1
|
Sinha S, Bansal G, Samad SA, Ajayababu A, Lal BM, Kabra SK, Lodha R, Sangle SA, Guha SK, Rajput N, Pandey RM, Ranjan S, Salvi S, Mundhe S, More M, Modak D, Datta K, Das BK, Kinikar A. Survival of Children Living with HIV/AIDS: A Multicentric Study from India. Natl Acad Sci Lett 2023. [DOI: 10.1007/s40009-023-01242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
|
2
|
Sinha S, Abdul Samad S, Bansal G, Verma S, A Sangle S, Kamal Guha S, Rajput N, M Pandey R, Ranjan S, Salvi S, Mundhe S, More M, Modak D, Datta K, K Kabra S, Lodha R, Nischal N, K Das B. Survival of persons living with HIV/AIDS: A multicentric study from India. Curr HIV Res 2023; 21:81-87. [PMID: 36734902 DOI: 10.2174/1570162x21666230123151639] [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: 09/04/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND It has been more than 17 years since the introduction of free ART in India. At this point, it would be prudent to look at the factors associated with the survival of persons living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLHA) who are already enrolled in the ART program. METHODS PLHAs enrolled from antiretroviral therapy (ART) centers located in three different cities in India - Delhi, Pune and Kolkata, and were followed up at six monthly intervals monitoring the WHO stage, CD4 counts, complete blood counts, and liver and kidney function tests, for a duration of three years. RESULTS AND DISCUSSION The incidence of mortality among HIV/AIDS patients on ART was 5·0 per 1000 patient-years (21/1410, 1.4%). Age at initiation of ART, being above 35 years, was the only significant predictor of mortality (log-rank p = 0·018). Multivariable analysis showed a significant association of an unfavourable outcome (defined as mortality or development of opportunistic infection during follow-up) with male gender (adjusted odds ratio (AOR) = 5.26, p = <0.01) and being unmarried at ART initiation (AOR = 1.39, p = 0.005). CONCLUSION The survival of PLHA with good adherence to ART is independent of the WHO stage or CD4 counts at the initiation of ART. Initiation of ART after 35 years of age was a significant predictor of mortality.
Collapse
Affiliation(s)
- Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Abdul Samad
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Bansal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurav Verma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Neetu Rajput
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- All India Institute of Medical Sciences Medicine New Delhi India
| | - Sanjay Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sonali Salvi
- Department of Medicine, B J Government Medical College and SGH, Pune, India
| | - Sanjay Mundhe
- Department of Medicine, B J Government Medical College and SGH, Pune, India
| | - Monika More
- Department of Medicine, B J Government Medical College and SGH, Pune, India
| | - Dolanchampa Modak
- Centre of Excellence in HIV care, School of Tropical Medicine, Kolkata, India
| | - Kalpana Datta
- Centre of Excellence in HIV care, School of Tropical Medicine, Kolkata, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal K Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
3
|
Choudhary ML, Chaudhary U, Salve M, Shinde P, Padbidri V, Sangle SA, Salvi S, Bavdekar AR, D'costa P, Alagarasu K. Functional Single-Nucleotide Polymorphisms in the MBL2 and TLR3 Genes Influence Disease Severity in Influenza A (H1N1)pdm09 Virus-Infected Patients from Maharashtra, India. Viral Immunol 2022; 35:303-309. [PMID: 35196173 DOI: 10.1089/vim.2021.0179] [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] [Indexed: 11/13/2022] Open
Abstract
The clinical outcome in influenza A (H1N1)pdm09 virus-infected subjects is determined by several factors, including host genetics. In the present study, single-nucleotide polymorphisms (SNPs) in the IFITM, MBL2, TLR3, TLR8, DDX58, IFIH1, CD55, and FCGR2, genes were investigated in influenza A (H1N1)pdm09 virus-infected subjects to find out their association with disease severity. Influenza A (H1N1)pdm09 virus-infected subjects with severe disease (n = 86) and mild disease (n = 293) from western India were included in the study. The SNPs were investigated by PCR-based methods. The results revealed a higher frequency of TLR3 rs5743313 T/T genotype [odds ratio (OR) with 95% confidence interval (CI) 2.55 (1.08-6.04) p = 0.039] and TLR3 two-locus haplotype rs3775291-rs3775290 T-A [OR with 95% CI 7.94 (2.05-30.68)] in severe cases. Lower frequency of the mutant allele of MBL2 rs1800450 [OR with 95% CI 0.51 (0.27-0.87), p = 0.01] and TLR3 two-locus haplotype rs3775291-rs3775290 T-G [OR with 95% CI 0.48 (0.27-0.85)] was observed in severe cases compared with cases with mild disease. Higher frequency of TLR3 two-locus haplotype rs3775291-rs3775290 T-A was observed in severe cases [OR with 95% CI 7.9 (2.0-30.7)]. The allele and genotype frequencies of other SNPs were not different between the study categories. The results suggest that the functional SNPs in MBL2 and TLR3 are associated with severe disease in influenza A (H1N1)pdm09 virus-infected subjects.
Collapse
Affiliation(s)
| | | | | | - Pooja Shinde
- ICMR-National Institute of Virology, Pune, India
| | | | | | - Sonali Salvi
- Department of Medicine, BJ Medical College, Pune, India
| | | | | | | |
Collapse
|
4
|
Alagarasu K, Kaushal H, Shinde P, Kakade M, Chaudhary U, Padbidri V, Sangle SA, Salvi S, Bavdekar AR, D’costa P, Choudhary ML. TNFA and IL10 Polymorphisms and IL-6 and IL-10 Levels Influence Disease Severity in Influenza A(H1N1)pdm09 Virus Infected Patients. Genes (Basel) 2021; 12:genes12121914. [PMID: 34946862 PMCID: PMC8700762 DOI: 10.3390/genes12121914] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 12/05/2022] Open
Abstract
Cytokines are key modulators of immune response, and dysregulated production of proinflammatory and anti-inflammatory cytokines contributes to the pathogenesis of influenza A(H1N1)pdm09 virus infection. Cytokine production is impacted by single nucleotide polymorphisms (SNPs) in the genes coding for them. In the present study, SNPs in the IL6, TNFA, IFNG, IL17A, IL10, and TGFB were investigated for their association with disease severity and fatality in influenza A(H1N1)pdm09-affected patients with mild disease (n = 293) and severe disease (n = 86). Among those with severe disease, 41 patients had fatal outcomes. In a subset of the patients, levels of IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, and IL-17 were assayed in the plasma for their association with severe disease. The frequency of TNFA rs1800629 G/A allele was significantly higher in severe cases and survived severe cases group compared to that of those with mild infection (OR with 95% for mild vs. severe cases 2.95 (1.52–5.73); mild vs. survived severe cases 4.02 (1.84–8.82)). IL10 rs1800896-rs1800872 G-C haplotype was significantly lower (OR with 95% 0.34 (0.12–0.95)), while IL10 rs1800896-rs1800872 G-A haplotype was significantly higher (OR with 95% 12.11 (2.23–76.96)) in fatal cases group compared to that of the mild group. IL-6 and IL-10 levels were significantly higher in fatal cases compared to that of survived severe cases. IL-6 levels had greater discriminatory power than IL-10 to predict progression to fatal outcome in influenza A(H1N1)pdm09 virus-infected patients. To conclude, the present study reports the association of TNFA and IL10 SNPs with severe disease in Influenza A(H1N1)pdm09 virus-infected subjects. Furthermore, IL-6 levels can be a potential biomarker for predicting fatal outcomes in Influenza A(H1N1)pdm09 virus infected subjects.
Collapse
Affiliation(s)
- Kalichamy Alagarasu
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
| | - Himanshu Kaushal
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
| | - Pooja Shinde
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
| | - Mahadeo Kakade
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
| | - Urmila Chaudhary
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
| | | | - Shashikala A. Sangle
- Department of Medicine, BJ Medical College, Pune 411001, India; (S.A.S.); (S.S.)
| | - Sonali Salvi
- Department of Medicine, BJ Medical College, Pune 411001, India; (S.A.S.); (S.S.)
| | | | - Pradeep D’costa
- KEM Hospital Research Center, Pune 411001, India; (A.R.B.); (P.D.)
| | - Manohar Lal Choudhary
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
- Correspondence: ; Tel.: +91-020-26006270
| |
Collapse
|
5
|
Soin AS, Kumar K, Choudhary NS, Sharma P, Mehta Y, Kataria S, Govil D, Deswal V, Chaudhry D, Singh PK, Gupta A, Agarwal V, Kumar S, Sangle SA, Chawla R, Narreddy S, Pandit R, Mishra V, Goel M, Ramanan AV. Tocilizumab plus standard care versus standard care in patients in India with moderate to severe COVID-19-associated cytokine release syndrome (COVINTOC): an open-label, multicentre, randomised, controlled, phase 3 trial. Lancet Respir Med 2021; 9:511-521. [PMID: 33676589 PMCID: PMC8078880 DOI: 10.1016/s2213-2600(21)00081-3] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Global randomised controlled trials of the anti-IL-6 receptor antibody tocilizumab in patients admitted to hospital with COVID-19 have shown conflicting results but potential decreases in time to discharge and burden on intensive care. Tocilizumab reduced progression to mechanical ventilation and death in a trial population enriched for racial and ethnic minorities. We aimed to investigate whether tocilizumab treatment could prevent COVID-19 progression in the first multicentre randomised controlled trial of tocilizumab done entirely in a lower-middle-income country. METHODS COVINTOC is an open-label, multicentre, randomised, controlled, phase 3 trial done at 12 public and private hospitals across India. Adults (aged ≥18 years) admitted to hospital with moderate to severe COVID-19 (Indian Ministry of Health grading) confirmed by positive SARS-CoV-2 PCR result were randomly assigned (1:1 block randomisation) to receive tocilizumab 6 mg/kg plus standard care (the tocilizumab group) or standard care alone (the standard care group). The primary endpoint was progression of COVID-19 (from moderate to severe or from severe to death) up to day 14 in the modified intention-to-treat population of all participants who had at least one post-baseline assessment for the primary endpoint. Safety was assessed in all randomly assigned patients. The trial is completed and registered with the Clinical Trials Registry India (CTRI/2020/05/025369). FINDINGS 180 patients were recruited between May 30, 2020, and Aug 31, 2020, and randomly assigned to the tocilizumab group (n=90) or the standard care group (n=90). One patient randomly assigned to the standard care group inadvertently received tocilizumab at baseline and was included in the tocilizumab group for all analyses. One patient randomly assigned to the standard care group withdrew consent after the baseline visit and did not receive any study medication and was not included in the modified intention-to-treat population but was still included in safety analyses. 75 (82%) of 91 in the tocilizumab group and 68 (76%) of 89 in the standard care group completed 28 days of follow-up. Progression of COVID-19 up to day 14 occurred in eight (9%) of 91 patients in the tocilizumab group and 11 (13%) of 88 in the standard care group (difference -3·71 [95% CI -18·23 to 11·19]; p=0·42). 33 (36%) of 91 patients in the tocilizumab group and 22 (25%) of 89 patients in the standard care group had adverse events; 18 (20%) and 15 (17%) had serious adverse events. The most common adverse event was acute respiratory distress syndrome, reported in seven (8%) patients in each group. Grade 3 adverse events were reported in two (2%) patients in the tocilizumab group and five (6%) patients in the standard care group. There were no grade 4 adverse events. Serious adverse events were reported in 18 (20%) patients in the tocilizumab group and 15 (17%) in the standard care group; 13 (14%) and 15 (17%) patients died during the study. INTERPRETATION Routine use of tocilizumab in patients admitted to hospital with moderate to severe COVID-19 is not supported. However, post-hoc evidence from this study suggests tocilizumab might still be effective in patients with severe COVID-19 and so should be investigated further in future studies. FUNDING Medanta Institute of Education and Research, Roche India, Cipla India, and Action COVID-19 India.
Collapse
Affiliation(s)
- Arvinder S Soin
- Medanta Institute of Education and Research, Medanta-The Medicity Hospital, Gurugram, Haryana, India.
| | - Kuldeep Kumar
- Medanta Institute of Education and Research, Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | - Narendra S Choudhary
- Medanta Institute of Education and Research, Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | - Pooja Sharma
- Medanta Institute of Education and Research, Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | - Yatin Mehta
- Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | | | - Deepak Govil
- Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | - Vikas Deswal
- Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | - Dhruva Chaudhry
- Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | | | | | - Vikas Agarwal
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | | | | | | | - Manoj Goel
- Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust and Translational Health Sciences, Bristol Medical School, Bristol, UK
| |
Collapse
|
6
|
Choudhary ML, Alagarasu K, Chaudhary U, Kawale S, Malasane P, Gurav YK, Padbidri V, Kadam D, Sangle SA, Salvi S, Bavdekar AR, D'costa P, Chadha MS. Association of Single Nucleotide Polymorphisms inTNFAandIL10Genes with Disease Severity in Influenza A/H1N1pdm09 Virus Infections: A Study from Western India. Viral Immunol 2018; 31:683-688. [DOI: 10.1089/vim.2018.0120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Urmila Chaudhary
- Human Influenza Group, ICMR-National Institute of Virology, Pune, India
| | - Samruddhi Kawale
- Human Influenza Group, ICMR-National Institute of Virology, Pune, India
| | - Prachi Malasane
- Human Influenza Group, ICMR-National Institute of Virology, Pune, India
| | - Yogesh K. Gurav
- Human Influenza Group, ICMR-National Institute of Virology, Pune, India
| | | | - Deelip Kadam
- Department of Medicine, BJ Medical College, Pune, India
| | | | - Sonali Salvi
- Department of Medicine, BJ Medical College, Pune, India
| | | | | | - Mandeep S. Chadha
- Human Influenza Group, ICMR-National Institute of Virology, Pune, India
| |
Collapse
|
7
|
Sangle SA. Reply from Author. J Assoc Physicians India 2015; 63:75. [PMID: 29900720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
8
|
Dhadke SV, Chaudhari AL, Deshpande NS, Dhadke VN, Sangle SA. Foreign Body in Left Main Bronchus. J Assoc Physicians India 2015; 63:70-71. [PMID: 26731835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tracheobronchial foreign body (TFB) aspiration is rare in adults, although incidence rates increases with advancing age. We report a case of foreign body in left main bronchus in an adult female who had no risk factor. She was successfully treated with removal of betel nuts by bronchoscopy. Unusual presentation and high index of suspicion can help in proper management.
Collapse
|
9
|
Sangle SA, Inamdar S, Deshmukh V. Cryptostegia grandiflora Toxicity Manifesting as Hyperkalemia, Complete Heart Block and Thrombocytopenia. J Assoc Physicians India 2015; 63:79-81. [PMID: 26591155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cardiac glycosides are widely available in botanic products and other naturally occurring substances worldwide. Accidental consumption of it leads to digitalis toxicity with varied systemic manifestations. We describe a case of consumption of extract of leaves of the Indian rubber vine plant (Crytostegia grandiflora) which led to gastrointestinal, cardiac, electrolyte, and hematological disturbances.
Collapse
|
10
|
|
11
|
Borse RT, Kadam DB, Sangle SA, Basavraj A, Prasad HB, Umarji PB, Jamkar AV. Comparison of demographic, clinical, radiological characteristics and comorbidities in mechanically ventilated and nonventilated, adult patients admitted in ICU with confirmed diagnosis of influenza A (H1N1). J Assoc Physicians India 2013; 61:887-893. [PMID: 24968544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and monitoring. Simple demographic, clinical and radiological variables are described in this article in mechanically ventilated and nonventilated patients. OBJECTIVES To describe and correlate demographic, clinical, radiographic characteristics and comorbidities in mechanically ventilated and nonventilated, adult patients admitted in ICU with confirmed diagnosis of Influenza A(H1N1) infection. MATERIAL AND METHODS Retrospective study of records of 100 RT-PCR confirmed patients with Influenza A (H1N1) infection from August 2009 to March 2010 was done. Each patient underwent an evaluation to determine demographic, clinical and radiographic features, comorbidities, mechanical ventilator required or not. RESULTS 35 Patients required mechanical ventilation. 27 required IMV, 4 required NIMV while 4 patients initially were put on NIMV required IMV subsequently. 19 (40.42%) female patients required mechanical ventilator. Mean age of mechanically ventilated patients was 33 years, mean duration of illness was 7.9 days, mean duration of hospital stay was 6.8 days. 07 (20.00%) patients with pregnancy, 05 (14.29%) with DM, 05 (14.29%) with HT, 04/11.43%) with obesity required mechanical ventilator. 97.14% patients with fever, 88.54% with breathlessness, 11.43% with haemoptysis, 31.42% patients with throat pain required mechanical ventilator. However except Tachypnoea (p <0.01) no other symptom was statistically significant for mechanical ventilation 33(36.26%) patients with abnormal X ray,16 (80.00%) patients with right sided, 09(60.00%) patients with left sided and 40(71.43%) patients with bilateral disease required mechanical ventilator, right sided (p < 0.01) and bilateral (p <0.01) disease is statistically significant for requirement of mechanical ventilator. 33(47.14%) patients with lower zone involvement, 44 (67.70%) patients with middle zone and 23 (47.92%) patients with upper zone involvement required mechanical ventilator. Upper zone disease (p < 0.01) and middle zone disease (p < 0.01) is statistically significant for requirement of ventilator. 23 (47.92%) patients with right upper zone, 29 (42.64%) patients with right middle zone, 29 (46.77%) with left middle zone, 32 (42.67%) with right lower zone involvement required mechanical ventilator. RUZ (p < 0.01), RMZ (p < 0.01), LMZ (p < 0.001) and RLZ (p < 0.01) involvement had statistical significance for requirement of mechanical ventilator. 20 (33.89%) patients with patchy consolidation, 08 (36.36%) patients with reticulonodular and 05 (50.00%) patients with nodular pattern required mechanical ventilator however none of the pattern is statistically significant for mechanical ventilator. 08 (72.72%) patients with 6 zone involvement, 05 (50.00%) patients with single zone, 08 (40.00%)patients with 4 zone and 06 (33.33%) patients with 3 zone involvement required mechanical ventilator,however none was statistically significant for mechanical ventilator. All four patients requiring NIMV survived, while 28 died out of 31 on IMV. CONCLUSIONS Mechanical ventilation requirement was more in females, in presence of comorbidities like pregnancy, DM, HT, in presence of tachypnoea, in presence of bilateral disease and in presence of middle zone and right upper zone disease and with multiple zone disease. All patients with heart involvement required mechanical ventilator. If there is radiological finding of right upper zone involvement, then, there is more probability that these patients require mechanical ventilator for case management. Similarly, RMZ, LMZ and RLZ and cardiomegaly if shown in X-ray, the necessity of ventilator management is more.
Collapse
|
12
|
Borse RT, Kadam DB, Sangle SA, Basavraj A, Prasad HB, Umarji PB, Khadase GJ, Rao SP, Mave V, Ghorpade SV, Bharadwaj R, Jamkar AV. Clinicoradiologic correlation in adult patients diagnosed with novel influenza A (H1N1). J Assoc Physicians India 2013; 61:600-607. [PMID: 24772694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and monitoring. OBJECTIVES To describe and correlate clinical and radiographic features of Influenza A(H1N1) infection in patients hospitalised in Intensive care unit. MATERIAL AND METHODS Retrospective study of records of 100 RT-PCR confirmed patients with Influenza A(H1N1) infection from August 2009 to March 2010 was done. Each patient underwent an evaluation to determine clinical and radiographic features. RESULTS Mean age of the patients was 33.43 years (+/- 12.152) with maximum patients between 18-40 years, with 53% males and 43% females. Cough (96%), Fever (95%), breathlessness (83%), throat pain (34%), crepitations (69%), Tachypnoea (59%)were the prominent symptoms and signs. 61% (n = 63) had comorbid condition like pregnancy (n = 13,20.63%), Diabetes Mellitus (DM) (n = 12,19.05%), HT (n = 11,17.60%), Obesity (n = 10, 15.87%) and Rheumatic Valvular Heart Disease (RVHD) (n = 6,09.52%). Chest X ray was abnormal in 91% patients and normal in 09% pts. Bilateral findings were seen in 61.53% cases. Most common zones affected were lower zones (77.46%), then middle zones (71.42%), followed by upper zones (42.7%). Most common patterns were consolidation (64.83%), reticulonodular (24.17%) and nodular (10.98%). 27.47% had two, 21.97% had four, 19.78% had three,12.08% had six, 7.69% had five and 10.98% had single zone involvement. Fever, cough and tachypnoea were present in all 100% pts with nodular pattern while crepitations were observed in 79.66% cases of consolidation. Patchy consolidation was seen in comorbidities like pregnancy (n = 10) and obesity (n = 06), while reticulonodular pattern was observed in hypertensive patients (n = 06). Maximum number of deaths were between 21 and 30 years of age (60.71%). Total number of deaths were 28 with 60.71% (n = 17) deaths between 21 and 30 years of age. Deaths were more in presence of comorbidities like Pregnancy (n = 5, 17.85%), Hypertension (n = 4,14.28%), Diabetes (n = 3 10.21%) and RVHD (n = 3,10.71%), in presence of RLZ involvement (92.85%), RMZ (89.28%), LMZ (85.21%) and RUZ involvement (71.42%), with consolidation pattern (57.14%) followed by reticulonodular pattern (21.42%) and in presence of six zone involvement (36.37%) followed by four zone (35%) and then by three(33%) and two (32%) zone involvement. Mean duration of hospital stay was 9.1 days. 23% patients stayed for less than 5 days, 41% stayed between 9 and 14 days while only 7% required to stay for more than 15 days. 37% pts showed normal Xray at the time of discharge or death. 38% patients showed persistence of radiological lesion at discharge or death. CONCLUSIONS Young to middle age patients were commonly affected. Common comorbidities were Pregnancy, Diabetes, Hypertension, and Obesity and patients had fever, cough, breathlessness, tachypnoea, crepitations as common clinical features. Radiologically it was multizonal, bilateral disease with predominant lower zone involvement and common patterns were consolidation followed by reticulonodular and nodular. Patchy consolidation was more common in pregnancy and obesity while reticulonodular pattern was more in hypertensive patients. Fever, cough and tachypnoea were present in all 100% pts with nodular pattern. Crepitations were common in pts with consolidation. Clinical recovery preceded radiological recovery. Young to middle aged individuals died more. Deaths were more in presence of comorbidities like Pregnancy, HT, DM and RVHD, also with RLZ, RMZ, LMZ involvement and with consolidation pattern and with six zone involvement.
Collapse
|
13
|
Sangle SA, Deshpande NS, Dhadke SV, Korade MB. Hyperkalemia due to fertilizer (N:P:K) poisoning. J Postgrad Med 2013; 59:333-4. [DOI: 10.4103/0022-3859.123179] [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] [Indexed: 11/04/2022] Open
|
14
|
Karne SS, Sangle SA, Kiyawat DS, Dharmashale SN, Kadam DB, Bhardwaj RS. Mycobacterium avium-intracellulare brain abscess in HIV-positive patient. Ann Indian Acad Neurol 2012; 15:54-5. [PMID: 22412276 PMCID: PMC3299074 DOI: 10.4103/0972-2327.93282] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 01/04/2011] [Revised: 03/08/2011] [Accepted: 06/01/2011] [Indexed: 11/04/2022] Open
Abstract
Mycobacterial opportunistic infections are a major cause of morbidity and mortality among patients living with HIV (PLHIV) worldwide. Nontuberculous mycobacterial (NTM) infection is one of the leading causes of opportunistic infection in patients with advanced acquired immunodeficiency syndrome i.e., with CD4 count less than 50/cu.mm. Mycobacterium avium complex (MAC) is among the most common opportunistic bacterial infections in those patients with advanced immunodeficiency apart from cryptococcal meningitis, progressive multifocal leukoencephalopathy, etc. Common presentations of mycobacterium avium complex are fever, lymphadenitis and respiratory disease. Immune reconstitution disease is also known to manifest with MAC infections in PLHIV on highly active antiretroviral therapy. Very few cases of central nervous system involvement due to NTM infection have been described. We are reporting a case of advanced acquired immunodeficiency who presented with brain abscess due to Mycobacterium avium intracellulare.
Collapse
Affiliation(s)
- Sampada S Karne
- Department of Medicine, B. J. Medical College and Sassoon General Hospitals, Pune, India
| | | | | | | | | | | |
Collapse
|
15
|
|
16
|
Sangle SA, Lohiy RV. Evan's syndrome in HIV infection. J Assoc Physicians India 2012; 60:49-50. [PMID: 23405542] [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: 06/01/2023]
Abstract
Haematological complications are common in HIV patients and it can be because of infection per se or secondary to opportunistic infections and antiretroviral therapy. Evan's syndrome, i.e., autoimmune haemolytic anaemia with thrombocytopenia is however a very rare occurrence inspite of high direct Coomb's test positivity in HIV patients. We are reporting one such rare case of Evan's syndrome in HIV patient probably first such reported case from India.
Collapse
Affiliation(s)
- Shashikala A Sangle
- Department of Medicine, B. J. Medical College and Sassoon General Hospitals, Pune
| | | |
Collapse
|
17
|
Prasad HB, Puranik SC, Kadam DB, Sangle SA, Borse RT, Basavraj A, Umarji PB, Mave V, Ghorpade SV, Bharadwaj R, Jamkar AV, Mishra AC. Retrospective analysis of necropsy findings in patients of H1N1 and their correlation to clinical features. J Assoc Physicians India 2011; 59:498-500. [PMID: 21887906] [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: 05/31/2023]
Abstract
India reported its first case of H1N1 in July 2009 in Pune and since then, the number of reported cases and deaths exploded in India. Since very little data is available about histopathological findings in patients of H1N1 fatal cases in India, a retrospective chart analysis of necropsy findings of 15 cases of 2009 H1N1 fatal cases was performed. Common clinical features were fever, cough, and breathlessness followed by sore throat and rhinorrhea. Common lung findings were mononuclear cell infiltration, thick alveolar septae, intraalveolar hemorrhage. The other findings were congested pulmonary blood vessels, pulmonary edema, cytomegaly, fibrin accumulation and formation of eosinophilic membrane. These findings are suggestive of diffuse alveolar damage (DAD) and DAD with hemorrhage. All patients who underwent necropsy had radiographic findings suggestive of unilobar or multilobar pneumonia. This clinical finding can be correlated pathologically in these patients as all of them had either polymorphonuclear or mononuclear infiltrate. Furthermore, necrotizing pneumonitis pattern seen on these patients is the likely cause of mortality in these patients. Although clinical ARDS pattern was noted in all these patients, it was well correlated in lung pathology in all these cases.
Collapse
Affiliation(s)
- H B Prasad
- B.J. Medical College Clinical Research Site, Pune
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
|
19
|
Sangle SA, Vadgaonkar G, Kadam DB, Chadha M. Influenza A (H3N2) associated acute necrotising encephalopathy. J Assoc Physicians India 2011; 59:52-54. [PMID: 21751668] [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: 05/31/2023]
Abstract
We present a case of 16 year old female admitted with complaints of influenza like symptoms followed by convulsions and sudden impairment of consciousness. Magnetic resonance imaging abnormalities were found in bilateral thalami including cerebellum. Diagnosis of influenza associated acute necrotizing encephalopathy was made on the basis of clinical features, neuroimaging findings and isolation of influenza A(H3N2) virus from throat swab. This is probably first case of Influenza associated acute necrotizing encephalopathy reported in India in 2009.
Collapse
Affiliation(s)
- S A Sangle
- Dept. of Medicine, B.J. Medical College, Pune
| | | | | | | |
Collapse
|
20
|
|
21
|
Sobhani R, Basavaraj A, Gupta A, Bhave AS, Kadam DB, Sangle SA, Prasad HB, Choi J, Josephs J, Gebo KA, Morde SN, Bollinger RC, Kakrani AL. Mortality & clinical characteristics of hospitalized adult patients with HIV in Pune, India. Indian J Med Res 2007; 126:116-121. [PMID: 17932435] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND & OBJECTIVE In India, data regarding mortality and clinical characteristics of hospitalized HIV-infected patients are sparse, which may limit the effectiveness of new hospital-based HIV programmes providing antiretroviral therapy (ART). The objective of our study was to determine mortality and clinical characteristics of hospitalized HIV-infected individuals in a high HIV prevalence region of India. METHODS A retrospective chart review was done of known HIV-infected adults admitted to the Medical Service of a large, public hospital in Pune, India, from January 2002 to November 2003. RESULTS A total of 655 HIV-infected patients were identified; 489 (74.7%) were male and 4 (0.6%) were on ART. The most common illnesses reported were tuberculosis (55.8%), diarrhoea (4.2%), and alcoholic liver disease (3.7%) . The inpatient mortality was 172 (26.3%). The most common causes of death of the 172 people were tuberculosis (52.9%) and cryptococcal meningitis (7.6%). In multivariate analysis, factors associated with increased mortality were male sex (adjusted odds ratio (AOR) 1.92, 95% CI: 1.08-3.41), haemoglobin level < 7 g/dl (AOR 2.75, 95% CI:1.23-6.14), length of stay < 2 days (OR 5.78, 95%, CI: 1.82-18.4), and cryptococcal meningitis (OR 4.44, 95% CI:1.19-16.6). INTERPRETATION & CONCLUSION In the era prior to widespread ART, a high inpatient mortality of 26 per cent was found among hospitalized HIV-infected individuals. Thus, while hospitalization is an important access and referral point for HIV care and treatment, earlier identification of HIV-infected persons must occur to ensure they will optimally benefit from the government's ART programme.
Collapse
Affiliation(s)
- Ramona Sobhani
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Sethi PP, Wadia RS, Kiyawat DP, Ichaporia NR, Kothari SS, Sangle SA, Wadhwa P. Ring or disc enhancing lesions in epilepsy in India. J Trop Med Hyg 1994; 97:347-53. [PMID: 7966536] [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: 01/28/2023]
Abstract
In India a common CT finding in epilepsy is a ring/disc enhancing lesion (RDEL). This lesion is hypodense on plain scan and shows a ring or disc-like enhancement on contrast CT scan. This study reports on 186 cases with such lesions, found in 26.1% of all focal epilepsy. It was commoner in children. Fifty-three per cent of the cases had had fits for less than 3 months, 29.6% had had fits for more than 6 months and 17.6% for more than a year. Focal signs were seen in 20% of cases and focal EEG slowing in 57.1%. The lesion cleared on anticonvulsants alone in 75% of cases. At present this is the preferred method of treatment unless there is coexisting CNS tuberculosis or close family contact with TB or extraneural cysticercosis. Biopsy was done in 16 cases and the two commonest causes were found to be cysticercosis and tuberculosis. A review of 58 biopsies in four centres in India is included. The frequency of this entity is apparently highest in India and even in other countries where cysticercosis is common, the lesion is not reported as frequently.
Collapse
Affiliation(s)
- P P Sethi
- Department of Neurology, Ruby Hall Clinic, Pune, India
| | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Strokes may occur with a large number of genetic disorders. Natowicz and Kelley have reviewed the single gene disorders capable of causing familial haemorrhagic strokes. These may be classified into four groups: a) hereditary disorders affecting clotting factors or platelets; b) hereditary disease producing vascular anomaly; c) hereditary disease causing hypertension and d) miscellaneous group including neurofibromatosis, sickle cell disease and tuberous sclerosis.
Collapse
Affiliation(s)
- R S Wadia
- Department of Neurology and Pathology, Ruby Hall Clinic, Pune, India
| | | | | | | | | |
Collapse
|
24
|
Sangle SA, Thomas A, Verma S, Wadia RS. Zinc phosphide poisoning. J Assoc Physicians India 1987; 35:591-4. [PMID: 3693313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|