixed mullerian tumours of the uterus were included. Data was obtained from the hospital electronic medical records and the hospital cancer registry. Data was analyzed using SPSS v.17. During this 6 year period we had 20 patients with carcinosarcoma of the uterus. 75 % of the patients belonged to Stage I and II. 95 % of the patients underwent Hysterectomy with Bilateral salpingo oophorectomy and 60 % had lymphadenectomy also along with hysterectomy.8 patients had disease recurrence. In patients who had gross extrauterine disease at the time of surgery, the survival was only 9 months whereas in patients who had complete staging with disease confined to the uterus, the survival was 36 months. Carcinosarcomas, accounts for more than 15 % of the uterine cancer associated deaths. Surgery remains the cornerstone of management for these tumors and surgery with pelvic and para aortic lymphadenectomy and peritoneal and omental biopsies is required for the correct staging of the disease and may also provide a survival advantage. Radiation therapy has been shown to provide only better local control without any survival advantage. Further studies are needed to assess whether chemotherapy offers a definite survival benefit in uterine carcinosarcomas. © 2013 Indian Association of Surgical Oncology.

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2012

U. Menon, Sheejamol V. S., and P, C., “Validation of Malayalam Version of the Voice Handicap Index”, International Journal of Phonosurgery and Laryngology, vol. 2, pp. 1-4, 2012.[Abstract]


Background: It is important to have a subjective measure of hoarseness. This can be best achieved if the questionnaire is in the patient’s own language. Objective: To translate the voice handicap index (VHI) into the Malayalam language, and to evaluate its clinical validity and internal consistency. Materials and methods: One hundred and six patients with dysphonia and 20 asymptomatic subjects were included in the study. Internal consistency was analyzed through Cronbach’s alpha coefficient. For the clinical validity assessment, the scores obtained in the patient group were compared with those found in asymptomatic individuals through the Mann-Whitney U-test. Also, comparison between the VHI scores before and after phonomicrosurgery on 14 out of the studied 106 patients was done using the nonparametric Wilcoxon signed ranks test. Spearman rank correlation was used to find the effect of patient’s age on VHI scores. Finally, the gender-wise average VHI score and its three subsets was analyzed using Wilcoxon signed ranks test. Results: The internal consistency was found to be excellent ( = 0.946). The control group scored significantly lower than the patients group (p < 0.001). Similarly, significant improvement was seen in the postoperative average VHI scores (p < 0.004). All of the preceding proves the validity of the translated questionnaire. Age showed a significant negative correlation for the overall VHI and their three domains (p < 0.001) in the dysphonic patients. There was no such correlation between male and female patient groups. Conclusion: This Malayalam language version of the VHI questionnaire is a valid instrument for use in the voice clinic. Clinical implication: Encouragement to all voice clinicians in India to develop and use the VHI in their native tongues.

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Publication Type: Conference Paper

Year of Publication Title

2014

P. Chelakkot, Vijayan, S., Ravind, R., Sheejamol V. S., and Keechilat, P., “Androgen receptor expression in triple negative breast cancer”, in EUROPEAN JOURNAL OF CANCER, 2014.