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Mondal U, Warren E, Bookstaver PB, Kohn J, Al-Hasan MN. Incidence and predictors of complications in Gram-negative bloodstream infection. Infection 2024:10.1007/s15010-024-02202-3. [PMID: 38436912 DOI: 10.1007/s15010-024-02202-3] [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: 11/29/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The incidence of metastatic complications in Gram-negative bloodstream infection (GN-BSI) remains undefined. This retrospective cohort study examines the incidence and predictors of complications within 90 days of GN-BSI. METHODS Patients with GN-BSIs hospitalized at two Prisma Health-Midlands hospitals in Columbia, South Carolina, USA from 1 January 2012 through 30 June 2015 were included. Complications of GN-BSI included endocarditis, septic arthritis, osteomyelitis, spinal infections, deep-seated abscesses, and recurrent GN-BSI. Kaplan-Meier analysis and multivariate Cox proportional hazards regression were used to examine incidence and risk factors of complications, respectively. RESULTS Among 752 patients with GN-BSI, median age was 66 years and 380 (50.5%) were women. The urinary tract was the most common source of GN-BSI (378; 50.3%) and Escherichia coli was the most common bacteria (375; 49.9%). Overall, 13.9% of patients developed complications within 90 days of GN-BSI. The median time to identification of these complications was 5.2 days from initial GN-BSI. Independent risk factors for complications were presence of indwelling prosthetic material (hazards ratio [HR] 1.73, 95% confidence intervals [CI] 1.08-2.78), injection drug use (HR 6.84, 95% CI 1.63-28.74), non-urinary source (HR 1.98, 95% CI 1.18-3.23), BSI due to S. marcescens, P. mirabilis or P. aeruginosa (HR 1.78, 95% CI 1.05-3.03), early clinical failure criteria (HR 1.19 per point, 95% CI 1.03-1.36), and persistent GN-BSI (HR 2.97, 95% CI 1.26-6.99). CONCLUSIONS Complications of GN-BSI are relatively common and may be predicted based on initial clinical response to antimicrobial therapy, follow-up blood culture results, and other host and microbiological factors.
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Affiliation(s)
- Utpal Mondal
- Department of Medicine, Division of Infectious Diseases, Audie L. Murphy VA Medical Center, San Antonio, TX, USA
- Department of Medicine, Long School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Erin Warren
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - P Brandon Bookstaver
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
- Department of Clinical Pharmacy and Outcomes Science, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - Majdi N Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA.
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA.
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Patel S, Kiker D, Mondal U, Sayana H, Saligram S, Rosenkranz L, Han S. Safety Parameters for the Use of Holmium:YAG Laser in the Treatment of Biliary Calculi: The Ex-Vivo Model. Medicina (Kaunas) 2024; 60:346. [PMID: 38399633 PMCID: PMC10889936 DOI: 10.3390/medicina60020346] [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] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: While studies have demonstrated the efficacy of cholangioscopy-guided Holmium-Yttrium aluminum garnet (Ho:YAG) laser lithotripsy for the treatment of refractory bile duct stones, data regarding the safety of the operating parameters for laser lithotripsy are lacking. The aim of this study was to determine safe, yet effective, energy settings for Ho:YAG laser in the ex-vivo model. Materials and Methods: This ex vivo experimental study utilized the Ho:YAG laser on porcine bile duct epithelium and human gallstones. Ho:YAG laser lithotripsy was applied in different power settings from 8 to 15 Watts (W) to six explanted porcine bile ducts. Settings that appeared safe were then utilized to fragment seventy-three human gallstones. Results: The median bile duct perforation times with the Ho:YAG laser between 8-15 W were: >60 s (8 W); 23 s (9 W); 29 s (10 W); 27 s (12 W); 12 s (14 W); and 8 s (15 W). Statistically significant differences in the median perforation times were noted between 8 W vs. 15 W, 9 W vs. 15 W, 10 W vs. 15 W, and 12 W vs. 15 W (p < 0.05). When using a 365 µm Ho:YAG laser probe at 8-12 W, the fragmentation rates on various size stones were: 100% (<1.5 cm); 80-100% (1.6-2.0 cm) and 0-32% (>2.0 cm). Optimal fragmentation was seen utilizing 12 W with high energy (2.4 J) and low frequency (5 Hz) settings. Using a larger 550 µm probe at these settings resulted in 100% fragmentation of stones larger than 2 cm. Conclusions: The Ho:YAG laser appears to be safe and effective in the treatment of large bile duct stones when used between 8-12 W in 5 s bursts in an ex vivo model utilizing porcine bile ducts and human gallstones.
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Affiliation(s)
- Sandeep Patel
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Dustin Kiker
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Utpal Mondal
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Hari Sayana
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Shreyas Saligram
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Laura Rosenkranz
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Mondal U, Warren E, Justo JA, Justo JA, Kohn J, Brandon Bookstaver P, Al-Hasan MN, Al-Hasan MN. 1841. Incidence and Predictors of Complications in Gram Negative Bloodstream Infection. Open Forum Infect Dis 2022. [PMCID: PMC9752556 DOI: 10.1093/ofid/ofac492.1470] [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] [Indexed: 12/23/2022] Open
Abstract
Background The incidence of complications in Gram negative bloodstream infection (GN-BSI) is not clearly defined. This retrospective cohort study evaluates the incidence of complications within 90 days of GN-BSI and examines the predictors for these complications. Methods Hospitalized adult patients with monomicrobial GN-BSI at Prisma Health-Midlands hospitals in South Carolina between 1/1/2012 and 6/30/2015 were evaluated. Complications of GN-BSI were defined as endocarditis, septic arthritis, osteomyelitis, spinal infections, deep seated abscesses, and recurrent GN-BSI within 90 days of the initial episode. Clinical and microbiological variables were assessed as potential risk factors for complications, including initial response to antimicrobial therapy within the first 72-96 hours of GN-BSI using the early clinical failure criteria. Kaplan-Meier analysis and multivariate Cox proportional hazards regression were used to examine the incidence and risk factors of complicated GN-BSI, respectively. Results A total 752 patients with GN-BSI were included in the study. The median age was 66 years and 380 (50.6%) were women. The urinary tract was the most common source of GN-BSI (378; 50.2%) and Escherichia coli was the most common bacteria (375; 49.9%). Overall, 13.9% developed complications within 90 days of GN-BSI. The median time to identification of these complications was 5.2 days from the index GN-BSI (interquartile range 1-28 days). The incidence of complications was notably higher in BSI due to Serratia species (39.7%), Proteus mirabilis (35.7%), and Pseudomonas aeruginosa (21.5%) than other bacteria (11.1%; log-rank p< 0.001). Independent risk factors for complications included early clinical failure criteria, non-urinary source, presence of indwelling prosthetic devices, BSI due to Serratia species, P. mirabilis or P. aeruginosa, and persistent GN-BSI (Table).
![]() Conclusion At least 13.9% of patients developed complications within 90 days of GN-BSI. Risk of development of complications may be predicted by specific host and microbiological factors. Stratification of patients based on these risk factors may aid in identifying patients requiring further diagnostic work up for early detection of complications. Disclosures Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck & Co: Advisor/Consultant|Merck & Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck & Co: Advisor/Consultant|Merck & Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant.
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Affiliation(s)
- Utpal Mondal
- University of South Carolina/Prisma Health, Columbia, South Carolina
| | - Erin Warren
- Prisma Health Richland Hospital, Prosperity, South Carolina
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Joseph Kohn
- Prisma Health Midlands, Columbia, South Carolina
| | | | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, South Carolina
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Mondal U, Schindler A, Rosenkranz L. Recurrent hematochezia in a patient with chronic constipation. Gastroenterology 2015; 149:1343-4. [PMID: 26409665 DOI: 10.1053/j.gastro.2015.08.015] [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: 07/13/2015] [Accepted: 08/10/2015] [Indexed: 12/02/2022]
Affiliation(s)
- Utpal Mondal
- Division of Gastroenterology and Nutrition, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Amy Schindler
- Division of Gastroenterology and Nutrition, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Laura Rosenkranz
- Division of Gastroenterology and Nutrition, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Mondal U, Henkes N, Henkes D, Rosenkranz L. Cavernous hemangioma of adult pancreas: A case report and literature review. World J Gastroenterol 2015; 21:9793-9802. [PMID: 26361427 PMCID: PMC4562964 DOI: 10.3748/wjg.v21.i33.9793] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 05/29/2015] [Accepted: 06/26/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic hemangioma is a rare type of benign vascular tumor. Low clinical suspicion and inability of current cross sectional imaging techniques to differentiate it from other pancreatic lesions, contribute to the difficulty in making the correct diagnosis. Without a definitive diagnosis, and due to concern for malignancy, in many instances, surgery is performed. We report a case of pancreas cavernous hemangioma in an 18-year-old female. The patient presented with three-month history of epigastric pain. Physical examination and routine blood tests were normal. Abdominal Computed Tomography scan revealed a 5 cm × 6 cm complex non-enhancing cystic mass in the head of pancreas. Magnetic resonance imaging, endoscopic ultrasonography (EUS) and EUS guided fine needle aspiration cytology were non-diagnostic. Because of uncontrolled symptoms, the patient underwent surgical resection. Histopathology and Immunohistochemical staining confirmed the diagnosis of cavernous hemangioma of pancreas.
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Haque R, Roy S, Siddique A, Mondal U, Rahman SMM, Mondal D, Houpt E, Petri WA. Multiplex real-time PCR assay for detection of Entamoeba histolytica, Giardia intestinalis, and Cryptosporidium spp. Am J Trop Med Hyg 2007. [PMID: 17426176 DOI: 10.4269/ajtmh.2007.76.713] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Entamoeba histolytica, Giardia intestinalis, and Cryptosporidium spp. are not only three of the most important and common diarrhea-causing parasitic protozoa, but they often have similar clinical presentations. Microscopic diagnosis of these parasites is neither sensitive nor specific. Recently, more specific and sensitive alternative molecular methods (polymerase chain reaction [PCR] and antigen detection tests) have been introduced for all three of these parasitic infections. The use of these molecular diagnostic tests in routine diagnostic laboratories is still limited. In this study, we developed a multiplex real-time PCR assay for the simultaneous detection of E. histolytica, G. intestinalis, and Cryptosporidium spp. in one reaction using species-specific probes. This assay was evaluated using clinical specimens and was found to be quite sensitive and specific. The reagents used in this multiplex PCR assay can also be used for detection of these parasites individually. The use of this real-time PCR multiplex assay in developing countries at present will have limited scope for routine diagnosis because the cost will be high for a single test, although in the developed world, the test could see immediate application.
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Affiliation(s)
- Rashidul Haque
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
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Haque R, Roy S, Siddique A, Mondal U, Rahman SMM, Mondal D, Houpt E, Petri WA. Multiplex real-time PCR assay for detection of Entamoeba histolytica, Giardia intestinalis, and Cryptosporidium spp. Am J Trop Med Hyg 2007; 76:713-7. [PMID: 17426176] [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: 05/14/2023] Open
Abstract
Entamoeba histolytica, Giardia intestinalis, and Cryptosporidium spp. are not only three of the most important and common diarrhea-causing parasitic protozoa, but they often have similar clinical presentations. Microscopic diagnosis of these parasites is neither sensitive nor specific. Recently, more specific and sensitive alternative molecular methods (polymerase chain reaction [PCR] and antigen detection tests) have been introduced for all three of these parasitic infections. The use of these molecular diagnostic tests in routine diagnostic laboratories is still limited. In this study, we developed a multiplex real-time PCR assay for the simultaneous detection of E. histolytica, G. intestinalis, and Cryptosporidium spp. in one reaction using species-specific probes. This assay was evaluated using clinical specimens and was found to be quite sensitive and specific. The reagents used in this multiplex PCR assay can also be used for detection of these parasites individually. The use of this real-time PCR multiplex assay in developing countries at present will have limited scope for routine diagnosis because the cost will be high for a single test, although in the developed world, the test could see immediate application.
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Affiliation(s)
- Rashidul Haque
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
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Ali IKM, Mondal U, Roy S, Haque R, Petri WA, Clark CG. Evidence for a link between parasite genotype and outcome of infection with Entamoeba histolytica. J Clin Microbiol 2006; 45:285-9. [PMID: 17122021 PMCID: PMC1829016 DOI: 10.1128/jcm.01335-06] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The factors determining whether a person infected with Entamoeba histolytica develops disease remain obscure. To investigate whether the parasite genome contributes to the outcome, we have investigated the distribution of parasite genotypes among E. histolytica-infected individuals in Bangladesh. Samples were obtained from individuals who either were asymptomatic, had diarrhea/dysentery, or had developed a liver abscess. Genotypes were determined by using six tRNA-linked polymorphic markers, and their distributions among the three sample groups were evaluated. A significant population differentiation in the genotype distribution was found for four of the six individual markers as well as for the combined genotypes, suggesting that the parasite genome does contribute in some way to the outcome of infection with E. histolytica. The markers themselves do not indicate the nature of the underlying genetic differences, but they may be linked to loci that do have an impact on the outcome of infection.
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Affiliation(s)
- Ibne Karim M Ali
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, Great Britain
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Mondal U, Ganesan M, Pal TK, Jayakumar M, Chattaraj TK, Roy K, Banerjee SN. Bioequivalence study of rabeprazole sodium on healthy human volunteers. J Indian Med Assoc 2004; 102:26, 28, 30. [PMID: 15195855] [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: 04/29/2023]
Abstract
The newly developed proton pump inhibitor rabeprazole sodium is expected to have beneficial effects in the treatment of peptic ulcer. The pharmacokinetic parameters (C(max), AUC(o-t), t(max)) of this drug have been evaluated to compare the single dose (20 mg) bioavailability of rabeprazole sodium with the standard reference. High performance liquid chromatography (HPLC) coupled with UV detector set at 280 nm has been used to determine plasma concentration of 12 human volunteers as per Drugs Controller General of India (DCGI) guidelines. The method has been validated over a linear range of 20-480 ng/ml from plasma. The minimum quantifiable concentration was set at 10 ng/ml [co-efficient of variance (CV) < 10%]. By comparing AUC(o-t) the relative bioavailability of test preparation has been found to be 100.88% of that of reference preparation.
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Affiliation(s)
- U Mondal
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata
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Dastidar SG, Mondal U, Niyogi S, Chakrabarty AN. Antibacterial property of methyl-DOPA & development of antibiotic cross-resistances in m-DOPA mutants. Indian J Med Res 1986; 84:142-7. [PMID: 3759165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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