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Kulirankal KG, Mary A, Moni M, Pillai GS, Sathyapalan DT. Long-term survival following medical management of Aspergillus endocarditis with dissemination as a consequence of steroid therapy in severe COVID-19 pneumonia. Med Mycol Case Rep 2024; 43:100638. [PMID: 38487405 PMCID: PMC10937298 DOI: 10.1016/j.mmcr.2024.100638] [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] [Received: 10/11/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
A male in his 40's with no known comorbidities developed severe COVID-19 pneumonia and received a four-week course of methylprednisolone. The patient subsequently developed disseminated Aspergillus endocarditis, manifesting as multiple organ involvement including the heart, eyes, and brain. Despite the poor prognosis generally associated with fungal endocarditis, the patient survived following aggressive medical management with a combination of liposomal amphotericin b and voriconazole therapy and is now doing well for over two years and is off antifungal therapy for a year.
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Affiliation(s)
- Kiran G. Kulirankal
- Division of Infectious Diseases, Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Ann Mary
- Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Merlin Moni
- Division of Infectious Diseases, Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Gopal S. Pillai
- Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, India
| | - Dipu T. Sathyapalan
- Division of Infectious Diseases, Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India
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Nair P, Nair CV, Kulirankal KG, Corley EM, Edathadathil F, Gutjahr G, Moni M, Sathyapalan DT. Characterization and predictive risk scoring of long COVID in a south indian cohort after breakthrough COVID infection; a prospective single centre study. BMC Infect Dis 2023; 23:670. [PMID: 37814234 PMCID: PMC10563355 DOI: 10.1186/s12879-023-08600-6] [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: 03/22/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND With the World Health Organization (WHO) declaring an end to the COVID-19 pandemic, the focus has shifted to understanding and managing long-term post-infectious complications. "Long COVID," characterized by persistent or new onset symptoms extending beyond the initial phase of infection, is one such complication. This study aims to describe the incidence, clinical features and risk profile of long COVID among individuals in a South Indian cohort who experienced post-ChAdOx1 n-Cov-2 vaccine breakthrough infections. METHODS A single-centre hospital-based prospective observational study was conducted from October to December 2021. The study population comprised adult patients (> 18 years) with a confirmed COVID-19 diagnosis who had received at least a single dose of vaccination. Data was collected using a specially tailored questionnaire at week 2, week 6, and week 12 post-negative COVID-19 test. A propensity score based predictive scoring system was developed to assess the risk of long COVID. RESULTS Among the 414 patients followed up in the study, 164 (39.6%) reported long COVID symptoms persisting beyond 6 week's post-infection. The presence of long COVID was significantly higher among patients above 65 years of age, and those with comorbidities such as Type II Diabetes Mellitus, hypertension, dyslipidemia, coronary artery disease, asthma, and cancer. Using backwards selection, a reduced model was developed, identifying age (OR 1.053, 95% CI 0.097-1.07, p < 0.001), hypertension (OR 2.59, 95% CI 1.46-4.59, p = 0.001), and bronchial asthma (OR 3.7176, 95% CI 1.24-11.12, p = 0.018) as significant predictors of long COVID incidence. A significant positive correlation was observed between the symptomatic burden and the number of individual comorbidities. CONCLUSIONS The significant presence of long COVID at 12 weeks among non-hospitalised patients underscores the importance of post-recovery follow-up to assess for the presence of long COVID. The predictive risk score proposed in this study may help identify individuals at risk of developing long COVID. Further research is needed to understand the impact of long COVID on patients' quality of life and the potential role of tailored rehabilitation programs in improving patient outcomes.
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Affiliation(s)
- Pranav Nair
- Department of Radiation Oncology, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Chithira V Nair
- Division of Infectious Diseases, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Kiran G Kulirankal
- Division of Infectious Diseases, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | | | - Fabia Edathadathil
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Georg Gutjahr
- Center for Research in Analytics and Technologies for Education (CREATE), Amrita Vishwa Vidyapeetham, Amritapuri, Kollam, Kerala, India
| | - Merlin Moni
- Division of Infectious Diseases, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Dipu T Sathyapalan
- Division of Infectious Diseases, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
- Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidhyapeetham, Kochi, 682041, Kerala, India.
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Hakeem SC, Kulirankal KG, Mary A, Moni M, Sathyapalan DT. Penicilliosis in a Non-HIV Patient: A Case Report. Cureus 2023; 15:e37484. [PMID: 37064726 PMCID: PMC10101194 DOI: 10.7759/cureus.37484] [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: 04/12/2023] [Indexed: 04/18/2023] Open
Abstract
A 68-year-old female, with a known case of mantle cell lymphoma, came with complaints of persistent cough with expectoration for three months, not responding to multiple courses of antibiotics. Bronchoscopy was done and bronchoalveolar lavage (BAL) culture revealed Penicillium species. She was started on IV liposomal amphotericin B for 14 days and then switched to oral itraconazole which showed a response to treatment. Early diagnosis of penicilliosis and prompt treatment are important as it is rare and associated with a high mortality rate.
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Affiliation(s)
- Sai Chandra Hakeem
- Department of Internal Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, IND
| | - Kiran G Kulirankal
- Department of Internal Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, IND
| | - Ann Mary
- Department of Internal Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, IND
| | - Merlin Moni
- Department of Internal Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, IND
| | - Dipu T Sathyapalan
- Department of Internal Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, IND
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T Sathyapalan D, V Nair C, Moni M, Edathadathil F, A A, Prasanna P, Pushpa Raghavan R, Jayant A. Incidence and characterisation of post-COVID-19 symptoms in hospitalized COVID-19 survivors: A single centre, prospective observational cohort study to recognize the syndemic connotations in India. JMIR Form Res 2023; 7:e40028. [PMID: 36920842 PMCID: PMC10131721 DOI: 10.2196/40028] [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: 06/02/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Long COVID or post-COVID-19 syndrome is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to pre pandemic states, post-COVID-19 state tends to be less recognised from low middle income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of the COVID 19, it is important to characterise post-COVID-19 syndrome. OBJECTIVE We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February 2021 to July 2021 from a tertiary care centre in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in non-ICU and ICU patients, assessing the persistence, severity and characteristics of post-COVID-19 manifestations and elucidating the risk factors associated with the presence of post-COVID-19 manifestations. METHODS 120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after informed written consent. The cohort included 50 patients requiring Intensive care unit and 70 patients with non-intensive care. The follow-up was conducted on the second and sixth week after discharge with a structured questionnaire. The questionnaire was filled by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow up at 6 weeks. RESULTS : Mean age of the cohort was 55 years and 55% were males. Only (5%) of the cohort had taken the first dose of COVID-19 vaccination.58.3% had mild COVID-19 and 41.7% had moderate to severe COVID-19 infection. 60.8% (n=73) of patients had at least one persistent symptom at sixth week of discharge. 50 (41.7%) patients required intensive care during their inpatient stay. Presence of persistent symptoms at 6 weeks was not associated with severity of illness, age or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8% followed by dyspnoea (20%) and weight loss (16.7%). Female sex (OR 2.4, 95% CI: 1.03-5.58, P=.04) and steroid administration during hospital stay (OR: 4.43; 95% CI: 1.9-10.28, P=.001), were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis. CONCLUSIONS 60.8% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 week's post- discharge from hospital. Incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate and severe COVID-19 severity categories. Female sex and steroid administration during hospital stay were identified as predictors of persistence of post-COVID-19 symptoms at 6 weeks. CLINICALTRIAL
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Affiliation(s)
- Dipu T Sathyapalan
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Chithira V Nair
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Merlin Moni
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Fabia Edathadathil
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Appukuttan A
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Preetha Prasanna
- Department of Medical Administration, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | | | - Aveek Jayant
- Department of Anaesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, IN
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T Sathyapalan D, Moni M, Prasanna P, Marwaha V, Bala Madathil S, Edathadathil F, Jose SA, Pavithran S, Muralikrishanan R, Ramachandran N, P R R, T S T, Nair AS, Kuriachan S, Louis Palatty P. Adverse events associated with Covishield vaccination among healthcare workers in a tertiary hospital in South India. Vaccine X 2022; 12:100210. [PMID: 36059598 PMCID: PMC9420054 DOI: 10.1016/j.jvacx.2022.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 04/28/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
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Krishnakumar RT, Asok A, Mohamed ZU, Padma UD, Sathyapalan DT, Moni M, Balachandran S, Kumar AV, Nair R, Sudhindran S, Singh SK. Colistin (Polymyxin E) Use in Abdominal Solid Organ. J Pharm Pract 2022:8971900221074967. [PMID: 35201947 DOI: 10.1177/08971900221074967] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Amrita Asok
- Department of Pharmacy Practice, Amrita School of Pharmacy, Cochin, India
| | - Zubair U Mohamed
- Department of Anaesthesia and Critical Care, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Uma D Padma
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Cochin, India
| | - Dipu T Sathyapalan
- Division of Infectious Diseases, Department of General Medicine, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Merlin Moni
- Division of Infectious Diseases, Department of General Medicine, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Sabarish Balachandran
- Department of Emergency Medicine and Critical Care, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Anil V Kumar
- Department of Microbiology, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Rajesh Nair
- Department of Nephrology, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Surendran Sudhindran
- Department of Gastro-intestinal Surgery and Transplantation, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Sanjeev K Singh
- Medical Superintendent, 29286Amrita Institute of Medical Sciences, Cochin, India
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George R, Mehta AA, Paul T, Sathyapalan DT, Haridas N, Kunoor A, Ravindran GC. Validation of MuLBSTA score to derive modified MuLB score as mortality risk prediction in COVID-19 infection. PLOS Glob Public Health 2022; 2:e0000511. [PMID: 36962449 PMCID: PMC10021136 DOI: 10.1371/journal.pgph.0000511] [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] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Abstract
COVID-19pandemic was started in December 2019. It has variable presentation from mild sore throat to severe respiratory distress. It is important to identify individuals who are likely to worsen. The Research question is how to identify patients with COVID-19 who are at high risk and to predict patient outcome based on a risk stratification model? We evaluated 251 patients with COVID-19 in this prospective inception study. We used a multi-variable Cox proportional hazards model to identify the independent prognostic risk factors and created a risk score model on the basis of available MuLBSTA score. The model was validated in an independent group of patients from October2020 to December 2021. We developed a combined risk score, the MuLBA score that included the following values and scores: Multi lobar infiltrates (negative0.254, 2), lymphopenia (lymphocytes of <0.8x109 /L, negative0.18,2), bacterial co- infection (negative, 0.306,3). In our MuLB scoring system, score of >8 was associated with high risk of mortality and <5 was at mild risk of mortality (P < 0.001). The interpretation was that The MuLB risk score model could help to predict survival in patients with severe COVID-19 infection and to guide further clinical research on risk-based treatment.
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Affiliation(s)
- Richie George
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Asmita A Mehta
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Tisa Paul
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Dipu T Sathyapalan
- Division of infectious Diseases, Department of Internal Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Nithya Haridas
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Akhilesh Kunoor
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Greeshma C Ravindran
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Balachandran S, Moni M, Sathyapalan DT, Varghese P, Jose MP, Murugan MR, Rajan C, Saboo D, Nair SS, Varkey RA, Balachandran P, Menon GR, Vasudevan BK, Banerjee A, Janakiram C, Menon JC. A comparison of clinical outcomes between vaccinated and vaccine-naive patients of COVID-19, in four tertiary care hospitals of Kerala, South India. Clinical Epidemiology and Global Health 2022; 13:100971. [PMID: 35075439 PMCID: PMC8769674 DOI: 10.1016/j.cegh.2022.100971] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/17/2021] [Accepted: 01/12/2022] [Indexed: 01/19/2023] Open
Abstract
The problem considered This multi-centric study analyzed data of COVID-19 patients and compared differences in symptomatology, management, and outcomes between vaccinated and vaccine-naive patients. Methods All COVID-19 positive individuals treated as an in-or out-patient from the 1stMarch to 15th May 2021 in four selected study sites were considered for the study. Treatment details, symptoms, and clinical course were obtained from hospital records. Chi-square was used to test the association of socio-demographic and treatment variables with the vaccination status and binary logistic regression were used to obtain the odds ratio with a 95% confidence interval. Results The analysis was of 1446 patients after exclusion of 156 with missing data of which males were 57.3% and females 42.7%. 346 were vaccinated; 189 received one dose and 157 both doses. Hospitalization was more in vaccinated (38.2% vs 27.4%); ICU admissions were less in vaccinated (3.5% vs 7.1%). More vaccinated were symptomatic (OR = 1.5); half less likely to be on non-invasive ventilation (OR = 0.5) while vaccine naive patients had 4.21 times the risk of death. Conclusion Severe infection, duration of hospital stays, need for ventilation and death were significantly less among vaccinated when compared with vaccine naive patients.
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Affiliation(s)
- Sabarish Balachandran
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India
| | - Merlin Moni
- Division of Infectious Diseases, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India
| | - Dipu T Sathyapalan
- Division of Infectious Diseases, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India
| | - Prinoj Varghese
- Department of General Medicine, Sree Narayana Institute of Medical Sciences, Kerala, 683594, India
| | - Manoj P Jose
- Department of General Medicine, Little Flower Hospital and Research Centre, Kerala, 683572, India
| | - Mithun R Murugan
- Internal Medicine, PRS Hospital, Thiruvananthapuram, Kerala, 695002, India
| | - C Rajan
- Department of General Medicine, Sree Narayana Institute of Medical Sciences, Kerala, 683594, India
| | - Dhanraj Saboo
- Department of Medicine, Little Flower Hospital and Research Centre, Kerala, India
| | - Sooraj S Nair
- PRS Hospital, Killipalam, Thiruvananthapuram, Kerala, 695002, India
| | - Reshmi Ann Varkey
- Department of Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India
| | - Parvathy Balachandran
- Amrita School of Dentistry, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India
| | - Geetha R Menon
- ICMR- National Institute of Medical Statistics, New Delhi, India
| | - Beena K Vasudevan
- Department of Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India
| | - Amitava Banerjee
- Professor in Clinical Data Science and Honorary Consultant Cardiologist, Institute of Health Informatics, University College London, United Kingdom
| | - Chandrasekhar Janakiram
- Amrita School of Dentistry, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India
| | - Jaideep C Menon
- Preventive Cardiology Unit, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India
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Rao B H, Nair P, Priya SK, Vallonthaiel AG, Sathyapalan DT, Koshy AK, Venu RP. Role of endoscopic ultrasound guided fine needle aspiration/biopsy in the evaluation of intra-abdominal lymphadenopathy due to tuberculosis. World J Gastrointest Endosc 2021; 13:649-658. [PMID: 35070026 PMCID: PMC8716983 DOI: 10.4253/wjge.v13.i12.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/26/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intra-abdominal lymphadenopathy due to tuberculosis (TB) poses a diagnostic challenge due to difficulty in tissue acquisition. Although endoscopic ultrasound guided fine needle aspiration/biopsy (EUS-FNA/B) has shown promise in the evaluation of mediastinal lymph nodes, its role in the evaluation of intra-abdominal lymphadenopathy is not clear.
AIM To assess the role of EUS-FNA/B in the evaluation of intra-abdominal lymphadenopathy due to TB.
METHODS This was a retrospective study where patients with intra-abdominal lymphadenopathy who underwent evaluation with EUS-FNA/B were included. TB was diagnosed if the patient had any one of the following: (1) Positive acid fast bacilli (AFB) stain/TB GeneXpert/TB-polymerase chain reaction/AFB culture of tissue sample; and (2) Positive Mantoux test and response to anti-tubercular therapy. EUS-FNA reports, clinical reports and imaging characteristics of patients were recorded for a detailed analysis of patients with TB.
RESULTS A total of 149 patients underwent an EUS-FNA/B from lymph nodes (mean age 51 ± 17 years, M:F = 1.2). Benign inflammatory reactive changes were seen in 45 patients (30.2%), while 54 patients (36.2%) showed granulomatous inflammation with/without caseation. Among these, 51 patients (94.4%) were confirmed to have TB as per pre-defined criteria. Patients with TB were more likely to have hypoechoic and matted nodes [40 patients (67.7%)]. EUS-FNA/B was found to have a sensitivity and specificity of 86% and 93% respectively, with a diagnostic accuracy of 88% in the evaluation of intra-abdominal lymphadenopathy due to TB.
CONCLUSION EUS-FNA/B has a high diagnostic yield with a good sensitivity and specificity in the evaluation of intra-abdominal lymphadenopathy due to TB. However, the validity of these findings in populations with low prevalence of TB needs further evaluation.
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Affiliation(s)
- Harshavardhan Rao B
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi 682041, Kerala, India
| | - Priya Nair
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi 682041, Kerala, India
| | - S Krishna Priya
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi 682041, Kerala, India
| | | | - Dipu T Sathyapalan
- Department of Internal Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi 682041, Kerala, India
| | - Anoop K Koshy
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi 682041, Kerala, India
| | - Rama P Venu
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi 682041, Kerala, India
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Moni M, Madathil T, Palabatla R, Balachandran S, Edathadathil F, Gutjahr G, Madathil SB, Pai R, Kv B, Jayant A, Sathyapalan DT. Waiting for Godot: A cross sectional survey based analysis of the hydroxychloroquine prophylaxis strategy against COVID-19 in India. J Public Health Res 2020; 9:1888. [PMID: 33457350 PMCID: PMC7802012 DOI: 10.4081/jphr.2020.1888] [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: 08/05/2020] [Accepted: 12/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background: India currently has the second largest burden of infections due to COVID-19. Health Care Worker (HCW) shortages are endemic to Indian healthcare. It should therefore be a huge priority to protect this precious resource as a critical component of the systemic response to this pandemic. Advisories from the Indian Council of Medical Research (ICMR) have focused on using hydroxychloroquine prophylaxis against COVID-19 in at risk HCW. This prophylaxis strategy has no evidence. In further jeopardy there appear to insubstantial attempts to build this evidence as well. In this connection, we commissioned a survey within our Institution to estimate the penetration of hydroxychloroquine (HCQ) use and use this to statistically model the impact of current ongoing studies in India. We also briefly review the literature on HCQ prophylaxis for COVID-19. Design and methods: A structured survey designed using RedCAP application was disseminated among healthcare professionals employed at an academic referral tertiary care centre via online social media platforms. The survey was kept open for the entire month of June 2020. The survey was additionally used to statistically model the size of studies required to comprehensively address the efficacy of HCQ in this setting. Results: 522 responses were received, of which 4 were incomplete. The ICMR strategy of 4 or more doses of HCQ was complete only in 15% of HCW in our survey. The majority of respondents were doctors (238, 46%). Amongst all category of responders, only 12% (n=63) received the full course. A majority of those who initiated the chemoprophylaxis with HCQ turned out to be medical professionals (59/63) with neither nurse nor other categories of healthcare workers accessing the medication. The respondents of our institutional survey did not report any life-threatening side effects. Presuming efficacy as per ICMR modelling for new registry trial on the lines of the published case control study, equal allocation between cases and controls and assuming a RR of 1.3.6, the power of such a study would be very low for n=2000 for event rates from 2.5-12.5%. Conclusion: We report the low penetration of HCQ chemoprophylaxis among the healthcare workers of our institution. We highlight the inherent drawbacks in the study design of current national COVID related trial based on the statistical modelling of our survey results and published literature, and thereby emphasis the need of evidence-based strategies contributing to research policy at national level. Significance for public health In the context of the mounting COVID pandemic in India crippling the public health system and curtailing healthcare workers of the country, we would like to report the low hydroxychloroquine chemoprophylaxis rate from our institutional survey among healthcare workers that highlights the poor penetration of a national hydroxychloroquine prophylaxis advisory. The brief review on hydroxychloroquine (HCQ) chemoprophylaxis strategy for COVID-19 that draws on from existing literature and countrywide COVID trials reveals tenuous research designs which would be consequently informing public health policies of the nation. We emphasize on the need for continued emphasis on evidence based protective measures and rigorous efforts to build this evidence when lacking.
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Affiliation(s)
- Merlin Moni
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
| | - Thushara Madathil
- Department of Anaesthesiology and Critical Care Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
| | - Rahul Palabatla
- Department of General Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
| | - Sabarish Balachandran
- Department of Emergency Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
| | - Fabia Edathadathil
- Department of Allied Health Sciences, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
| | - Georg Gutjahr
- Department of Statistics, AmritaCREATE, Amrita Vishwa Vidyapeetham, Amritapuri Kollam Kerala
| | - Sai B Madathil
- Department of Nursing services, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
| | - Rajesh Pai
- Department of Medical Administration, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
| | - Beena Kv
- Department of Medical Administration, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
| | - Aveek Jayant
- Department of Anaesthesiology and Critical Care Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
| | - Dipu T Sathyapalan
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Sathyapalan DT, Padmanabhan A, Moni M, P-Prabhu B, Prasanna P, Balachandran S, Trikkur SP, Jose S, Edathadathil F, Anilkumar JO, Jayaprasad R, Koramparambil G, Kamath RC, Menon V, Menon V. Efficacy & safety of Carica papaya leaf extract (CPLE) in severe thrombocytopenia (≤30,000/μl) in adult dengue - Results of a pilot study. PLoS One 2020; 15:e0228699. [PMID: 32074143 PMCID: PMC7029881 DOI: 10.1371/journal.pone.0228699] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 01/21/2020] [Indexed: 11/22/2022] Open
Abstract
Severe thrombocytopenia in dengue often prompts platelet transfusion primarily to reduce bleeding risk. In India, about 11–43% of dengue patients report receiving platelet transfusions which is considered scarce and expensive especially in resource limited settings. Herein, we evaluated the efficacy and safety of Carica papaya leaf extract (CPLE) in the management of severe thrombocytopenia (≤30,000/μL) in dengue infection. 51 laboratory confirmed adult dengue patients with platelet counts ≤30,000/μL were randomly assigned to either treatment (n = 26) or placebo (n = 24) group. By day 3, CPLE treated patients reported significantly (p = 0.007) increased platelet counts (482%± 284) compared to placebo (331%±370) group. In the treatment group, fewer patients received platelet transfusions (1/26 v/s 2/24) and their median time for platelets to recover to ≥ 50,000/μL was 2 days (IQR 2–3) compared to 3 days (IQR 2–4) in placebo. Overall, CPLE was safe and well tolerated with no significant decrease in mean hospitalization days. Plasma cytokine profiling revealed that by day 3, mean percent increase in TNFα and IFNγ levels in treatment group was less compared to that observed in placebos; (TNFα: 58.6% v/s 127.5%; p = 0.25 and IFNγ: 1.93% v/s 62.6% for; p = 0.12). While a mean percent increase in IL-6 levels occurred in placebos (15.92%±29.93%) by day 3, a decrease was noted in CPLE group (12.95%±21.75%; p = 0.0232). Inversely, CPLE treated patients reported a mean percent increase compared to placebo by day 3 (143% ±115.7% v/s 12.03%± 48.4%; p = 0.006). Further, by day 3, a faster clearance kinetics of viral NS1 antigenemia occurred–mean NS1 titers in treatment group decreased to 97.3% compared to 88% in placebos (p = 0.023). This study demonstrates safety and efficacy of CPLE in increasing platelet counts in severe thrombocytopenia in dengue infections. A possible immunomodulatory and antiviral activity may be attributed to CPLE treatment. These findings merit validation in larger prospective studies. Trial registration Name of the registry: Clinical Trials Registry—India (CTRI) Registration No.: CTRI-REF/2017/02/013314
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Affiliation(s)
- Dipu T. Sathyapalan
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Athira Padmanabhan
- Clinical Virology Laboratory, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Merlin Moni
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Binny P-Prabhu
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Preetha Prasanna
- Department of Medical Administration, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sabarish Balachandran
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sreekrishnan P. Trikkur
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Soumya Jose
- Clinical Virology Laboratory, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Fabia Edathadathil
- Department of Allied Health Sciences, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Jagan O. Anilkumar
- Clinical Virology Laboratory, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Rekha Jayaprasad
- Department of Medical Administration, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - Ravindra C. Kamath
- Department of Integrated & Holistic Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Veena Menon
- Clinical Virology Laboratory, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Vidya Menon
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
- * E-mail:
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12
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Mohamed ZU, Prasannan P, Moni M, Edathadathil F, Prasanna P, Menon A, Nair S, Greeshma CR, Sathyapalan DT, Menon V, Menon V. Vitamin C Therapy for Routine Care in Septic Shock (ViCTOR) Trial: Effect of Intravenous Vitamin C, Thiamine, and Hydrocortisone Administration on Inpatient Mortality among Patients with Septic Shock. Indian J Crit Care Med 2020; 24:653-661. [PMID: 33024370 PMCID: PMC7519616 DOI: 10.5005/jp-journals-10071-23517] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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] [Indexed: 12/13/2022] Open
Abstract
Background Sepsis remains a leading cause of death worldwide despite advances in management strategies. Preclinical and observational studies have found mortality benefit with high-dose vitamin C in sepsis. Our study aims to prospectively evaluate the effect of intravenous hydrocortisone, vitamin C [ascorbic acid (AA)], and thiamine (HAT) administration in reducing inpatient all-cause mortality among patients with septic shock. Materials and methods Our single-center, prospective, open-label, randomized controlled trial recruited patients with admitting diagnosis of septic shock and assigned eligible patients (1:1) into either intervention (HAT) or control group (routine). The HAT group received intravenous combination of vitamin C (1.5 g every 6 hours), thiamine (200 mg every 12 hours), and hydrocortisone (50 mg every 6 hours) within 6 hours of onset of septic shock admission. The treatment was continued for at least 4 days, in addition to the routine standard of care provided to the control group. Thiamine and hydrocortisone use in control arm was not restricted. Vitamin C levels were estimated at baseline and at the end of the 4 days of treatment for both groups. The primary outcome evaluated was mortality during inpatient stay. Results Among 90 patients enrolled, 88 patients completed the study protocol. The baseline characteristics between the HAT (n = 45) and the routine (n = 43) groups were comparable. The all-cause mortality in the HAT cohort was 57% (26/45) compared to 53% (23/43) in the routine care group (p = 0.4, OR 1.19, 95% CI 0.51-2.76). The time to reversal of septic shock was significantly lower in the HAT (34.58 ± 22.63 hours) in comparison to the routine care (45.42 ± 24.4 hours) (p = 0.03, mean difference -10.84, 95% CI -20.8 to -0.87). No significant difference was observed between the HAT and the routine care with respect to changes in sequential organ failure assessment (SOFA) scores at 72 hours (2.23 ± 2.4 vs 1.38 ± 3.1), the use of mechanical ventilation (48% vs 46%), and mean Vasoactive Inotropic Score (7.77 ± 12.12 vs 8.86 ± 12.5). Conclusion Intravenous administration of vitamin C, thiamine, and hydrocortisone did not significantly improve the inpatient all-cause mortality among patients with septic shock. Clinical significance HAT protocol does not reduce hospital mortality but decreases time to shock reversal in septic shock. How to cite this article Mohamed ZU, Prasannan P, Moni M, Edathadathil F, Prasanna P, Menon A, et al. Vitamin C Therapy for Routine Care in Septic Shock (ViCTOR) Trial: Effect of Intravenous Vitamin C, Thiamine, and Hydrocortisone Administration on Inpatient Mortality among Patients with Septic Shock. Indian J Crit Care Med 2020;24(8):653-661.
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Affiliation(s)
- Zubair U Mohamed
- Department of Anesthesia and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Pratibha Prasannan
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Merlin Moni
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Fabia Edathadathil
- Department of Allied Health Sciences, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Preetha Prasanna
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Anup Menon
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sabarish Nair
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - C R Greeshma
- Department of Biostatistics, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Dipu T Sathyapalan
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Veena Menon
- Clinical Virology Laboratory, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Vidya Menon
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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