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Kumar A, Kuttalam S, Tanwar D, Choudhary B, Garg MK, Gopalakrishnan M. First report of clinically significant bites due to Platyceps ventromaculatus (GRAY, 1834) from Thar Desert region, Rajasthan, India. Toxicon 2024; 240:107638. [PMID: 38311255 DOI: 10.1016/j.toxicon.2024.107638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Platyceps ventromaculatus is a non-front-fanged colubrid snake of unknown medical significance. In this study, we highlight the clinical manifestations and outcomes of P. ventromaculatus bites. We also emphasise the need to create awareness among clinicians and the public for its potential to be confused with serious venomous bites such as Echis carinatus sochureki. METHODS This series is part of an ongoing observational clinical study from our tertiary care hospital in Jodhpur, India on the profile and outcomes of snakebite envenoming. Data was collected after approval from Institute Ethics Committee. The date and time of the bite, geographical location, type of human-snake conflict, time-to-reach a healthcare facility, antivenom used (dose), and outcomes were recorded. We retrospectively examined our clinical data for images suggestive of P. ventromaculatus and present the clinical details of these patients. The photographs were identified utilising taxonomic keys for species identification. RESULTS A total of four images and three patients with bites due to P. ventromaculatus were identified. The clinical effects included mild local erythema, pain, transient local bleeding, and edema. All bites occurred during daylight hours, 2 during agricultural activities, and one at home. Twenty-minute Whole Blood Clotting Test was persistently prolonged for 12 h after the bite in one patient. All patients were treated symptomatically, observed at the emergency department, and discharged within 24 h. None of the patients received antivenom. CONCLUSIONS To our knowledge, P. ventromaculatus has so far not been reported to result in envenoming or medically significant bites. This study highlights that Platyceps bite can present with clinically significant local and possibly systemic findings that may lead to confusion with saw-scaled viper (Echis) envenoming. Clinicians must receive appropriate training so as to be aware and recognize regional snake species that do not require antivenom so as to avoid unnecessary antivenom administration.
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Affiliation(s)
- Akhilesh Kumar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Sourish Kuttalam
- Molecular Ecology and Evolution at Bangor, School of Natural Sciences, Bangor University, Environment Centre Wales, Bangor, LL57 2UW, Wales, UK; Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal, 712407, India; Captive & Field Herpetology Ltd, 13 Hirfron, Llaingoch, Holyhead, Anglesey, LL65 1YU, Wales, UK
| | - Divya Tanwar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Bharat Choudhary
- Department of Trauma and Emergency (Paediatrics), All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Mahendra Kumar Garg
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Maya Gopalakrishnan
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India.
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Mondal S, Gargari P, Bose C, Garg MK, Chowdhury S, Mukhopadhyay S. Abnormal Body Composition Increases the Cardiometabolic Risk in Adolescents and Young Adults With Turner Syndrome. Endocr Pract 2024; 30:259-269. [PMID: 38042448 DOI: 10.1016/j.eprac.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/02/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE To determine the cardiometabolic risk of adolescents and adults with Turner syndrome (TS) and whether and how anthropometry and body composition predict this risk. METHODS We compared the anthropometric, biochemical, and dual-energy x-ray absorptiometry-derived body composition parameters of 103 girls and women with TS aged 12 to 30 years and 103 controls of the same age and body mass index: (1) between TS with and without metabolic syndrome (MetS), (2) between the different karyotypes of TS, and (3) between growth hormone recipients and nonrecipients. RESULTS Individuals with TS had higher prevalence rates of truncal obesity (57.2%), MetS (37.9%), prediabetes (20.4%), dyslipidemia (73.8%), hypertension (9.7%), and hepatic steatosis (15.5%) and a greater total body fat percentage (38.43% vs 34.26%) and fat mass index (9.15 vs 6.71 kg/m2) but a lower lean mass index (11.05 vs 12.49 kg/m2) than controls (P <.001). Individuals with TS and MetS (n = 39) had a higher total body fat percentage (41.74% vs 36.42%, P <.0001), truncal fat percentage (44.66% vs 36.09%, P <.0001), and visceral adipose tissue mass (495.57 vs 276 g, P <.0001) than those with TS but without MetS. Those with classic TS (45,X) had a higher prevalence of prediabetes (32.6% vs 10.5%, P =.01). Growth hormone recipients had a lower prevalence of MetS and lesser truncal obesity. Altered body composition was significantly correlated with metabolic risk. The truncal fat percentage independently predicted MetS (odds ratio, 1.12; 95% confidence interval, 1.003-1.24; P =.04). Waist circumference and waist-hip ratio predicted metabolic risk with good sensitivity and specificity. CONCLUSION Adverse cardiometabolic risk and altered body composition start early in life in TS. Postpubertal women with TS should be routinely assessed for truncal obesity, dysglycemia, dyslipidemia, and liver steatosis, irrespective of body mass index and karyotype.
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Affiliation(s)
- Sunetra Mondal
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Piyas Gargari
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Chiranjit Bose
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Mahendra Kumar Garg
- Department of Medicine and Endocrinology, All India Institute of Medical Sciences, Jodhpur, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
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Chaudhary M, Midha NK, Sukhadiya P, Kumar D, Garg MK. Metformin-Induced Chronic Diarrhea Misdiagnosed as Irritable Bowel Syndrome for Years. Cureus 2024; 16:e56828. [PMID: 38654785 PMCID: PMC11037500 DOI: 10.7759/cureus.56828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Metformin is the most prescribed and recommended drug for type 2 diabetes mellitus because of its better tolerability, pleiotropic benefits, and cost-effectiveness. Metformin inhibits hepatic glucose production and increases muscle glucose uptake. Metformin is also associated with gastrointestinal side effects like abdominal bloating, flatulence, diarrhea, nausea, and vomiting. Metformin-related gastrointestinal side effects are mainly due to alteration in gut microbiota, raised intestinal glucose, and increased ileal bile salt reabsorption. We report a case of a 62-year-old diabetic patient who presented with chronic diarrhea with a weight loss of 6 kg from the last six years after initiation of metformin. He underwent multiple investigations and was finally misdiagnosed with irritable bowel syndrome for years. After discontinuation of metformin, there was a significant improvement in gastrointestinal symptoms. Our case highlights the importance of metformin-induced chronic diarrhea if no other causes for the diarrhea are obvious in patients with type 2 diabetes taking metformin. Consideration of this potential side effect of metformin must be valuable to avoid unwarranted investigations, additional drug therapy, and annoyance of the patients.
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Affiliation(s)
- Monika Chaudhary
- General Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Naresh K Midha
- General Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Pankaj Sukhadiya
- General Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Deepak Kumar
- General Medicine, All India Institute of Medical Sciences, Jodhpur, IND
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Tomo S, Kiran Kumar PVSN, Yadav D, Sankanagoudar S, Charan J, Purohit A, Nag VL, Bhatia PK, Singh K, Dutt N, Garg MK, Misra S, Sharma P, Purohit P. Association of Serum Complement C3 Levels with Severity and Mortality in COVID 19. Indian J Clin Biochem 2023; 38:447-456. [PMID: 37746543 PMCID: PMC10516839 DOI: 10.1007/s12291-023-01148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/25/2023] [Indexed: 09/26/2023]
Abstract
The severe acute respiratory distress syndrome-associated coronavirus-2 infection can activate innate and adaptive immune responses which may lead to harmful tissue damage, both locally and systemically. C3, a member of complement system of serum proteins, is a major component of innate immune and inflammatory responses. This study is aimed to assess serum C3 as a marker of COVID-19 severity and a predictor of disease progression. A total of 150 COVID-19 patients, confirmed by RT-PCR, and 50 healthy controls were recruited. Serum C3 levels were determined by using direct colorimetric method. Median levels of serum C3 in total cases and controls were 157.8 and 165.7 mg/dL respectively. Serum C3 although not significantly decreased, they were lower in cases when compared to controls. Similarly, significant differences were found between the groups, with severe group (140.6 mg/dL) having low levels of serum C3 protein when compared to mild (161.0 mg/dL) and moderate group (167.1 mg/dL). Interestingly, during hospitalization, significant difference between baseline (admission) and follow-up (discharge) was observed only in patients with moderate disease. Based on our results, lower levels of C3, with an increase in IL-6 and d-dimer levels, are associated with higher odds of mortality. Therefore, we would like to emphasize that measuring serum C3 levels along with other inflammatory markers might give an added advantage in early identification of patients who are prone to having a severe disease course and can help in a more effective follow-up of disease progression. Supplementary Information The online version contains supplementary material available at 10.1007/s12291-023-01148-x.
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Affiliation(s)
- Sojit Tomo
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS) Jodhpur, Basni Phase 2, Jodhpur, Rajasthan 342005 India
| | - PVSN Kiran Kumar
- Department of Biochemistry, Andhra Medical College, Visakhapatnam, India
| | - Dharamveer Yadav
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS) Jodhpur, Basni Phase 2, Jodhpur, Rajasthan 342005 India
| | - Shrimanjunath Sankanagoudar
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS) Jodhpur, Basni Phase 2, Jodhpur, Rajasthan 342005 India
| | - Jayakaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhishek Purohit
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pradeep Kumar Bhatia
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS) Jodhpur, Basni Phase 2, Jodhpur, Rajasthan 342005 India
| | - Purvi Purohit
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS) Jodhpur, Basni Phase 2, Jodhpur, Rajasthan 342005 India
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Lubin J, Haynes-Lewis H, Viswanathan S, Xie X, Kamara A, Tang J, Kalnicki S, Jariwala S, Garg MK, Klein J. Assessment of Electronic Health Literacy among Patients in an Urban, Academic Radiation Therapy Department. Int J Radiat Oncol Biol Phys 2023; 117:e39. [PMID: 37785310 DOI: 10.1016/j.ijrobp.2023.06.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The COVID-19 pandemic dramatically affected health outcomes and healthcare access, especially with the abrupt transition to virtual care. Cancer patients in the New York City borough of the Bronx, a potentially marginalized community with high rates of poverty and non-English speakers, may be particularly vulnerable to healthcare disparities, given their advanced age and possible difficulty navigating telemedicine appointments due to decreased electronic health literacy (EHL). We investigated EHL levels using both subjective and objective measures and associated predictors of EHL in patients within an academic, urban radiation oncology department. MATERIALS/METHODS We conducted a prospective IRB-approved study of patients aged ≥18 presenting for care in our department. Patients' internet access and established habits were surveyed via Health Information National Trends Survey (HINTS). Subjective EHL, self-reported comfort using the internet for health information, was assessed via the eHealth Literacy Scale (eHEALS), which calculates a score by adding participants' answers for 8 questions (each on a 1 to 5-point Likert scale). Subjective EHL was categorized as low (8-23), moderate (24-31), or good (32-40). Objective EHL was determined by the eHealth Literacy Objective Scale (eHeLiOS), which tests responses to 9 common scenarios on gathering and assessing electronic health information via multiple-choice questions. The numbers of correct answers were totaled and categorized into low (1-4), moderate (5-7), or good (8-9) EHL. RESULTS Patients were enrolled between December 2020 and December 2022. 56 patients completed the subjective eHEALS assessment, while 49 completed the eHeLiOS objective test. 52% and 27% of patients identified as Black and Hispanic, respectively; 66% were male, and the median age was 67 (range 28-86). 76% reported accessing the internet regularly, of which 92% reported doing so via broadband network. The prevalence of good EHL was 10% using objective and 29% using subjective surveys. Using a proportional odds logistic model, only age was associated with EHL. For every increased year of age, there was an 11% decrease in objective (OR 0.89, p = 0.02) and 5% decrease in subjective (OR 0.95, p = 0.08) EHL odds, respectively. Gender, race/ethnicity, income, insurance, and employment status were not significantly associated with EHL. CONCLUSION Few study patients, who represent an older and potentially marginalized population, showed good EHL levels; more perceived good EHL via subjective testing than we observed using our objective measure. These data suggest implementation of an objective EHL assessment would aid in identifying patients who may benefit from learning activities to improve EHL and support to navigate telehealth visits effectively. Further research is needed to optimize telemedicine strategies for older cancer patients with low EHL.
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Affiliation(s)
- J Lubin
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - H Haynes-Lewis
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - S Viswanathan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - X Xie
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - A Kamara
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - J Tang
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - S Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - S Jariwala
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - M K Garg
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - J Klein
- Department of Radiation Oncology, State University of New York (SUNY) Downstate Medical Sciences University and Maimonides Medical Center, Brooklyn, NY
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Yaparpalvi R, Mynampati DK, Garg MK, Tome WA. Clinical Experience with Commissioning a GRID Collimator for Spatially Fractionated Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e741. [PMID: 37786152 DOI: 10.1016/j.ijrobp.2023.06.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In this study, we report our physics commissioning experience for clinically implementing a GRID collimator based Spatially Fractionated Radiation Therapy (SFRT). MATERIALS/METHODS For SFRT commissioning, we utilized a commercially available brass GRID collimator (DotDecimal, Sanford, FL) that is mounted on a blocking tray for positioning into the accessory mount of the Linac. The brass GRID is 7.62 cm thick and weighs 15.8 kg. The GRID has a total of 149 divergent holes arranged in a hexagonal pattern (1.43 cm in diameter and hole-centers spaced at 2.11 cm when projected at the isocenter distance). The GRID encompasses a maximum field size of 25 × 25 cm at the isocenter. A commercial 48 × 48 × 48 cm water phantom scanning system was used to collect GRID output factors (GRID field to open field ratio), depth dose and beam profile data. Output measurements were performed using a 0.13 cm3 active volume ion-chamber and beam scans were obtained with a diode detector. Data was collected for both flattening and flattening-free beams of nominal energies 6 MV and 10 MV photons. The measurement depths were at dmax (1.5 cm for 6 MV and 2.5 cm for 10 MV), 5-cm and 10-cm respectively. For each energy and depth of measurement, collimator settings were varied from 5 × 5 cm to 28 × 28 cm. From scan profiles at different depths, the valley (lowest) to peak (highest) dose ratios (VPDR) were calculated. A commercial treatment planning system (TPS) was used to test the accuracy of dose calculations with GRID. This was accomplished by importing vendor generated DICOM RT file into the TPS. A block transmission factor of 7% for 6 MV and 10.2% for 10 MV energy beams were applied. All measured data were compared with corresponding TPS calculated data. Test patient treatment plans with GRID were created in TPS and planned distributions were verified using a commercial detector array with 2.5 mm detector spacing. RESULTS The VPDR, expressed as %, are presented in Table 1. Measured and TPS calculated output factors agreed within 2% for 6 MV and within 3% for 10 MV photon beams. Percent depth doses were lower in magnitude for GRID field compared to open field for all energies studied (for e.g., 6 MV depth dose at 10 cm depth for 10 cm x10cm field 62% for GRID field vs. 66% for open field). Measured and calculated GRID beam profiles agreed within 5% dose difference and 1 mm distance-to agreement. For all test cases, the planned vs. measured dose distributions passed at an average gamma passing rate of 96.5% using a 3% dose difference/ 3 mm distance to agreement and 10% threshold criteria. CONCLUSION The Dot Decimal GRID collimator provides a simple way of achieving SFRT in the clinic, albeit heavy to use and has an irradiation field size limitation of 25 cm × 25 cm.
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Affiliation(s)
- R Yaparpalvi
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | - M K Garg
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - W A Tome
- Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY
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Meena DS, Kumar D, Meena V, Bohra GK, Tak V, Garg MK. Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review. Trop Med Health 2023; 51:54. [PMID: 37749661 PMCID: PMC10518932 DOI: 10.1186/s41182-023-00546-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND CNS manifestations represent an emerging facet of NTM infection with significant mortality. Due to protean presentation and low index of suspicion, many cases are often treated erroneously as tubercular meningitis or fungal infections. OBJECTIVES Literature on NTM CNS disease is scarce, with most available data on pulmonary disease. This systematic review aimed to evaluate the epidemiology, clinical presentation, diagnostic modalities, and predictors of outcome in CNS NTM infection. METHODS The literature search was performed in major electronic databases (PubMed, Google Scholar, and Scopus) using keywords "CNS," "Central nervous system," "brain abscess," "meningitis," "spinal," "Nontuberculous mycobacteria," "NTM". All cases of CNS NTM infection reported between January 1980 and December 2022 were included. RESULTS A total of 77 studies (112 cases) were included in the final analysis. The mean age of all patients was 38 years, with most patients male (62.5%). Mycobacterium avium complex (MAC) was the most common aetiology, followed by M. fortuitum and M. abscessus (34.8%, 21.4% and 15.2%, respectively). The disseminated disease was found in 33% of cases. HIV (33.9%) and neurosurgical hardware (22.3%) were the common risk factors. Intracranial abscess (36.6%) and leptomeningeal enhancement (28%) were the most prevalent findings in neuroimaging. The overall case fatality rate was 37.5%. On multivariate analysis, male gender (adjusted OR 2.4, 95% CI 1.2-7.9) and HIV (adjusted OR 3.7, 95% CI 1.8-6.1) were the independent predictors of mortality). M. fortuitum infection was significantly associated with increased survival (adjusted OR 0.18, 95% CI (0.08-0.45), p value 0.012). CONCLUSIONS Current evidence shows the emerging role of rapid-grower NTM in CNS disease. Male gender and HIV positivity were associated with significant mortality, while M fortuitum carries favourable outcomes.
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Affiliation(s)
- Durga Shankar Meena
- Department of Internal Medicine (Division of Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India.
| | - Deepak Kumar
- Department of Internal Medicine (Division of Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Vasudha Meena
- Department of Pediatrics, Dr. S.N. Medical College, Jodhpur, 342005, India
| | - Gopal Krishana Bohra
- Department of Internal Medicine (Division of Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Mahendra Kumar Garg
- Department of Internal Medicine (Division of Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India
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Meena M, Khichar S, Pawar A, Midha N, Kumar S, Purohit A, Bohra GK, Garg MK, Singhai A. Iron Deficiency Anemia Presenting With Pancytopenia: A Study From India. Cureus 2023; 15:e45034. [PMID: 37829950 PMCID: PMC10566395 DOI: 10.7759/cureus.45034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. IDA is commonly associated with thrombocytosis and normal or slightly decreased leukocyte count. Sometimes it can present with thrombocytopenia, but rarely present with pancytopenia. Here we are presenting six cases of severe iron deficiency presenting with pancytopenia, which responded to iron replenishment. METHODS This 12-month observational study was conducted in the Department of General Medicine at a tertiary care Centre in India. All cases of pancytopenia (after exclusion of other causes) with IDA were included. IDA was established with the help of a complete blood count (CBC), peripheral smear examination, serum iron studies, and serum ferritin. Results: In our study, CBC at four weeks later of iron transfusion without other supplementation showed significant improvement in hematological parameters. CONCLUSION Severe iron deficiency is a reversible etiology of pancytopenia. It should be kept as a differential diagnosis of pancytopenia if common causes of pancytopenia are ruled out.
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Affiliation(s)
- Mahadev Meena
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Satyendra Khichar
- General Medicine, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Akash Pawar
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Naresh Midha
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Saurabh Kumar
- Neurology, King George's Medical University (KGMU), Lucknow, IND
| | - Abhishek Purohit
- Pathology and Hematopathology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Gopal K Bohra
- General Medicine, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Mahendra Kumar Garg
- General Medicine, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Abhishek Singhai
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Vihari N, Bohra GK, Yadev RR, Kumar D, Meena DS, Tak V, Sharma A, Nag V, Garg MK. The emergence of multidrug-resistant Gram-positive bloodstream infections in India - a single center prospective cohort study. Germs 2023; 13:229-237. [PMID: 38146377 PMCID: PMC10748842 DOI: 10.18683/germs.2023.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/19/2023] [Accepted: 08/05/2023] [Indexed: 12/27/2023]
Abstract
Introduction Gram-positive bloodstream infections (BSIs) are an emerging health concern, especially in resource-limited settings. There is a paucity of data regarding the antimicrobial resistance (AMR) pattern of Gram-positive BSIs. The rise in multidrug-resistant infections further convoluted antibiotic selection. We aimed to assess the incidence, clinical and microbiological profile, antimicrobial resistance (AMR) and outcome in Gram-positive BSIs. Methods This was a single-center prospective study conducted at a tertiary care hospital in Western India. All patients (age ≥18 years) with culture-proven Gram-positive BSIs were included. Data were collected on all patients' demography, risk factors, AMR and clinical outcome. Results A total of 210 clinically significant isolates were grown from July 2020 to December 2021. The incidence of Gram-positive BSIs was 29% (n=61); 55.9% of cases were healthcare-associated, while 44.1% were community-acquired. Coagulase-negative staphylococci (CoNS) were the major isolates (36.1%), followed by Enterococcus spp. (27.9%), methicillin-susceptible Staphylococcus aureus (MSSA) (18%) and methicillin-resistant Staphylococcus aureus (MRSA) (14.7%). The proportion of vancomycin and teicoplanin-resistant CoNS isolates was 13.6% and 19%. Among Enterococcus isolates, the proportion of vancomycin-resistant enterococci (VRE) and linezolid-resistant enterococci (LRE) were 11.8% and 5.9%. The overall mortality in Gram-positive BSIs was 42.6%. Older age, MRSA infection, septic shock, and high NLR were significantly associated with mortality. On the Cox regression model, age ≥65 years (HR: 2.5; 95%CI: 1.1-5.8; p=0.024) and MRSA infection (HR: 3.6; 95%CI: 1.5-8.5; p=0.021) were found as independent predictors of 30-day mortality. Conclusions This study found substantial mortality with Gram-positive BSIs, especially MRSA infections. Moreover, the emergence of VRE and LRE is also alarming. Active surveillance of AMR and evaluation of mortality predictors may help overcome the therapeutic challenges in managing BSIs.
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Affiliation(s)
- Nakka Vihari
- MD, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Gopal Krishana Bohra
- MD, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Ram Ratan Yadev
- MS, Department of General Surgery, S.K. Medical College, Sikar, India
| | - Deepak Kumar
- MD, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Durga Shankar Meena
- MD, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Vibhor Tak
- MD, Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Ankur Sharma
- MD, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Vijaylaxmi Nag
- MD, Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- DM, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
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P N, Kumar D, Meena DS, R NT, Bohra GK, Tak V, Sharma A, Midha NK, Garg MK. Difficult-to-treat resistant gram-negative blood stream infections - the beginning of a superbug era - a prospective observational study. Indian J Med Microbiol 2023; 44:100364. [PMID: 37356828 DOI: 10.1016/j.ijmmb.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/22/2023] [Accepted: 02/19/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Carbapenem resistant gram-negative bacterial infections are a growing concern worldwide. However, India is already in the era of a shortage of effective antibiotics for the management of these infections. Moreover, Difficult-to-Treat Resistance (DTR) gram-negative infections, which are not much studied, further complicate the scenario. This study emphasized the incidence and outcomes of DTR infections. METHODOLOGY This is a single-center prospective observational study. The study included hospitalised patients aged ≥18 years with gram-negative bacterial bloodstream infections (GNBSI). Blood cultures with the growth of contaminants and/or single positive culture taken from the femoral site were excluded. Incidences of DTR infections and outcomes in the form of 30-day mortality were analysed. RESULTS Two hundred forty patients with GNBSI episodes were recorded. The Incidence of DTR GNBSI was 37.9% (91/240). Multivariate analysis found that Hospital-acquired infections, ICU admission and mechanical ventilation were independent risk factors for DTR GNBSI. The most common DTR GNB isolates were Klebsiella pneumoniae (31/49, 63.3%) and Acinetobacter baumannii (26/52, 50%). The adjusted relative risk of mortality was remarkably high in DTR GNBSI (aRR 3.9; 95% CI 1.9-7.9) as compared to CR+/DTR- GNBSI (aRR 0.3; 95% CI 0.1-1.0) and ESCR/CS GNBSI (aRR 1.1; 95% CI 0.5-2.4). CONCLUSION DTR GNB infections are growing concern in India and this need to be evaluated in multicentric studies. Moreover, DTR GNBSI was associated with significantly higher mortality and there is need of further empowerment of antibiotic stewardship practices.
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Affiliation(s)
- Naveenraj P
- Department of General Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Deepak Kumar
- Department of General Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Durga Shankar Meena
- Department of General Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Neetha T R
- Department of General Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Gopal Krishana Bohra
- Department of General Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Ankur Sharma
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Naresh Kumar Midha
- Department of General Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Mahendra Kumar Garg
- Department of General Medicine and Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
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Shadrach BJ, Dutt N, Elhence P, Banerjee M, Chauhan NK, Jalandra RN, Garg MK, Garg P, Tandon A, Shishir S, Kochar R, Chhatwani B, Pareek P, Parrikar A. Clinical Utility of Bronchoalveolar Lavage Neutrophilia and Biomarkers for Evaluating Severity of Chronic Fibrosing Interstitial Lung Diseases. Cureus 2023; 15:e42162. [PMID: 37602059 PMCID: PMC10439013 DOI: 10.7759/cureus.42162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction It is hypothesized that bronchoalveolar lavage (BAL) neutrophilia, Krebs von den Lungen-6 (KL-6), and C-reactive protein (CRP) predict the severity of chronic fibrosing interstitial lung diseases (CF-ILDs). Methods This cross-sectional study enrolled 30 CF-ILD patients. Using Pearson's correlation analysis, BAL neutrophils, KL-6, and CRP were correlated with forced vital capacity (FVC), diffusing lung capacity for carbon monoxide (DLCO), six-minute walk distance (6MWD), partial pressure of oxygen (PaO2), computed tomography fibrosis score (CTFS), and pulmonary artery systolic pressure (PASP). Using the receiver operator characteristic (ROC) curve, BAL KL-6 and CRP were evaluated against FVC% and DLCO% in isolation and combination with BAL neutrophilia for predicting the severity of CF-ILDs. Results BAL neutrophilia significantly correlated only with FVC% (r = -0.38, P = 0.04) and DLCO% (r = -0.43, P = 0.03). BAL KL-6 showed a good correlation with FVC% (r = -0.44, P < 0.05) and DLCO% (r = -0.50, P = 0.02), while BAL CRP poorly correlated with all parameters (r = 0.0-0.2). Subset analysis of BAL CRP in patients with CTFS ≤ 15 showed a better association with FVC% (r = -0.28, P = 0.05) and DLCO% (r = -0.36, P = 0.04). BAL KL-6 cut-off ≥ 72.32 U/ml and BAL CRP ≥ 14.55 mg/L predicted severe disease with area under the curve (AUC) values of 0.77 and 0.71, respectively. The combination of BAL neutrophilia, KL-6, and CRP predicted severity with an AUC value of 0.89. Conclusion The combination of BAL neutrophilia, KL-6, and CRP facilitates the severity stratification of CF-ILDs complementing existing severity parameters.
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Affiliation(s)
- Benhur Joel Shadrach
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Poonam Elhence
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, IND
| | - Nishant Kumar Chauhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Ram N Jalandra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bathinda, IND
| | - Mahendra Kumar Garg
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Pawan Garg
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Abhishek Tandon
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Saumya Shishir
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Rishabh Kochar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Bhavesh Chhatwani
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Piyush Pareek
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Anika Parrikar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, IND
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Meena DS, Kumar D, Sharma M, Malik M, Ravindra A, Santhanam N, Bohra GK, Garg MK. The epidemiology, clinical presentation and treatment outcomes in CNS actinomycosis: a systematic review of reported cases. Orphanet J Rare Dis 2023; 18:133. [PMID: 37269006 DOI: 10.1186/s13023-023-02744-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND CNS actinomycosis is a rare chronic suppurative infection with non-specific clinical features. Diagnosis is difficult due to its similarity to malignancy, nocardiosis and other granulomatous diseases. This systematic review aimed to evaluate the epidemiology, clinical characteristics, diagnostic modalities and treatment outcomes in CNS actinomycosis. METHODS The major electronic databases (PubMed, Google Scholar, and Scopus) were searched for the literature review by using distinct keywords: "CNS" or "intracranial" or "brain abscess" or "meningitis" OR "spinal" OR "epidural abscess" and "actinomycosis." All cases with CNS actinomycosis reported between January 1988 to March 2022 were included. RESULTS A total of 118 cases of CNS disease were included in the final analysis. The mean age of patients was 44 years, and a significant proportion was male (57%). Actinomycosis israelii was the most prevalent species (41.5%), followed by Actinomyces meyeri (22.6%). Disseminated disease was found in 19.5% of cases. Most commonly involved extra-CNS organs are lung (10.2%) and abdomen (5.1%). Brain abscess (55%) followed by leptomeningeal enhancement (22%) were the most common neuroimaging findings. Culture positivity was found in nearly half of the cases (53.4%). The overall case-fatality rate was 11%. Neurological sequelae were present in 22% of the patients. On multivariate analysis, patients who underwent surgery with antimicrobials had better survival (adjusted OR 0.14, 95% CI 0.04-0.28, p value 0.039) compared to those treated with antimicrobials alone. CONCLUSION CNS actinomycosis carries significant morbidity and mortality despite its indolent nature. Early aggressive surgery, along with prolonged antimicrobial treatment is vital to improve outcomes.
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Affiliation(s)
- Durga Shankar Meena
- Department of Internal Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Deepak Kumar
- Department of Internal Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India.
| | - Mukesh Sharma
- Department of Microbiology, Dr. S.N. Medical College, Jodhpur, India
| | - Manika Malik
- Department of Internal Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Akshatha Ravindra
- Department of Internal Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - N Santhanam
- Department of Internal Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Gopal Krishana Bohra
- Department of Internal Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Mahendra Kumar Garg
- Department of Internal Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, 342005, India
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Mahajan D, Gupta MK, Mantri N, Joshi NK, Gnanasekar S, Goel AD, Srinivasan S, Gonade NM, Sharma SK, Garg MK, Bhardwaj P. Musculoskeletal disorders among doctors and nursing officers : an occupational hazard of overstrained healthcare delivery system in western Rajasthan, India. BMC Musculoskelet Disord 2023; 24:349. [PMID: 37142985 PMCID: PMC10157123 DOI: 10.1186/s12891-023-06457-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The present study was conducted to estimate the prevalence and distribution of MSDs in different anatomical regions among Doctors and NO and to determine their ergonomic risk factors and predictors. METHODS This cross-sectional study was conducted in an apex institution in Western India. The socio-demographic information, medical and occupational history, and other personal and work-related attributes were captured using a semi-structured questionnaire, which was developed and finalized by piloting on 32 participants (who were not part of the study). Nordic Musculoskeletal and International Physical Activity Questionnaires were used to assess MSDs and Physical activity. Data were analyzed using SPSS v.23. Prevalence of Musculoskeletal Symptoms (M.S.), Multisite Musculoskeletal Symptoms (MMS), and Widespread Musculoskeletal Symptoms (WMS) were calculated. A comparison was made to estimate the burden and distribution of MSD among Doctors and Nursing officers. Logistic regression was applied to identify the predictors of MSDs and pinpoint the risk factors associated with MSDs. RESULTS A total of 310 participants, of which 38.7% were doctors, and 61.3% were Nursing Officers (NOs) were included in the study. The mean age of the respondents was 31.63 ± 4.9 years. Almost 73% (95%CI: 67.9-78.1) of participants had MSD in the last 12 months, with approximately 41.6% (95%CI: 36.1-47.3) suffering from MSDs in the previous seven days of the survey. The lower back (49.7%) and the neck (36.5%) were the most affected sites. Working in the same position for a long time (43.5%) and not taking adequate breaks (31.3%) were the highest self-reported risk factors. Females had significantly higher odds of having pain in the upper back [aOR:2.49(1.27-4.85)], neck [aOR:2.15(1.22-3.77)], shoulder [aOR:2.8 (1.54-5.11)], hips [aOR:9.46 (3.95-22.68)] and knee [aOR:3.8(1.99-7.26)]. CONCLUSIONS Females, who are NOs, work for > 48 h per week, and fall in the obese category were significantly at more risk of developing MSDs. Working in an awkward position, treating an excessive number of patients in a day, working in the same position for a long period, performing repeated tasks, and not having enough rest breaks were significant risk factors for MSDs.
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Affiliation(s)
- Diksha Mahajan
- School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Manoj Kumar Gupta
- School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India.
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India.
| | - Neha Mantri
- School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Nitin Kumar Joshi
- School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Sridevi Gnanasekar
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Akhil Dhanesh Goel
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Srikanth Srinivasan
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Nitesh Manohar Gonade
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Suresh Kumar Sharma
- Department of Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Mahendra Kumar Garg
- School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Pankaj Bhardwaj
- School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
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Anne PB, Gupta A, Misra S, Sharma SK, Garg MK, Bajpayee A, Bundas S, Bohra M, Asirvatham V. Economic Evaluation of Nucleic Acid Testing for Screening of Blood Donations for Thalassemia Patients (ECONAT) in Western India. Indian J Hematol Blood Transfus 2023; 39:317-324. [PMID: 37006984 PMCID: PMC10064373 DOI: 10.1007/s12288-022-01564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Transfusion Transmitted infections(TTI) are of significant concern for blood safety. The thalassemia patients who receive multiple transfusions are at an increased risk of TTIs and the Nucleic Acid Test (NAT ) has been advocated for safe blood. Though NAT can reduce the window period compared to serology, cost is a constraint. Methods The thalassemia patient and NAT yield data from the centralized NAT lab in AIIMS Jodhpur was evaluated for cost-effectiveness using the Markov model. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the difference between the cost for NAT and the cost of medical management of TTI-related complications by the product of the difference in utility value of a TTI health state with time and Gross National Income(GNI) per capita. Results Out of the 48,762 samples tested by NAT, 43 samples were discriminated NAT yield all of which were reactive for Hepatitis B (NAT yield of 1:1134). There was no HCV and HIV NAT yield despite HCV being the most prevalent TTI in this population. The cost of this intervention was INR 5,85,14,400. The number of lifetime QALY saved was 1.38 years. The cost of medical management is INR 82,19,114. Therefore the ICER for intervention is INR 3,64,45,860 per QALY saved which is 274 times the GNI per capita of India. Conclusions The provision of IDNAT-tested blood for thalassemia patients in Rajasthan state was not found to be cost-effective. Measures to bring down the cost or alternative options to increase blood safety should be explored.
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Affiliation(s)
- Puneeth Babu Anne
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Anubhav Gupta
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Sanjeev Misra
- All India Institute of Medical Sciences, 342005 Jodhpur, India
| | | | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Archana Bajpayee
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Sunita Bundas
- Department of Immunohematology and Transfusion Medicine, S.M.S. Medical college, 302004 Jaipur, India
| | - Manju Bohra
- Department of Immunohematology and Transfusion Medicine, Dr. S. N. Medical College, 342003 Jodhpur, India
| | - Vasanth Asirvatham
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
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15
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Sukhadiya P, Kumar P, Meena DS, Kumar P H A, Vijayan N, Garg P, Garg MK. Unmasking of systemic lupus erythematosus in a patient with hemophagocytic lymphohistiocytosis- macrophage activation syndrome (HLA-MAS) and diffuse alveolar hemorrhage. Reumatismo 2023; 74. [PMID: 36942984 DOI: 10.4081/reumatismo.2022.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 01/01/2023] [Indexed: 03/23/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome caused by macrophages and cytotoxic T cells with aberrant activation. The primary (genetic) form, which is caused by mutations that affect lymphocyte cytotoxicity and immune regulation, is most prevalent in children, whereas the secondary (acquired) form is prevalent in adults. Secondary HLH is commonly caused by infections or cancers, but it can also be caused by autoimmune disorders, in which case it is known as macrophage activation syndrome (MAS; or MAS-HLH). A 25-year-old female presented with a high-grade fever that lasted for two weeks. His laboratory results revealed pancytopenia, neutropenia, hypertriglyceridemia, hypofibrinogenemia, and hyperferritinemia. Based on the clinical presentation and laboratory findings, a provisional diagnosis of HLH has been made. A HLH protocol was utilized to treat the patient. During the course of hospitalization, systemic lupus erythematosus (SLE) was identified as the underlying cause. She improved dramatically after receiving an immunosuppressive regimen of etoposide, cyclosporine, and dexamethasone according to HLH protocol-2004 with individualized modifications. The clinician should be aware that HLH may be the initial manifestation of underlying SLE. Early diagnosis and aggressive, individualized treatment are the key to improving outcomes.
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Affiliation(s)
- P Sukhadiya
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - P Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - D S Meena
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - A Kumar P H
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - N Vijayan
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - P Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur.
| | - M K Garg
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur.
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Shekhawat J, Kumar D, Bhardwaj P, Meena DS, Garg MK. Trends and Pattern of Diseases Under Integrated Disease Surveillance Project in Jodhpur, Rajasthan: A Retrospective Observational Study. Indian J Community Med 2023; 48:321-325. [PMID: 37323727 PMCID: PMC10263029 DOI: 10.4103/ijcm.ijcm_334_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 02/09/2023] [Indexed: 06/17/2023] Open
Abstract
Background Progress of the Integrated Disease Surveillance (IDSP) is of utmost importance to ensure optimal performance in Jodhpur, Rajasthan, India. The purpose of the study was to document the physical performance of the surveillance system on its core and support functions. Material and Methods Mixed method study was conducted between September 2020 to October 2020. Quantitative data was collected from the district IDSP unit of the Chief Medical and Health Office (CMHO) for various blocks of Rajasthan using syndromic, presumptive, and laboratory-confirmed reporting formats. Ethical clearance was obtained from the Institutional Ethical Committee of AIIMS, Jodhpur. Results Rajasthan reported outbreaks between 0.55 to 1.2% of the national average between 2015-2019. Acute respiratory infections, fever of unknown origin, and acute diarrhea were the leading diseases under the presumptive reporting format. Major syndromic cases reported were cough with/without fever (more than three weeks) and fever less than seven days with the rash. Laboratory-confirmed Dengue, Malaria, and hepatitis were reported more in urban Jodhpur. Conclusion Despite some pitfalls, IDSP has made satisfactory improvements in its core and support functions in the Jodhpur district of Rajasthan. The number of preventable morbidity and mortality cases associated with notifiable infectious diseases in our country can be effectively countered by strengthening the IDSP reporting system.
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Affiliation(s)
| | - Deepak Kumar
- General Medicine, AIIMS, Jodhpur, Rajasthan, India
| | - Pankaj Bhardwaj
- Community Medicine and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
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Samantaray S, Kumar D, Meena DS, Bohra GK, Akshatha R, Jain V, Tiwari S, Balamurugan T, Midha N, Garg MK. Invasive Cerebral Aspergillosis in Non-Neutropenic Patients: A Case Series from Western India. J Mycol Med 2023; 33:101380. [PMID: 37031499 DOI: 10.1016/j.mycmed.2023.101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/01/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Invasive cerebral aspergillosis (ICA) is a rare but fatal infection affecting neutropenic immunocompromised patients. Recently cases have been reported in non-neutropenic settings also. We hereby present a series of ICA cases in non-neutropenic patients diagnosed at our tertiary care centre in Western India between March to October 2021. METHODS All patients with clinico-radiological suspicion of CNS infections were analysed. Data regarding Clinico-radiological features, diagnosis, treatment and outcome were collected. After ruling out bacterial, viral and mycobacterial causes, appropriate samples were sent for KOH (potassium hydroxide) wet mount, fungal culture, histopathology and serum/CSF galactomannan. RESULTS A total of four patients were diagnosed with ICA with a mean age of 43.5 years. Three patients had significant comorbidities; Diabetes mellitus, chronic liver disease and COVID-19 pneumonia treated with dexamethasone, respectively. One patient had no known predisposing factor. Radiologically, one patient presented with a frontal brain abscess and two patients had multiple subcortical hyperintensities. Three patients were diagnosed based on CSF galactomannan (Platelia™ Aspergillus antigen, Bio-Rad, France) with OD >1 and one patient had high serum galactomannan (OD >2). CSF culture grew Aspergillus species in two patients. All patients were treated with Voriconazole. One patient recovered, and the remaining three succumbed due to delayed presentation and extensive cerebral involvement. CONCLUSION Even in non-neutropenic patients, a high index of suspicion is warranted for cerebral aspergillosis. CSF galactomannan can be considered a reliable marker for diagnosing ICA in non-neutropenic settings. Early diagnosis allows timely antifungal therapy, which could be a key to improving the outcomes.
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Affiliation(s)
- Subhashree Samantaray
- Department of General Medicine (Infectious diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Kumar
- Department of General Medicine (Infectious diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Durga Shankar Meena
- Department of General Medicine (Infectious diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gopal Krishana Bohra
- Department of General Medicine (Infectious diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - R Akshatha
- Department of General Medicine (Infectious diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - T Balamurugan
- Department of Pathology and lab medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naresh Midha
- Department of General Medicine (Infectious diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Kumar Garg
- Department of General Medicine (Infectious diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Sharma S, Samantaray S, Kumar D, Meena DS, Chaudhary R, Jain V, Bohra GK, Garg MK. Prosthetic valve endocarditis due to Candida parapsilosis - a rare case report. Access Microbiol 2023; 5:000462.v4. [PMID: 36911424 PMCID: PMC9996159 DOI: 10.1099/acmi.0.000462.v4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 12/06/2022] [Indexed: 01/26/2023] Open
Abstract
Fungal endocarditis is a rare and fatal condition, most frequently caused by species of the genera Candida and Aspergillus. Fever and changing heart murmur are the most common clinical manifestations. The diagnosis of fungal endocarditis is challenging, with prosthetic valve endocarditis being extremely difficult to diagnose. The optimal management of the condition still remains debatable. We present a case of prosthetic valve endocarditis caused by Candida parapsilosis, managed empirically with liposomal amphotericin B, which was later shifted to combination therapy with high-dose echinocandin and fluconazole, but had a fatal outcome because the patient could not undergo timely surgical intervention. Treating C. parapsilosis endocarditis cases is difficult because of their biofilm production on native and prosthetic heart valves. A combined approach consisting of a high index of clinical suspicion, early diagnosis using serological markers followed by culture or PCR and prompt initiation of appropriate antifungals may aid in improving outcomes.
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Affiliation(s)
- Shivang Sharma
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Subhashree Samantaray
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Kumar
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Durga Shankar Meena
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Chaudhary
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gopal Krishana Bohra
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Kumar Garg
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Pvsn KK, Tomo S, Purohit P, Sankanagoudar S, Charan J, Purohit A, Nag V, Bhatia P, Singh K, Dutt N, Garg MK, Sharma P, Misra S, Yadav D. Comparative Analysis of Serum Zinc, Copper and Magnesium Level and Their Relations in Association with Severity and Mortality in SARS-CoV-2 Patients. Biol Trace Elem Res 2023; 201:23-30. [PMID: 35064475 PMCID: PMC8782674 DOI: 10.1007/s12011-022-03124-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/17/2022] [Indexed: 01/11/2023]
Abstract
The deficiencies of trace elements and infectious diseases often coexist and exhibit complex interactions. Several trace elements such as zinc (Zn), copper (Cu) and magnesium (Mg) have immunomodulatory functions and thus influence the susceptibility to the course and outcome of a variety of viral infections. So, this present study was aimed to study relations of trace metals in association with severity and mortality in SARS-CoV-2 patients. A total of 150 individuals infected with COVID-19 and 50 healthy individuals were recruited. Cases were divided based on severity (mild, moderate and severe) and outcome (discharged or deceased). Serum Zn, Mg and Cu levels were analysed by direct colourimetric method. Both serum Cu and Zn levels were significantly decreased in cases when compared to those in controls (p < 0.005 and p < 0.0001). Serum magnesium levels although not significant were found to be slightly decreased in controls. On comparing the trace elements between the deceased and discharged cases, a significant difference was found between serum copper and zinc levels, but for magnesium, both groups have similar levels. The receiver operating characteristic (ROC) curve results indicate that a serum Cu/Zn ratio along with the age of patient provides some reliable information on COVID-19 course and survival odds by yielding an AUC of 95.1% with a sensitivity of 93.8% and specificity of 89.8%. Therefore, we would like to emphasize that measuring the serum copper and zinc along with their ratio can be used as routine investigations for COVID-19 patients in proper identification and management of severe cases in upcoming new waves of COVID-19.
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Affiliation(s)
- Kiran Kumar Pvsn
- Department of Biochemistry, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, 342005, India
| | - Sojit Tomo
- Department of Biochemistry, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, 342005, India
| | - Purvi Purohit
- Department of Biochemistry, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, 342005, India
| | - Shrimanjunath Sankanagoudar
- Department of Biochemistry, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, 342005, India
| | - Jayakaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhishek Purohit
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vijaylakshami Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pradeep Bhatia
- Department of Anaesthesia, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, 342005, India
| | - Sanjeev Misra
- Department of Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Dharamveer Yadav
- Department of Biochemistry, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, 342005, India.
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Sharma D, Rohila A, Deora S, Garg MK, Misra S. Cardiac assessment of patients during post COVID-19 recovery phase: a prospective observational study. Glob Cardiol Sci Pract 2022; 2022:e202218. [PMID: 36660166 PMCID: PMC9840129 DOI: 10.21542/gcsp.2022.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It usually presents as a respiratory syndrome but also known to cause many cardiovascular complications during acute phase. However, little is documented about cardiac complications during the post COVID-19 recovery phase. Therefore, this prospective observational study was planned to evaluate cardiovascular effects of the disease in patients recovering from COVID-19. Methods: This was a prospective observational study with a total of 63 patients presenting at 6-month follow-up in post COVID-19 outpatient clinics. Patients with known cases of underlying ischemic heart disease, cardiomyopathy, or any other cardiac disorder, and patients with chronic lung disorder or severe anemia were excluded. Results: Dyspnea was the most common presenting complaint. In biochemical parameters, none of them showed any significant difference between these two groups including NT pro BNP, ferritin, CK-MB. But NT pro BNP was high in moderate/severe cases, especially those having reduced ejection fraction. On echocardiographic evaluation, LVEF was low in moderate/severe group patients (59.7% vs. 51.1%, p < 0.0001). LV diastolic dysfunction was also observed more commonly in moderate/severe group patients (55.9% vs. 86.2%, p = 0.009). There was no significant difference in RV function assessment parameters. Conclusion: Patients in the moderate/severe group during index hospitalization for COVID-19 should be followed up with NT Pro BNP and echocardiography. This may help in early recognition of heart failure during follow-up of COVID-19 patients.
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Affiliation(s)
- Deepak Sharma
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amit Rohila
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surender Deora
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Raj, India
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Gopalakrishnan M, Khichar S, Saurabh S, Vijayvergia P, Thangaraju K, Tripathi S, Devarakonda HV, Kumar A, Kumar PS, Garg MK. Effectiveness of early awake self proning strategy in non-intubated patients with COVID-19 hypoxemia: an open-labelled randomized clinical trial from Jodhpur, India. Monaldi Arch Chest Dis 2022; 93. [PMID: 36524853 DOI: 10.4081/monaldi.2022.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Awake self-proning is being used widely as respiratory support in COVID-19 hypoxemia, in resource-limited settings. We aimed to investigate the effectiveness of early awake self-proning in preventing mortality and the need for intubation in adults with moderate COVID-19 hypoxemia. In this randomized clinical trial with inten-tion-to-treat analysis, we enrolled eligible adults with COVID-19 hypoxemia (SpO2 <94%), requiring supplemental oxygen via nasal prongs or facemask from a tertiary-care setting in Jodhpur, India between June 15 to December 24, 2020. Awake proning comprised of 4-hour cycles with prone position maintained 2 h per cycle. The control group did not maintain any specific position. All participants received standard care. The primary outcomes were 30-day mortal-ity and requirement for mechanical ventilation. Of 502 participants included, mean (SD) age was 59.7 (12.7) years with 124 women (24.6%); 257 were randomized to awake-proning, 245 to control group and all 502 were included for follow-up mortality analysis. Mortality at follow-up was 16.3% in the awake-prone and 15.1% in the control group [OR:1.10 (0.68-1.78), p=0.703). The requirement of mechanical ventilation was 10% in both groups (p=0.974). Survival time (in days) was not significantly different between the groups [Log-rank test, HR: 1.08 (95% CI, 0.70-1.68), p=0.726]. Likewise, time to intubation was comparable (Log-rank test, HR: 0.93 (95% CI, 0.56-1.70), p=0.974). Hence, awake self-proning did not improve survival or requirement of mechanical-ventilation in non-intubated patients with mild to moderate COVID-19 hypox-emia. Trial Registration: Clinical trial registry of India, ID: CTRI/2020/06/025804. The trial is accessible from WHO's International Clinical Trials Registry Platform (ICTRP) at https://trialsearch.who.int *************************************************************** *Appendix Authors list Deepak Kumar1, Gopal Krishna Bohra1, Nishant Kumar Chauhan2, Nikhil Kothari3, Vijaya Lakshmi Nag4 Sanjeev Misra5 1Department of Internal Medicine; 2Department of Pulmonary Medicine; 3Department of Anaesthesiology and Critical Care; 4Department of Microbiology; 5Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India.
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Affiliation(s)
- Maya Gopalakrishnan
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Satyendra Khichar
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Suman Saurabh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Parag Vijayvergia
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Karthikeyan Thangaraju
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Swapnil Tripathi
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | | | - Akhilesh Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Pranav S Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Mahendra Kumar Garg
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
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Naguthevar S, Kumar D, Sharma S, ID DM, Bohra GK, Meena DS, Midha NK, Kombade SP, Jain V, Garg MK, Singh K. 340. GeneXpert Ultra for Diagnosis of Central Nervous System Tuberculosis in the High Tuberculosis Prevalence Country - A Prospective Study from India. Open Forum Infect Dis 2022. [PMCID: PMC9751834 DOI: 10.1093/ofid/ofac492.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Early diagnosis and initiation of antitubercular treatment are vital steps to reducing the impact of TB in high burden countries. The molecular method like GeneXpert has significantly improved the diagnosis of TB. GeneXpert Ultra is more sensitive to the diagnosis and helps in paucibacillary samples like cerebrospinal fluid (CSF). This study aims to provide its utility in diagnosis of central nervous system tuberculosis (CNS TB) in high TB burden geography. Methods This prospective observational study included the suspected cases of CNS TB with age ≥12 years. Patients who presented with ≥ 5 days history of CNS symptoms suggestive of tuberculosis with a lancet score of ≥ 6 on combination of clinical, CSF and imaging criteria were included in the study. Patients diagnosed with aetiology other than tuberculosis for CNS disease were excluded. CSF was analysed for GeneXpert Ultra and mycobacterial culture. The sensitivity, specificity, positive predictive value (PPV), and Negative predictive value (NPV) of GeneXpert Ultra were analysed in comparison with culture results. Results A total of 107 patients with mean age of 33.2±18.5 years were analysed. CSF mycobacterial culture was positive in 45.8% (n=49) of patients. However, Mycobacterial tuberculosis via GeneXpert Ultra was detected in 57.9% (n=62) of patients. Sensitivity, specificity, PPV and NPV for GeneXpert Ultra were found 83.7%, 63.8%, 20.4% and 97.2% respectively. According to the lancet score, 70.1% (n=75) and 29.9% (n=32) of patients had probable and possible CNS TB, respectively. Among them, definitive CNS TB were diagnosed in 65.3% (n=49) and 65.6% (n=21) patients with probable and possible CNS TB, respectively. Conclusion GeneXpert Ultra has an excellent sensitivity and negative predictive value for the diagnosis of CNS TB in CSF samples. Even with possible CNS TB according to the lancet score, it is better to consider antitubercular treatment in a high TB burden country. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
| | | | | | - D M ID
- AIIMS, Jodhpur, Rajasthan, India
| | | | | | | | | | | | - M K Garg
- AIIMS, Jodhpur, Rajasthan, India
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Naguthevar S, Kumar D, Ravindra A, Samantaray S, Kombade SP, Krishna Bohra G, Shankar Meena D, Kumar Midha N, Jain V, Garg MK, Singh K. 341. GeneXpert Ultra for the Diagnosis of Extrapulmonary Lymphnode Tuberculosis – A Diagnostic Study from High Tuberculosis Burden Country. Open Forum Infect Dis 2022. [PMCID: PMC9752163 DOI: 10.1093/ofid/ofac492.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Extrapulmonary tuberculosis (EPTB) is quite prevalent in India, ranging from 8.3% and 13.1%. Diagnosis of EPTB is often challenging as it resembles other granulomatous conditions pathologically. TB culture remains the gold standard for definitive diagnosis, but it takes longer time and WHO has recommended the use of GeneXpert Ultra for rapid diagnosis. This study aims the utility of GeneXpert Ultra for diagnosis of tubercular adenitis. Methods This prospective study included the suspected tubercular adenitis patients with lymphnode size of ≥ 20mm. Patients diagnosed with other aetiology of adenitis were excluded. Excision biopsy was performed in all patients. Tissue samples were sent for Ziehl Neelson (ZN) stain, GeneXpert Ultra, histopathology and mycobacterial culture (BACTEC). The sensitivity, specificity, positive predictive value (PPV), and Negative predictive value (NPV) of GeneXpert Ultra were analysed in comparison with culture results. Results A total of 85 patients Lymph node were included, of which 60% (n=51) had cervical LN, 15%(n=13) abdominal LN, 12%(n=11) mediastinal LN, and 15%(n=11) others. Most of the patients (97%) HPE findings of granulomatous inflammation of which only 20%(n=17) were ZN stain Positive. TB culture showed positivity of 56.47%(n=48) . Mycobacterial tuberculosis was detected in 69%(n=59) of patients by GeneXpert Ultra & none of them showed Rifampicin resistance. The Sensitivity, specificity, PPV & NPV for GeneXpert Ultra were found 85.4%, 51.3%, 25.06% and 94.8%, respectively. Conclusion GeneXpert Ultra showed excellent sensitivity and negative predictive value for the diagnosis of TB Lymphadenitis. Further this method detects Rifampin sensitivity which is crucial for initiation of appropriate antitubercular drugs. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - M K Garg
- AIIMS, Jodhpur, Rajasthan, India
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Yadav D, Pvsn KK, Tomo S, Sankanagoudar S, Charan J, Purohit A, Nag V, Bhatia P, Singh K, Dutt N, Garg MK, Sharma P, Misra S, Purohit P. Association of iron-related biomarkers with severity and mortality in COVID-19 patients. J Trace Elem Med Biol 2022; 74:127075. [PMID: 36174458 PMCID: PMC9472468 DOI: 10.1016/j.jtemb.2022.127075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nutritional deficiency is associated with weaken immune system and increased susceptibility to infection. Among other nutrients, several trace elements have been shown to regulate immune responses. Iron is one of the most abundant trace elements present in our body, which is required in various biological processes. Iron has an immunomodulatory function and thus influence the susceptibility to the course and outcome of a variety of viral infections. So, this present study was aimed to study relations of different iron-related biomarkers in association to severity and mortality in SARS-CoV-2 patients. MATERIALS AND METHODS A total of 150 individuals infected with COVID-19 and 50 healthy individuals were recruited. Cases were divided based on severity (mild, moderate, and severe) and outcome (discharged or deceased). Serum iron, TIBC, ferritin, transferrin, transferrin saturation levels were analyzed by the direct colourimetric method. RESULTS In cases the median levels of serum iron, TIBC, transferrin, transferrin saturation and ferritin are 29 µg/dL, 132.53 µg/dL, 106.3 mg/dL, 17.74 % and 702.9 ng/dL respectively. Similarly, in controls the median levels of serum iron, TIBC, transferrin, transferrin saturation and ferritin are 53 µg/dL, 391.88 µg/dL, 313.51 mg/dL, 12.81 % and 13.52 ng/dL respectively. On comparing the cases with the controls, a significant lower level of iron, TIBC, and transferrin were found in the cases along with the significant higher levels of ferritin and transferrin saturation. On comparing the Receiver operating characteristic (ROC) curves of Iron, Ferritin, Transferrin, Transferrin sat % and TIBC in relation to survival in COVID-19 patients it was found that iron, followed by transferrin and ferritin has the highest area under the curve (AUC) with 74 %, 63 % and 61 % respectively. Further, in pairwise analysis of ROC curve, a significant difference was found between the Iron-transferrin (p < 0.01), iron-TIBC (p < 0.001) and transferrin-ferritin (P < 0.01). The multiple regression model based on Iron and transferrin outperformed any other combination of variables via stepwise AIC selection with an AUC of 98.2 %. The cutoff point according to Youden's J index is characterized with a sensitivity of 98 % and a specificity of 96.8 %, indicating that iron along with transferrin can be a useful marker that may contribute to a better assessment of survival chances in COVID-19. CONCLUSION Our study demonstrated a significantly decreased levels of iron, TIBC, & transferrin and a significantly increased levels of ferritin and transferrin saturation in COVID-19 patients when compared with controls. Further, Iron and transferrin were observed to be a good predictor of mortality in patients with COVID-19. From the above analysis we confirm that iron-related biomarkers play an important role in the development of oxidative stress and further lead to activation of the cytokine storm. So, continuous monitoring of these parameters could be helpful in the early detection of individuals developing the severe disease and can be used to decrease mortality in upcoming new waves of COVID-19.
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Affiliation(s)
- Dharamveer Yadav
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Kiran Kumar Pvsn
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Sojit Tomo
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Jayakaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhishek Purohit
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vijaylakshami Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pradeep Bhatia
- Department of Anaesthesia, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- Department of Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Purvi Purohit
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India.
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Swami MK, Mahal P, Arora IK, Mishra VC, Panda TK, Nebhinani N, Kumar D, Banerjee M, Garg MK. Psychiatric morbidity among patients attending the post-COVID clinic and its association with hematological inflammatory markers. Asian J Psychiatr 2022; 78:103293. [PMID: 36279816 PMCID: PMC9547390 DOI: 10.1016/j.ajp.2022.103293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Mukesh Kumar Swami
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Pankaj Mahal
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Isha Kaur Arora
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Vikash Chandra Mishra
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Tushar Kanta Panda
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Deepak Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
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Shakrawal J, Sharma V, Goyal A, Kumar D, Meena S, Tiwari S, Jain V, Elhence P, Soni K, Choudhury B, Bhatnagar K, Garg MK, Misra S. Outcomes of transcutaneous retrobulbar Amphotericin B (TRAMB) as an adjuvant therapy for rhino-orbital-cerebral mucormycosis (ROCM) following COVID-19. Int Ophthalmol 2022; 43:1919-1926. [DOI: 10.1007/s10792-022-02591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 11/12/2022] [Indexed: 11/27/2022]
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Mittal M, Nahid E, Roy A, Garg MK. Lines of healing. Pediatr Neonatol 2022; 64:349-350. [PMID: 36396544 DOI: 10.1016/j.pedneo.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Madhukar Mittal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur 342005, India.
| | - Eram Nahid
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Ayan Roy
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Kalyani 741252, India
| | - M K Garg
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur 342005, India
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Gupta A, Garg PK, Khera PS, Panda S, Bohra GK, Yadav T, Garg MK, Tiwari S. Multiphase computed tomography angiography (mCTA) derived source images in acute ischemic stroke: Beyond collaterals. Can it obviate the need for computed tomography perfusion (CTP)? Clin Neurol Neurosurg 2022; 222:107421. [PMID: 36067545 DOI: 10.1016/j.clineuro.2022.107421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE To compare Multiphase CT Angiography derived source images (mCTA-SI) in acute ischemic stroke (AIS) with CT Perfusion (CTP) derived automated color maps of cerebral blood flow (CBF) and cerebral blood volume (CBV) and to assess the comparability of mCTA-SI with CTP in the prediction of final radiological and clinical outcome. METHODS This prospective single-centre observational study comprised of patients with AIS of the anterior circulation, presenting within 24 h and undergoing neuroimaging under stroke protocol with follow-up. Non-contrast computed tomography (NCCT), mCTA, and CTP were acquired with follow-up NCCT at 24 h and modified Rankin score (mRS) at 3 months. mCTA-SI and CTP color maps were scored by the ASPECTS (Alberta Stroke program early CT score) method and compared amongst each other and with the outcome. ROC (Receiver operating characteristic) curves were plotted considering mRS 0-2 and FIV≤ 28 ml as favourable clinical and radiological outcomes respectively. RESULTS The study included 55 patients. The 1st and 2nd phase of mCTA-SI correlated significantly with CBF maps (r = 0.845, p < 0.01, r = 0.842, p < 0.01 respectively). 3rd phase of mCTA-SI correlated significantly with CBV maps (r = 0.904, p < 0.01). A favourable functional and radiological outcome was best predicted by the 1st (AUC 0.8, 95%CI 0.671-0.896) and 2nd ( AUC 0.895, 95% CI 0.783-0.962) phase of mCTA-SI respectively. CONCLUSIONS The 1st and 2nd phases of mCTA-SI produces results congruent to CBF color maps and the 3rd phase of mCTA-SI simulate CBV color maps. In addition to predicting radiological and functional outcomes, mCTA can predict the salvageable and non-salvageable tissue in AIS and is non-inferior to CTP.
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Affiliation(s)
- Aanchal Gupta
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India.
| | - Pawan K Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India.
| | - Pushpinder S Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India.
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India.
| | - Gopal K Bohra
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India.
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India.
| | - M K Garg
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India.
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India.
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Muacevic A, Adler JR, Kumar D, Purohit A, Garg M, Kanchan DT, Dutt N, Kothari N, Bhaskar S, Elhence P, Bhatia P, Nag VL, Garg MK, Misra S, Pandey A, Dhawan A. Ultrastructural Changes in Autopsy Tissues of COVID-19 Patients. Cureus 2022; 14:e31932. [PMID: 36582579 PMCID: PMC9794915 DOI: 10.7759/cureus.31932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic resulted in substantial morbidity and mortality across the world. The prognosis was found to be poor in patients with co-morbidities such as diabetes, hypertension, interstitial lung disease, etc. Although biochemical studies were done in patient samples, no study has been reported from the Indian subcontinent about ultrastructural changes in the vital organs of COVID-19 patients. The present study was, therefore, conducted to understand the ultrastructural changes in the lung, liver, and brain of the deceased patients. METHODS The present study was conducted on samples obtained from reverse transcription-polymerase chain reaction (RT-PCR)-positive patients who were admitted to a tertiary care hospital in Western India. Core needle biopsies were done in eight fatal cases of COVID-19. The samples were taken from the lungs, liver, and brain and subjected to light microscopy, immunohistochemistry (IHC), and transmission electron microscopy (TEM). Clinical details and biochemical findings were also collected. Results: The study participants included seven males and one female. The presenting complaints included fever, breathlessness, and cough. Light microscopy revealed diffuse alveolar damage in the lungs. Further, a positive expression of SARS-CoV-2 nucleocapsid protein was observed in the pulmonary parenchyma of five patients. Also, the TEM microphotograph showed viral particles of size up to 80nm localized in alveolar epithelial cells. However, no viral particles were found in liver or brain samples. In the liver, macrovesicular steatosis and centrizonal congestion with loss of hepatocytes were observed in light microscopy. CONCLUSION This is the first study in the Indian population showing the in-situ presence of viral particles in core biopsies from fatal cases of COVID-19. As evident from the results, histology and ultrastructural changes in the lung correlated with the presence of viral particles. The study revealed a positive correlation between the damage in the lungs and the presence of viral particles.
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Sharma S, Samantaray S, Ravindra A, Naguthevar S, Khatod Y, R NT, Kumar D, Meena DS, Bohra GK, Garg MK, Tiwari S, Kombade S. P283 A rare case of vertebral osteomyelitis caused by co-infection of Candida and Mycobacterium Tuberculosis: a double trouble. Med Mycol 2022. [PMCID: PMC9509847 DOI: 10.1093/mmy/myac072.p283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction The vertebral osteomyelitis can be pyogenic (bacterial), non-pyogenic-granulomatous (tuberculosis, brucella, fungi), or parasitic. Fungal spondylodiscitis only accounts for 0.7%-2.7% of all spinal infections. Tubercular vertebral osteomyelitis has a high prevalence in developing countries like India. Co-infection of the spine by both fungal and tuberculous organisms is rare, there is only one case that has been reported till now in our literature review. Case A 62-year-old man presented with complaints of lower back pain for 3 months and fever with chills for 1 month. He had done multiple OPD visits at other centers for his lower back pain in the past 2 months, where a whole spine MRI was done which was suggestive of prolapsed intervertebral disc at multiple spinal segments- maximum at L4-L5 causing indentation of nerve roots for which he was given 3 days of IV and followed by 15 days of oral methylprednisolone. On steroids, patient developed fever and increased lower back pain for which he was admitted. Repeat MRI spine revealed features s/o axial spondylo-arthropathy. At this point, he was referred to our center for further management and was admitted. He was a known case of diabetes and underwent bilateral DJ stenting for nephrolithiasis 3 months before. On post-operative day 4, he had developed low back ache. He was vitally stable but febrile, unable to sit or walk without support. He also had tingling and numbness in bilateral lower limbs. Laboratory results showed raised inflammatory markers. Vertebral biopsy was done, CBNAAT was negative, while culture revealed growth of Candida albicans. He was started on injection of fluconazole 800 mg loading dose followed by 400 mg daily. After 5 days he got afebrile but, lower limb weakness and lower back pain persisted. Hence a repeat vertebral biopsy was planned. Surprisingly, CBNAAT of the biopsy sample detected very low MTB and indeterminate rifampicin resistance, following which the patient was initiated on weight-based HRZE regimen along with fluconazole. Currently, patient is afebrile and his lower limb weakness has improved with lower limb muscles power 0/5 to 3/5 on follow-up after a month. Conclusion Non-pyogenic vertebral osteomyelitis due to tuberculosis is common in a high TB burden country like India. Even though Candida is a rare causative agent, but should always be considered as a differential in patients having risk factors. In our patient abdominal surgery, DM and steroids could have predisposed for developing Candida vertebral osteomyelitis. The possibility of co-infection of TB and Candida should not be ignored in patients who have risk factors, especially if they present with clinical and radiological signs befitting its manifestations. High suspicion and tissue diagnosis remain crucial factors for early diagnosis and aids in better clinical outcomes.
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Affiliation(s)
| | | | | | | | - Yash Khatod
- General Medicine , AIIMS Jodhpur, Jodhpur , India
| | - Neetha T R
- General Medicine , AIIMS Jodhpur, Jodhpur , India
| | - Deepak Kumar
- General Medicine , AIIMS Jodhpur, Jodhpur , India
| | | | | | - M K Garg
- General Medicine , AIIMS Jodhpur, Jodhpur , India
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R NEETHAT, Khatod Y, Samantaray S, Khichar S, Bohra GK, Kumar D, Garg MK. P297 Disseminated histoplasmosis from skin to adrenals a cosmetic
catastrophe—a rare case report. Med Mycol 2022. [PMCID: PMC9509762 DOI: 10.1093/mmy/myac072.p297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background The varying presentations of histoplasmosis is always a diagnostic dilemma for clinicians. Cases of disseminated histoplasmosis can present in multiple specialties like dermatology, medicine, endocrinology, with skin, and mucosal hyperpigmentation as the only major symptom. Case Report Here we present a case of a 54-year-old male with hyperpigmentation all over the body with multiple specialty consultations done in the past 2 years. There was a significant history of loss of weight over a period of 2 years. His cortisol levels were low which explained the focus in the adrenals, with bilateral adrenomegaly found in imaging studies. His diagnostic work-up for TB and possible malignancy was ruled out. The provisional diagnosis of histoplasmosis was made and confirmed with biopsy and culture. Definitive treatment with antifungals was initiated, which showed improvement on follow-up. Conclusion Histoplasmosis is always underreported, because of a lack of information regarding the various clinical presentations. Early diagnosis and prompt treatment may save the patient from catastrophic adrenal insufficiency. The diagnosis of adrenal histoplasmosis should be considered in patients presenting with constitutional symptoms and adrenal masses with or without adrenal insufficiency. Adrenal histoplasmosis can be the only possible presentation in disseminated histoplasmosis.
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Affiliation(s)
- NEETHA T R
- All India Institute of Medical Sciences , Jodhpur City , India
| | - Yash Khatod
- All India Institute of Medical Sciences , Jodhpur City , India
| | | | | | | | - Deepak Kumar
- All India Institute of Medical Sciences , Jodhpur City , India
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Mittal M, Jethwani P, Naik D, Garg MK. Non-medicalization of medical science: Rationalization for future. World J Methodol 2022; 12:402-413. [PMID: 36186743 PMCID: PMC9516546 DOI: 10.5662/wjm.v12.i5.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
As we delve into the intricacies of human disease, millions of people continue to be diagnosed as having what are labelled as pre-conditions or sub-clinical entities and may receive treatments designed to prevent further progression to clinical disease, but with debatable impact and consequences. Endocrinology is no different, with almost every organ system and associated diseases having subclinical entities. Although the expansion of these “grey” pre-conditions and their treatments come with a better understanding of pathophysiologic processes, they also entail financial costs and drug adverse-effects, and lack true prevention, thus refuting the very foundation of Medicine laid by Hippocrates “Primum non nocere” (Latin), i.e., do no harm. Subclinical hypothyroidism, prediabetes, osteopenia, and minimal autonomous cortisol excess are some of the endocrine pre-clinical conditions which do not require active pharmacological management in the vast majority. In fact, progression to clinical disease is seen in only a small minority with reversal to normality in most. Giving drugs also does not lead to true prevention by changing the course of future disease. The goal of the medical fraternity thus as a whole should be to bring this large chunk of humanity out of the hospitals towards leading a healthy lifestyle and away from the label of a medical disease condition.
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Affiliation(s)
- Madhukar Mittal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
| | - Parth Jethwani
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
| | - Dukhabandhu Naik
- Department of Endocrinology and Metabolism, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - MK Garg
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
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R A, Bohra GK, Shankar D, Kumar D, Midha NK, Jain V, Sharma S, N S, Garg MK, Singh K, Chauhan NK, Sharma A. P144 The uncommon meets the common: Invasive Aspergillosis and tuberculosis co-infection in non-neutropenic patients— arare association. Med Mycol 2022. [PMCID: PMC9515724 DOI: 10.1093/mmy/myac072.p144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background and Objective Invasive aspergillosis (IA) is known to occur in immunocompromised patients including neutropenic patients. But, recently increasing cases have been reported in patients with non-classical risk factors and non-neutropenic patients like diabetes mellitus, chronic lung disease, HIV infection, critically ill patients, etc. According to ISHAM these non-classical risk factors should be included in EORTC/MSG host criteria for diagnosis of invasive aspergillosis. India has a high tuberculosis (TB) burden, and this is always considered as the first differential for any patient with fever, cough, hemoptysis, and weight loss. Post-tubercular chronic pulmonary aspergillosis common reported condition. However, co-infection of active TB and invasive aspergillosis is less reported. This co-infection could be one of the contributors of high morbidity and mortality in cases with tuberculosis. We hereby present a series of five cases of TB concomitant with invasive aspergillosis in non-neutropenic patients. Methods This is a prospective observational study, all patients admitted with molecular diagnosis (GeneXpert) of tuberculosis and with at least one non-classical risk factor for invasive aspergillosis were subjected to further evaluation. Diagnosis of invasive aspergillosis was considered in patients who had at least one clinical and one mycological EORTC criteria. Galactomannan level in different samples was measured via PlateliaTM ELISA. The efficacy of different antifungals and outcomes were analyzed. Results Total 57 patients with TB underwent for evaluation of invasive aspergillosis. Among them, five patients were diagnosed to have concomitant TB and invasive aspergillosis, of which three cases of CNS TB and CNS aspergillosis and two had concomitant pulmonary infections. The average age was 31 ± 12 years with a female preponderance (4/5). Two patients were HIV positive, while among non-HIV patients, one had CD4 cytopenia (CD4-171). One patient had no known predisposing factor. Radiologically, most common pulmonary lesions were patchy consolidation with centrilobular nodules with tree in bud appearance, while CNS lesions showed multiple ring-enhancing lesions. All the patients had CBNAAT positive, two from BAL sample, 1 from CSF, and 1 from the lymph node. Rifampicin was sensitive in all, except one who had rifampicin resistance indeterminate. Of these patients, four were probable invasive aspergillosis satisfying the host, mycological and clinical factors as per the EORTC/MSGERC 2021 guidelines. The treatment of coinfection is challenging due to the interaction of rifampicin with voriconazole, which is the drug of choice for invasive aspergillosis. Here, 3 patients were treated with Inj amphotericin B, while the other 2 patients were started on voriconazole with rifampicin sparing regimen for TB. Of the 5 patients, 4 patients survived with excellent response to the treatment, with one fatality. Conclusion The possibility of concurrent TB and invasive aspergillosis in non-neutropenic hosts should be considered to avoid devastating outcomes. The lack of clinical suspicion may result in misdiagnosis, and most importantly, the chronicity of the infection makes it indistinguishable from TB. Moreover, the co-administration of antifungal and anti-TB medications presents significant therapeutic challenges necessitating thorough evaluation and monitoring.
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Affiliation(s)
- Akshatha R
- Department of Medicine , AIIMS Jodhpur, Jodhpur , India
| | | | - Durga Shankar
- Department of Medicine , AIIMS Jodhpur, Jodhpur , India
| | - Deepak Kumar
- Department of Medicine , AIIMS Jodhpur, Jodhpur , India
| | | | - Vidhi Jain
- Department of Microbiology , AIIMS Jodhpur, Jodhpur , India
| | | | - Santhanam N
- Department of Medicine , AIIMS Jodhpur, Jodhpur , India
| | | | - Kuldeep Singh
- Department of Pediatrics , AIIMS Jodhpur, Jodhpur , India
| | | | - Ankur Sharma
- Department of Anesthesia , AIIMS Jodhpur, Jodhpur , India
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Naguthevar S, Garg MK, Bohra GK, Jain V, Kumar D, Midha NK, Meena DS, Sharma S, R A, Singh K, Kombade SP. P243 Case series of Cryptococcal Meningitis—Experience in North Western India over 1 year (2021–22). Med Mycol 2022. [PMCID: PMC9509734 DOI: 10.1093/mmy/myac072.p243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective Cryptococcosis is an opportunistic fungal infection causing high morbidity and mortality in patients, preferentially affecting immunocompromised. It can cause a wide array of clinical manifestation, which includes meningitis, pulmonary, as well as disseminated infection. Cryptococcus neoformans causes more than 90% cases of cryptococcal meningitis. Methodology We performed a retrospective review of patients with confirmed cryptococcal meningitis during 1 year period from 2021 to 2022 in tertiary care center, AIIMS Jodhpur. We assessed clinical, radiological, microbiological, and biochemical parameters along with treatment provided and outcomes of the patient. Results Of 189 patients screened for suspected cryptococcal meningitis, 6 were microbiologically confirmed positive. All the patients were immunocompromised, of which four were HIV positive and one was a solid organ transplant recipient on immunosuppression and one was old TB Meningitis. Most common symptom was headache and altered sensorium (100%). Radiological findings showed 30% had no significant abnormality. CSF examination revealed average CSF protein 97.6 (63-163), CSF chloride 103.3 (108-132), sugar 36.33 (1-68), with predominant lymphocytes. All the patients were microbiologically confirmed by CSF cryptococcal latex test. A total of 4/5 patients received amphotericin B (3 mg/kg) with fluconazole (1200 mg) for 2 weeks in the induction phase followed by fluconazole consolidation phase and maintenance phase. Of the five patients, four patients survive with a good response to the treatment with one fatality. Conclusion Through our case series we emphasize the fact that Cryptococcal meningitidis may present with non-significant radiological features. Thus, the differential diagnosis of C. meningitidis must always be thought of when an immunocompromised patient presents with headaches and other signs and symptoms involving the central nervous system.
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Affiliation(s)
| | - MK Garg
- Department of Medicine , AIIMS, Jodhpur, Jodhpur , India
| | | | - Vidhi Jain
- Department of Microbiology , AIIMS, Jodhpur, Jodhpur , India
| | - Deepak Kumar
- Department of Medicine , AIIMS, Jodhpur, Jodhpur , India
| | | | | | - Shivang Sharma
- Department of Medicine , AIIMS, Jodhpur, Jodhpur , India
| | - Akshatha R
- Department of Medicine , AIIMS, Jodhpur, Jodhpur , India
| | - Kuldeep Singh
- Department of Pediatric Medicine , AIIMS, Jodhpur, Jodhpur , India
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Tomo S, Banerjee M, Karli S, Purohit P, Mitra P, Sharma P, Garg MK, Kumar B. Assessment of DHEAS, cortisol, and DHEAS/cortisol ratio in patients with COVID-19: a pilot study. Hormones (Athens) 2022; 21:515-518. [PMID: 35804262 PMCID: PMC9266078 DOI: 10.1007/s42000-022-00382-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/14/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Dehydroepiandrosterone sulfate (DHEAS) is observed to be decreased in sepsis and inflammatory conditions. In the present study, we assessed the levels of DHEAS and cortisol and the DHEAS/cortisol ratio and their association with inflammatory markers in patients with COVID-19. METHODS The study recruited 76 RT-PCR-positive COVID-19-positive patients and 79 healthy controls. The blood samples were collected and were analyzed for cortisol and DHEAS. RESULTS We observed decreased levels of DHEAS and DHEAS/cortisol ratio and increased levels of cortisol in cases when compared with controls. DHEAS and DHEAS/cortisol ratio showed a decreasing trend with the increase in disease severity. CONCLUSION The present study is the first of its kind comparing DHEAS levels and DHEAS/cortisol ratio in COVID-19 patients and control subjects. DHEAS, with its inhibitory effect on IL6 and activation of Tregs, may play a crucial role in immune defense mechanisms against COVID-19.
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Affiliation(s)
- Sojit Tomo
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India.
| | - Sreenivasulu Karli
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Purvi Purohit
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Prasenjit Mitra
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - M K Garg
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Bharat Kumar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Meena DS, Kumar B, Kachhwaha A, Kumar D, Khichar S, Bohra GK, Sharma A, Kothari N, Garg P, Sureka B, Banerjee M, Garg MK, Misra S. Comparison of clinical characteristics and outcome in RT-PCR positive and false-negative RT-PCR for COVID-19: A Retrospective analysis. Infez Med 2022; 30:403-411. [PMID: 36148177 PMCID: PMC9448311 DOI: 10.53854/liim-3003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/08/2022] [Indexed: 06/16/2023]
Abstract
Cases with SARS-CoV-2 RT-PCR negative pneumonia are an understudied group with uncertainty remaining regarding their treatment approach. We aimed to compare the clinical and radiological characteristics of RT-PCR positive and clinically diagnosed RT-PCR negative COVID-19. This was a single-centre retrospective study conducted at a tertiary care hospital in Western India. All patients (age ≥18 years) with suspicion of COVID-19 with SARI (severe acute respiratory infections) who were subjected to RT-PCR testing (nasal/oropharyngeal swab) were included. Based on RTPCR results, patients were categorized and compared for demographic, clinical, and biochemical characteristics and outcomes. Out of 500 patients, 339 (67.8%) found RT-PCR positive. Except for the radiological findings, both groups differ in clinical presentation, disease severity (inflammatory markers), and outcome. RT-PCR-positive patients had raised ferritin, NLR (Neutrophil-Lymphocyte ratio), LDH, and high mortality compared to the swab-negative group. In-hospital mortality was also significantly high in RT-PCR positive group (HR=1.9, 95% CI=1.4-2.5, p=0.001). On multivariate analysis, NLR, ferritin, and d-dimer were the independent predictors of mortality in RT-PCR-positive (p=0.038, 0.054, and 0.023). At the same time, raised TLC (total leukocyte count) and procalcitonin were the risk factors for poor outcomes in RT-PCR-negative patients (p=0.041 and 0.038). We found significantly raised ferritin, NLR, and LDH levels and increased mortality in RT-PCR positive patients compared to RT-PCR negative. Incorporating clinical features, radiological, and biochemical parameters could be prudent while managing the RT-PCR-negative patients.
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Affiliation(s)
- Durga Shankar Meena
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bharat Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjun Kachhwaha
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Satyendra Khichar
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gopal Krishana Bohra
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankur Sharma
- Department of Trauma and Emergency (Anaesthesiology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nikhil Kothari
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Kumar Garg
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Dutt N, Shishir S, Chauhan NK, Jalandra R, kuwal A, Garg P, Kumar D, Vishwajeet V, Chakraborti A, Deokar K, Asfahan S, Babu A, bajad P, Gupta N, Khurana A, Garg MK. Mortality and Its Predictors in COVID-19 Patients With Pre-existing Interstitial Lung Disease. Cureus 2022; 14:e27759. [PMID: 36106257 PMCID: PMC9448685 DOI: 10.7759/cureus.27759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/05/2022] Open
Abstract
Background The data on the impact of coronavirus disease 2019 (COVID-19) on interstitial lung disease (ILD) is still limited. To the best of our knowledge, there has been no study from India to date to assess the impact of COVID-19 in patients with preexisting ILD. We undertook this study to assess the clinical outcome of ILD patients admitted to our hospital with COVID-19. Methods In this retrospective observational study, records of reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients with preexisting ILD who were admitted to the hospital in the period from May 1, 2020, to April 30, 2021, were obtained from the hospital database. The clinical outcomes of the patients were recorded. Univariate analysis was performed to find relation between various predetermined risk factors for mortality and those with significant p values (p<0.05) were subjected to multiple logistic regression to determine independent risk factors. Results In our study of 28 patients, the overall mortality was 35.7%. On comparing the parameters associated with increased mortality, there was no effect of age, gender, comorbidities, type of ILD, CT thorax findings on diagnosis, use of corticosteroids and antifibrotics in the past, spirometric findings on mortality. On multivariate analysis, the significant parameters were interleukin 6 (IL-6), p=0.02, OR=1.020 (1.006-1.043) and D-dimer, p=0.04, OR=2.14 (5.55-1.14). Conclusion COVID-19 in patients with pre-existing ILD has a comparatively higher mortality. D-dimer and IL-6 are significant predictors of mortality in ILD patients infected with COVID-19.
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Sureka B, George T, Garg MK, Banerjee M, Deora S, Sukhla R, Goel A, Garg PK, Yadav T, Khera PS. Cutoff values of body fat composition to predict metabolic risk factors with normal waist circumference in Asian Indian population. Eur Radiol 2022; 33:711-719. [DOI: 10.1007/s00330-022-09009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/06/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
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Vijayan N, Vijayvergia P, Bohra GK, Garg MK, Gopalakrishnan M. Clinical characteristics and outcomes of digital gangrene in connective tissue disorders: a longitudinal single-centre experience from Jodhpur, India. Clin Rheumatol 2022; 41:3543-3549. [PMID: 35780227 DOI: 10.1007/s10067-022-06265-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 11/26/2022]
Abstract
Epidemiology, clinical presentation, and outcomes for digital gangrene in connective tissue disorders (CTD) remain underreported from tropical countries like India. In this series, we aimed to explore the clinical profile and outcomes of patients who presented with digital gangrene and a diagnosis of CTD. Hospital-based longitudinal observational study. Patients with digital gangrene and underlying diagnosis of CTD presenting to our tertiary-care centre in Jodhpur, India between1st January 2018 and 31st June 2021 were included. Clinical outcomes including mortality, limb outcomes, functional status and other systemic involvement were assessed. Of the 312 patients registered in the rheumatology clinic during this period, 22 (7%) patients were found to satisfy the inclusion criteria. Mean age was 46 years and 90% were females. The most common underlying diagnosis was Mixed connective tissue disorder (MCTD). Digital gangrene was the presenting symptom in 13 (60%) patients. Half of the patients received only corticosteroids as immunosuppression. Two died due to systemic complications. Complete resolution occurred in 17 (85%), autoamputation in 3, and infection requiring surgical drainage in one patient. All surviving patients reported good functional limb outcome on 6 months follow-up. MCTD is an important cause of digital gangrene in rheumatology practice. In patients presenting with digital gangrene, an active search for an underlying CTD is imperative, as this could result in timely initiation of appropriate limb-saving therapy. Corticosteroids alone with rapid tapering may be an appropriate option to consider in the initial management of digital gangrene in CTD. Key Points • Mixed connective tissue disorder is an important cause of digital gangrene in rheumatology practice in western India. • In patients presenting with digital gangrene, an active search for an underlying connective tissue disorder is imperative, as this could result in timely initiation of appropriate therapy and can prove limb saving. • Corticosteroids alone with rapid tapering may be an appropriate option to consider in the initial management of digital gangrene in connective tissue disorders.
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Affiliation(s)
- Neeraja Vijayan
- Department of Internal Medicine, All India Institute of Medical Sciences, Basni Industrial Estate, Jodhpur, 342005, India
| | - Parag Vijayvergia
- Department of Internal Medicine, All India Institute of Medical Sciences, Basni Industrial Estate, Jodhpur, 342005, India
| | - Gopal Krishna Bohra
- Department of Internal Medicine, All India Institute of Medical Sciences, Basni Industrial Estate, Jodhpur, 342005, India
| | - Mahendra Kumar Garg
- Department of Internal Medicine, All India Institute of Medical Sciences, Basni Industrial Estate, Jodhpur, 342005, India
| | - Maya Gopalakrishnan
- Department of Internal Medicine, All India Institute of Medical Sciences, Basni Industrial Estate, Jodhpur, 342005, India.
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Mittal M, Garg MK. Vitamin K: A Vitamin that Spans Blood, Bones and Carbs. Indian J Endocrinol Metab 2022; 26:232-233. [PMID: 36248050 PMCID: PMC9555368 DOI: 10.4103/ijem.ijem_95_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/05/2022] [Accepted: 04/17/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Madhukar Mittal
- Department of Endocrinology and Metabolism, AIIMS, Jodhpur, Rajasthan, India
| | - Mahendra Kumar Garg
- Department of Endocrinology and Metabolism, AIIMS, Jodhpur, Rajasthan, India
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Samantaray S, Karan P, Sharma A, Nag V, Dutt N, Garg MK, Bhatia PK, Misra S. Prevalence, presentation and outcome of secondary bloodstream infections among the COVID-19 patients. Infect Disord Drug Targets 2022; 22:77-84. [PMID: 35440319 DOI: 10.2174/1871526522666220418093450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/22/2021] [Accepted: 12/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The higher mortality rate in COVID-19 patients is still a concern. Though some studies mention that elderly patients with co-morbidities are at higher risk of mortality, some others report uneventful outcomes in young patients even without co-morbidities. Secondary bacterial and fungal infections, especially with nosocomial pathogens are known to be associated with worse outcome in the ongoing pandemic as well as in the previous viral outbreaks. In such a scenario, the outcome of hospitalized COVID-19 patients can be improved by timely identification of secondary infections using appropriate biomarkers and by following appropriate infection control measures to prevent the spread of nosocomial pathogens. OBJECTIVE The study aims to find out the prevalence of bloodstream infections (BSI) among hospitalized COVID-19 patients and to analyze their laboratory markers and outcome by comparing them with those without BSI. METHODS In this descriptive cross-sectional study, the prevalence of secondary BSI was determined among the hospitalized COVID-19 patients by including 388 blood culture bottles collected from 293 patients, which were received in the microbiology lab within the study period. RESULTS The overall prevalence of BSI in COVID-19 patients was 39.5% (116/293), out of which 35.5% (104/293) infections were bacterial, and 4.1% (12/293) were fungal, while 8.9% (26/293) patients grew contaminants, and 51.5% (151/293) were sterile. Common causative agents of secondary BSI were found to be MDR Klebsiella pneumoniae (10.9%) and Acinetobacter baumannii (8.8%) followed by Candida species (4.1%). Patients with co-morbidities like diabetes, hypertension and COPD were at higher risk of developing BSI with significantly higher levels of sepsis markers such as Creactive protein (CRP), procalcitonin, ferritin and Interleukin-6 (IL-6). The mortality rate was significantly higher (60.2%) in patients with BSI compared to the group of patients without BSI. CONCLUSION Our findings suggest the necessity of early diagnosis of the secondary infections using appropriate biomarkers and following proper infection control measures to prevent the spread of the nosocomial infections and improve the outcome of hospitalized COVID-19 patients.
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Affiliation(s)
- Subhashree Samantaray
- Department of Microbiology, Senior Resident, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Priyabrat Karan
- Department of Anesthesiology and Critical care, Senior Resident, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anuradha Sharma
- 3Department of Microbiology, Additional professor, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vijayalakshmi Nag
- Department of Microbiology, Professor, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, Additional Professor, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Kumar Garg
- Department of Internal Medicine, Professor, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Kumar Bhatia
- Department of Anesthesiology and Critical care, Professor, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- Department of Surgical Oncology, Professor, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Bohra GK, Bhatia PK, Khichar S, Garg MK, Sharma P. Association of Inflammatory markers with Covid-19 Outcome among Hospitalized adult Patients. J Assoc Physicians India 2022; 70:11-12. [PMID: 35443502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED COVID-19 is a highly infectious disease with varied presentation as well as outcome. Inflammation plays a major role in the outcome of COVID-19 infection. This study was aimed to evaluate the role of conventional feasible inflammatory markers in predicting the outcome of COVID-19 in hospitalized adult patients. MATERIAL A total of 100 confirmed COVID-19 patients were included in the study. Clinical and demographic data were collected. Biochemical, hematological, and inflammatory markers were assessed in all the patients. Disease severity and primary outcome as survival and or mortality were recorded. OBSERVATION Hematological indices and inflammatory markers were significantly higher among the non-survivor. N/L (Neutrophil/Lymphocyte) ratio and CRP (C-reactive protein) can differentiate non-survivor from survivors with the sensitivity of 85.7%, 85.7%, and specificity of 96.8 %, 77.4% with a cut-off value of 6.44, 23.02 respectively in the receiver operator curve (ROC). N/L ratio and CRP were significantly increased among the patients with severe COVID-19 infection. Cox regression Survival analysis showed that an elevated N/L ratio and CRP were significantly associated with mortality with the Hazard ratio of 1.331 (P <0.001) and 1.014 (P <0.015) respectively. CONCLUSION The present study implicates that increased N/L ratio and CRP were significantly correlated with severity and mortality in COVID-19 patients. These conventional feasible markers can be useful in predicting the outcome of COVID-19 infection.
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Meena DS, Kumar D, Agarwal M, Bohra GK, Choudhary R, Samantaray S, Sharma S, Midha N, Garg MK. Clinical features, diagnosis and treatment outcome of fungal endocarditis: A systematic review of reported cases. Mycoses 2022; 65:294-302. [PMID: 34787939 DOI: 10.1111/myc.13398] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 12/21/2022]
Abstract
The landscape of fungal endocarditis (FE) has constantly been evolving in the last few decades. Despite the advancement in diagnostic methods and the introduction of newer antifungals, mortality remains high in FE. This systematic review aimed to evaluate the epidemiology, clinical features, diagnostic and therapeutic interventions in patients with FE. We also aim to examine the aforementioned factors as a determinant of mortality in FE. A literature search was performed in PubMed, Google Scholar and Scopus, and all patients ≥18 years with proven fungal endocarditis were included. A total of 220 articles (250 patients) were included in the final analysis. Candida was the commonest aetiology (49.6%), followed by Aspergillus (30%) and Scedosporium species (3.2%). The proportion of prosthetic valve endocarditis (PVE) and intravenous drug users was 35.2% and 16%, respectively. The overall mortality rate was 40%. On multivariate analysis, Aspergillus endocarditis (HR 3.7, 95% CI 1.4-9.7; p = .009) and immunocompromised state (HR 2.8, 95% CI 1.24-6.3; p = .013) were independently associated with mortality. Patients treated with surgery along antifungals had better survival (HR 0.20, 95% CI 0.09-0.42; p < .001) compared to those treated with antifungals alone. Recurrence of FE was reported in 10.4% of patients. In conclusion, FE carries significant mortality, particularly in immunodeficient and Aspergillus endocarditis. We advocate the use of surgery combined with antifungals to improve clinical outcomes.
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Affiliation(s)
- Durga Shankar Meena
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Deepak Kumar
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Madhulata Agarwal
- Department of Internal Medicine, SMS Medical College, Jodhpur, India
| | - Gopal Krishana Bohra
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Rahul Choudhary
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Subhashree Samantaray
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Shivang Sharma
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Naresh Midha
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Kumar A, Gopalakrishnan M, Kuri HR, Bajpayee A, Kothari N, Garg MK. Case Report: Delayed Diffuse Alveolar Hemorrhage in Echis sochureki Envenoming, Jodhpur, India. Am J Trop Med Hyg 2022; 106:967-969. [PMID: 35100564 PMCID: PMC8922478 DOI: 10.4269/ajtmh.21-1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/28/2021] [Indexed: 11/07/2022] Open
Abstract
Snakebite envenoming is a common occupational hazard in the tropics. Venom-induced consumption coagulopathy and acute kidney injury are the most frequently encountered complications of viper bites. Diffuse alveolar hemorrhage (DAH) is an unusual presentation reported rarely in the literature. Our case report highlights the uncommon presentation of delayed pulmonary hemorrhage after snakebite envenoming. A 40-year-old healthy man presented to our emergency department after 6 hours of Echis sochureki (a saw-scaled viper subspecies) bite. He had abnormal coagulation parameters and thrombocytopenia with no signs of acute kidney injury. Transfusion protocols were initiated because of active bleeding and a rapid decrease in hemoglobin levels over next few days. Around day 10, his coagulation profile and hemoglobin were corrected, but he developed hemoptysis with rapidly progressive respiratory distress. Computed tomography of the chest was suggestive of DAH and the patient was started on plasma exchange with pulse methylprednisolone. After the initial worsening, he had rapid symptomatic improvement and radiological resolution. The patient had persistent hypofibrinogenemia, which resolved, and was discharged and remained healthy at the 60-day follow-up. This case highlights a presentation with an initial phase of venom-induced consumption coagulopathy followed by delayed DAH in saw-scaled viper envenoming that was treated successfully with immunosuppressants and plasma exchange.
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Affiliation(s)
- Akhilesh Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Maya Gopalakrishnan
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India;,Address correspondence to Maya Gopalakrishnan, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Basni Industrial Estate, Jodhpur, Rajasthan, India. E-mail:
| | - Harshavardhan R. Kuri
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Archana Bajpayee
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Nikhil Kothari
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Jalandra RN, Shahul AS, Asfahan S, Garg MK, Nebhinani N, Dutt N, Chauhan NK, Swami MK, Bhatia PK, Bhardwaj P, Suthar N, Kumar A, Kumawat R, Andani R, Misra S. Emotional distress among health professionals involved in care of inpatients with COVID-19: a survey based cross-sectional study. Adv Respir Med 2022; 90:ARM.a2022.0026. [PMID: 35199842 DOI: 10.5603/arm.a2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/27/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Health care workers (HCWs) are directly involved in processes linked with diagnosis, management, and assistance of coronavirus disease-19 (COVID-19) patients which could have direct implications on their physical and emotional health. Emotional aspects of working in an infectious pandemic situation is often neglected in favour of the more obvious physical ramifications. This single point assessment study aimed to explore the factors related to stress, anxiety and depression among HCWs consequent to working in a pandemic. MATERIAL AND METHODS This was a cross-sectional study involving healthcare workers who were working in COVID-19 inpatient ward, COVID-19 screening area, suspect ward, suspect intensive care unit (ICU) and COVID-19 ICU across four hospitals in India. A web-based survey questionnaire was designed to elicit responses to daily challenges faced by HCWs. The questionnaire was regressed using machine-learning algorithm (Cat Boost) against the standardized Depression, Anxiety and Stress Scale - 21 (DASS 21) which was used to quantify emotional distress experienced by them. RESULTS A total of 156 participants were included in this study. As per DASS-21 scoring, severe stress was seen in ∼17% of respondents. We could achieve an R² of 0.28 using our machine-learning model. The major factors responsible for stress were decreased time available for personal needs, increasing age, being posted out of core area of expertise, setting of COVID-19 care, increasing duty hours, increasing duty days, marital status and being a resident physician. CONCLUSIONS Factors elicited in this study that are associated with stress in HCWs need to be addressed to provide wholesome emotional support to HCWs battling the pandemic. Targeted interventions may result in increased emotional resilience of the health-care system.
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Affiliation(s)
- Ram Niwas Jalandra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences Jodhpur, India
| | - Aneesa S Shahul
- Department of Pulmonary Medicine, All India Institute of Medical Sciences Jodhpur, India
| | - Shahir Asfahan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences Jodhpur, India
| | - M K Garg
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
| | - Naresh Nebhinani
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
| | - Naveen Dutt
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
| | - Nishant Kumar Chauhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences Jodhpur, India
| | | | | | - Pankaj Bhardwaj
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
| | - Navratan Suthar
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
| | - Ashok Kumar
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
| | - Rajani Kumawat
- All India Institute of Medical Sciences Bathinda, Punjab, India
| | - Rupesh Andani
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
| | - Sanjeev Misra
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
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Vyas V, Singh K, Pareek P, Garg MK, Didel S, Priyanka P, Goel AD, Misra S. Guardian-Reported Impact of the COVID-19 Pandemic on the Lifestyle of Children with Diabetes Mellitus. J Trop Pediatr 2022; 68:6523956. [PMID: 35137217 PMCID: PMC8903385 DOI: 10.1093/tropej/fmac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The coronavirus disease-2019 (COVID-19) pandemic has had an unprecedented impact on the lives and lifestyles of people of all ages worldwide. Lifestyle has an essential role in the management of diabetes mellitus in children. METHODS The study was carried out at a tertiary care centre in India. A telehealth survey was conducted among the parents/guardians of children with diabetes to study the impact of the COVID-19 pandemic. The survey evaluated the effects on lifestyle, diabetes management and challenges in connecting to a new telemedicine programme. RESULTS The survey was completed by guardians of 91 patients. The mean age of the patients was 13.0 ± 3.8 years in boys and 11.9 ± 4.5 years in girls. Fifty-seven per cent of them were boys, and 63.7% stayed in rural areas. The pandemic has resulted in a significant increase in screen time and sleep duration. The median non-educational screen time has gone up from 1.00 (0.5-2.0) to 2.50 (1.0-4.0) h. The mean sleep duration in children increased from 9.1 ± 1.4 to 9.7 ± 1.4 h. Telemedicine services have been established with minimum resources, but they have limitations, and awareness about them is also limited. CONCLUSION The COVID-19 pandemic has made the lifestyle of children with diabetes more sedentary. Some of them have also faced challenges with regard to diabetes-related supplies and management. It would be fair to anticipate more complications related to this sedentary lifestyle in the future and work towards identifying and treating them.
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Affiliation(s)
- Varuna Vyas
- Associate Professor, Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India,Corresponding Author: Dr Varuna Vyas, , Department of Pediatrics, Room number 3147, Academic Block, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India 342005, Telephone number: + 91 9810508477
| | - Kuldeep Singh
- Professor and Head, Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Puneet Pareek
- Additional Professor, Department of Radio- Therapy, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- Professor and Head, Department of Endocrinology, All India Institute of Medical Sciences, Jodhpur, India
| | - Siyaram Didel
- Assistant Professor, Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Priyanka Priyanka
- Senior Resident, Department of Pediatrics, All India Institute of Medical Sciences, Patna, India
| | - Akhil Dhanesh Goel
- Associate Professor, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- Director, Professor and Head, Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
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Chauhan NK, Shadrach BJ, Dutt N, Jalandra RN, Deokar K, Garg MK, Nag VL, Bhardwaj P, Jain V, Misra S. Safe Practice of Flexible Bronchoscopy for Non-COVID-19 Indications during the SARS-CoV-2 Pandemic. Tanaffos 2022; 21:207-213. [PMID: 36879727 PMCID: PMC9985126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/17/2021] [Indexed: 06/18/2023]
Abstract
BACKGROUND Flexible bronchoscopy is an aerosol-generating procedure (AGP), which increases the risk of transmission of SARS-CoV-2 infection. We aimed to find COVID-19 symptoms among healthcare workers (HCWs) involved in flexible bronchoscopies for non-COVID-19 indications during the SARS-CoV-2 pandemic. MATERIALS AND METHODS The participants of this hospital-based single-center descriptive study were HCWs of our hospital involved in flexible bronchoscopies of patients with non-COVID-19 indications. These patients had no clinical features of COVID-19 and were tested negative for SARS-CoV-2 by the real-time polymerase chain reaction of nasopharyngeal and throat swabs before the procedure. The study outcome was the occurrence of COVID-19 in study participants after exposure to bronchoscopies. RESULTS Thirteen HCWs performed 81 bronchoscopies on 62 patients. Indications for bronchoscopies included malignancy (61.30%), suspected infections (19.35%), non-resolving pneumonia (6.45%), mucus plug removal (6.45%), central airway obstruction (4.84%), and hemoptysis (1.61%). The mean age of patients was 50.44 ± 15.00 years, and the majority was males (72.58%). Bronchoscopic procedures included 51 bronchoalveolar lavages, 32 endobronchial ultrasound- transbronchial needle aspiration (EBUS-TBNA), 26 endobronchial biopsies, 10 transbronchial lung biopsy (TBLB), 3 mucus plug removals, 2 conventional TBNA, and 2 radial EBUS-TBLB. Except for two HCWs who complained of transient throat irritation of non-infectious cause, none of the cases developed any clinical features suggestive of COVID-19. CONCLUSION A dedicated bronchoscopy protocol helps in minimizing the risk of transmission of SARS-CoV-2 infection among HCWs involved in flexible bronchoscopies for non-COVID-19 indications during the SARS-CoV-2 pandemic.
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Affiliation(s)
- Nishant Kumar Chauhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Benhur Joel Shadrach
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Ram Niwas Jalandra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
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Sureka B, Rai B, Varshney VK, Nag VL, Garg MK, Garg P, Yadav T, Khera PS. Diffusion-Weighted Magnetic Resonance Imaging Is an Ideal Imaging Method to Detect Infection in Pancreatic Collections: A Brief Primer for the Gastroenterologists. Cureus 2022; 14:e21530. [PMID: 35223305 PMCID: PMC8863503 DOI: 10.7759/cureus.21530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The development of infection in pancreatitis significantly increases the mortality rate up to 100% in the absence of any intervention. Therefore, it is extremely important to diagnose these cases at an early stage. The objectives of this study were to assess the diagnostic performance of computed tomography (CT) and diffusion-weighted MR imaging (DW-MRI) in the diagnosis of infection in pancreatic collections. Materials and methods: Prospective observational study of abdominal collections due to pancreatitis that underwent both CT and DW-MRI from August 2018 to July 2020 were enrolled in the study. The collections were analysed for infections - air foci in CT and diffusion restriction on DW-MRI. Results: Of the 39 patients recruited in the study, infected collections were present in 17, and 22 cases had sterile collections. On CT, air foci within the collection were present only in seven of the cases in our study (sensitivity 35%, specificity 95.4%, PPV 85.7%, NPV 65.6%). DW-MRI detected infection in all 17 cases (sensitivity 100%, specificity 72.7%, PPV 74%, NPV 100%). Discussion: Thirteen out of 17 collections suspicious for infection on DW-MR showed microbiological growth on culture examination. We believe that this is likely due to the patient's prior antibiotic use, which might have altered the micro-environment or inflammatory cell and bacterial content of the collection. Conclusion: DW-MRI is complementary and superior to CT in detecting infection in pancreatic collections. CT may be used to detect disease burden, extent and vascular complication.
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Shekhawat J, Kumar D, Bhardwaj P, Garg MK. Assessment of Knowledge, Attitude and Practices of Integrated Disease Surveillance Program in Tertiary Level Care Center in Western Rajasthan. Infect Disord Drug Targets 2022; 22:e190122200366. [PMID: 35043769 DOI: 10.2174/1871526522666220119113549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Jayshree Shekhawat
- MPH Scholar, School of Public Health, All India Institute of Medical Sciences, Jodhpur, India
| | - Deepak Kumar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- Department Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Meena DS, Kumar D, Bohra GK, Midha N, Garg MK. Clinical Characteristics and Treatment Outcome of Central Nervous System Nocardiosis: A Systematic Review of Reported Cases. Med Princ Pract 2022; 31:333-341. [PMID: 35700710 PMCID: PMC9485982 DOI: 10.1159/000525509] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical spectrum of systemic nocardiosis encompasses pulmonary and disseminated disease. Central nervous system (CNS) involvement is an important feature of disseminated disease with significant mortality and high relapse rate, especially in those with suppressed cell-mediated immunity. This systematic review aimed to evaluate the epidemiology, clinical features, diagnosis, therapeutic interventions, and outcome in patients with CNS nocardiosis. METHODS A literature search was performed in major databases (PubMed, Google Scholar, and Scopus) by using distinct keywords: "CNS disease," "Nocardia," "meningitis," "brain abscess," "disseminated disease," and "Cotrimoxazole." We included all patients ≥18 years with CNS nocardiosis reported between January 2000 and December 2020. RESULTS A total of 129 papers were included in the final analysis. The mean age of patients was 55 ± 16 years, and the majority were male (70.8%). Nocardia farcinica was the commonest species (39.6%), followed by Nocardia nova (5.9%). Thirty-four percent of the patients were found to be immunocompetent. Corticosteroid use was the most common predisposing factor (55.8%). Among neuroimaging findings, brain abscess was most common (86.9%), followed by leptomeningeal enhancement (12.1%). The overall case-fatality rate in CNS disease was 22.8%. On multivariate analysis, patients who underwent surgery (OR 2.4, 95% CI 0.99-4.11, p value 0.046) had better survival than those treated with antimicrobial therapy alone. Immunodeficient state (OR 0.32, 95% CI 0.15-0.90, p value 0.019) was independently associated with poor outcome. CONCLUSION CNS nocardiosis carries significant mortality, especially in immunodeficient patients. We advocate the use of surgery combined with antimicrobials to improve clinical outcome.
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