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Mehta P, Chattopadhyay P, Mohite R, D'Rozario R, Bandopadhyay P, Sarif J, Ray Y, Ganguly D, Pandey R. Suppressed transcript diversity and immune response in COVID-19 ICU patients: a longitudinal study. Life Sci Alliance 2024; 7:e202302305. [PMID: 37918965 PMCID: PMC10622646 DOI: 10.26508/lsa.202302305] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
Understanding the dynamic changes in gene expression during Acute Respiratory Distress Syndrome (ARDS) progression in post-acute infection patients is crucial for unraveling the underlying mechanisms. Study investigates the longitudinal changes in gene/transcript expression patterns in hospital-admitted severe COVID-19 patients with ARDS post-acute SARS-CoV-2 infection. Blood samples were collected at three time points and patients were stratified into severe and mild ARDS, based on their oxygenation saturation (SpO2/FiO2) kinetics over 7 d. Decline in transcript diversity was observed over time, particularly in patients with higher severity, indicating dysregulated transcriptional landscape. Comparing gene/transcript-level analyses highlighted a rather limited overlap. With disease progression, a transition towards an inflammatory state was evident. Strong association was found between antibody response and disease severity, characterized by decreased antibody response and activated B cell population in severe cases. Bayesian network analysis identified various factors associated with disease progression and severity, viz. humoral response, TLR signaling, inflammatory response, interferon response, and effector T cell abundance. The findings highlight dynamic gene/transcript expression changes during ARDS progression, impact on tissue oxygenation and elucidate disease pathogenesis.
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Affiliation(s)
- Priyanka Mehta
- https://ror.org/05ef28661 Division of Immunology and Infectious Disease Biology, INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Partha Chattopadhyay
- https://ror.org/05ef28661 Division of Immunology and Infectious Disease Biology, INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Ramakant Mohite
- https://ror.org/05ef28661 Division of Immunology and Infectious Disease Biology, INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
| | - Ranit D'Rozario
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- https://ror.org/01kh0x418 IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Purbita Bandopadhyay
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- https://ror.org/01kh0x418 IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Jafar Sarif
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- https://ror.org/01kh0x418 IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Yogiraj Ray
- Infectious Disease and Beleghata General Hospital, Kolkata, India
- Department of Infectious Diseases, Shambhunath Pandit Hospital, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Dipyaman Ganguly
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- https://ror.org/01kh0x418 IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Rajesh Pandey
- https://ror.org/05ef28661 Division of Immunology and Infectious Disease Biology, INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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Singh UB, Ray Y, Kanswal S, Sharma HP, Aayilliath AK, Wig N, Ahuja V, Biswas A, Velpandian T. Low rifampicin levels in plasma associated with a poor clinical response in patients with abdominal TB. Int J Tuberc Lung Dis 2023; 27:787-789. [PMID: 37749829 PMCID: PMC10519389 DOI: 10.5588/ijtld.23.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/15/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- U B Singh
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi
| | - Y Ray
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, Department of Medicine, AIIMS, New Delhi
| | - S Kanswal
- Centralized Core Research Facility, AIIMS, New Delhi
| | - H P Sharma
- Centralized Core Research Facility, AIIMS, New Delhi
| | - A K Aayilliath
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, Department of Medicine, AIIMS, New Delhi
| | - N Wig
- Department of Medicine, AIIMS, New Delhi
| | - V Ahuja
- Department of Gastroenterology, AIIMS, New Delhi
| | - A Biswas
- Department of Medicine, AIIMS, New Delhi
| | - T Velpandian
- Department of Ocular Pharmacology & Pharmacy, AIIMS, New Delhi, India
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Kumar G, Bhalla A, Mukherjee A, Turuk A, Talukdar A, Mukherjee S, Bhardwaj P, Menon GR, Sahu D, Misra P, Sharma LK, Mohindra R, S S, Suri V, Das H, Sarkar D, Ghosh S, Ghosh P, Dutta M, Chakraborty S, Kumar D, Gupta MK, Goel AD, Baruah TD, Kannauje PK, Shukla AK, Khambholja JR, Patel A, Shah N, Bhuniya S, Panigrahi MK, Mohapatra PR, Pathak A, Sharma A, John M, Kaur K, Nongpiur V, Pala S, Shivnitwar SK, Krishna BR, Dulhani N, Gupta B, Gupta J, Bhandari S, Agrawal A, Aggarwal HK, Jain D, Shah AD, Naik P, Panchal M, Anderpa M, Kikon N, Humtsoe CN, Sharma N, Vohra R, Patnaik L, Sahoo JP, Joshi R, Kokane A, Ray Y, Rajvansh K, Purohit HM, Shah NM, Madharia A, Dube S, Shrivastava N, Kataria S, Shameem M, Fatima N, Ghosh S, Hazra A, D H, Salgar VB, Algur S, M L KY, M PK, Panda S, Vishnu Vardhana Rao M, Bhargava B. Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19. BMJ Glob Health 2023; 8:e012245. [PMID: 37816536 PMCID: PMC10565174 DOI: 10.1136/bmjgh-2023-012245] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/20/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities. METHODS Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting. RESULTS Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03). CONCLUSION Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.
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Affiliation(s)
- Gunjan Kumar
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Ashish Bhalla
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aparna Mukherjee
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Alka Turuk
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | | | | | | | - Geetha R Menon
- National Institute of Medical Statistics, New Delhi, India
| | - Damodar Sahu
- National Institute of Medical Statistics, New Delhi, India
| | | | | | - Ritin Mohindra
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Samita S
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Himadri Das
- Medical College and Hospital Kolkata, Kolkata, India
| | | | | | - Priyanka Ghosh
- College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Moumita Dutta
- College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | | | - Deepak Kumar
- All India Institute of Medical Sciences, Jodhpur, India
| | | | | | | | | | | | | | | | | | - Sourin Bhuniya
- All India Institute of Medical Sciences, Bhubaneswar, India
| | | | | | | | | | - Mary John
- Christian Medical College and Hospital, Ludhiana, India
| | | | | | | | | | | | | | | | | | | | | | - H K Aggarwal
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Deepak Jain
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Arti D Shah
- SBKS Medical Institute and Research Centre, Vadodara, India
| | - Parshwa Naik
- SBKS Medical Institute and Research Centre, Vadodara, India
| | | | | | - Nyanthung Kikon
- Department of Health and Family Welfare, Government of Nagaland, Kohima, India
| | | | - Nikita Sharma
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Rajaat Vohra
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | | | - Rajnish Joshi
- All India Institute of Medical Sciences, Bhopal, India
| | - Arun Kokane
- All India Institute of Medical Sciences, Bhopal, India
| | - Yogiraj Ray
- Institute of Postgraduate Medical Education and Research, Kolkata, India
| | | | | | - Nehal M Shah
- Smt NHL Municipal Medical College, Ahmedabad, India
| | | | | | | | | | | | | | - Saumitra Ghosh
- Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Himanshu D
- King George Medical University, Lucknow, India
| | | | - Santosh Algur
- Gulbarga Institute of Medical Sciences, Gulbarga, India
| | - Kala Yadhav M L
- Shri Atal Bihari Vajpayee Medical College and Research Institution, Bengaluru, India
| | | | - Samiran Panda
- Indian Council of Medical Research, New Delhi, India
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Talukdar D, Bandopadhyay P, Ray Y, Paul SR, Sarif J, D'Rozario R, Lahiri A, Das S, Bhowmick D, Chatterjee S, Das B, Ganguly D. Association of gut microbial dysbiosis with disease severity, response to therapy and disease outcomes in Indian patients with COVID-19. Gut Pathog 2023; 15:22. [PMID: 37161621 PMCID: PMC10170741 DOI: 10.1186/s13099-023-00546-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/13/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Severe coronavirus disease 2019 (COVID-19) is associated with systemic hyper-inflammation. An adaptive interaction between gut microbiota and host immune systems is important for intestinal homeostasis and systemic immune regulation. The association of gut microbial composition and functions with COVID-19 disease severity is sparse, especially in India. We analysed faecal microbial diversity and abundances in a cohort of Indian COVID-19 patients to identify key signatures in the gut microbial ecology in patients with severe COVID-19 disease as well as in response to different therapies. The composition of the gut microbiome was characterized using 16Sr RNA gene sequences of genomic DNA extracted from faecal samples of 52 COVID-19 patients. Metabolic pathways across the groups were predicted using PICRUSt2. All statistical analyses were done using Vegan in the R environment. Plasma cytokine abundance at recruitment was measured in a multiplex assay. RESULTS The gut microbiome composition of mild and severe patients was found to be significantly different. Immunomodulatory commensals, viz. Lachnospiraceae family members and Bifidobacteria producing butyrate and short-chain fatty acids (SCFAs), were under represented in patients with severe COVID-19, with an increased abundance of opportunistic pathogens like Eggerthella. The higher abundance of Lachnoclostridium in severe disease was reduced in response to convalescent plasma therapy. Specific microbial genera showed distinctive trends in enriched metabolic pathways, strong correlations with blood plasma cytokine levels, and associative link to disease outcomes. CONCLUSION Our study indicates that, along with SARS-CoV-2, a dysbiotic gut microbial community may also play an important role in COVID-19 severity through modulation of host immune responses.
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Affiliation(s)
- Daizee Talukdar
- Functional Genomics Laboratory, Translational Health Science and Technology Institute, Faridabad, India
| | - Purbita Bandopadhyay
- CSIR-Indian Institute of Chemical Biology, Kolkata, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Yogiraj Ray
- Department of Medicine, Infectious Diseases and Beleghata General Hospital, Kolkata, India
- Department of Infectious Disease, SSKM Hospital, Kolkata, India
| | - Shekhar Ranjan Paul
- Department of Medicine, Infectious Diseases and Beleghata General Hospital, Kolkata, India
| | - Jafar Sarif
- CSIR-Indian Institute of Chemical Biology, Kolkata, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Ranit D'Rozario
- CSIR-Indian Institute of Chemical Biology, Kolkata, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Abhishake Lahiri
- CSIR-Indian Institute of Chemical Biology, Kolkata, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Santanu Das
- Functional Genomics Laboratory, Translational Health Science and Technology Institute, Faridabad, India
| | - Debaleena Bhowmick
- CSIR-Indian Institute of Chemical Biology, Kolkata, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Shilpak Chatterjee
- CSIR-Indian Institute of Chemical Biology, Kolkata, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Bhabatosh Das
- Functional Genomics Laboratory, Translational Health Science and Technology Institute, Faridabad, India.
| | - Dipyaman Ganguly
- CSIR-Indian Institute of Chemical Biology, Kolkata, India.
- Academy of Scientific and Innovative Research, Ghaziabad, India.
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5
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D’Rozario R, Raychaudhuri D, Bandopadhyay P, Sarif J, Mehta P, Liu CSC, Sinha BP, Roy J, Bhaduri R, Das M, Bandyopadhyay S, Paul SR, Chatterjee S, Pandey R, Ray Y, Ganguly D. Circulating Interleukin-8 Dynamics Parallels Disease Course and Is Linked to Clinical Outcomes in Severe COVID-19. Viruses 2023; 15:v15020549. [PMID: 36851762 PMCID: PMC9960352 DOI: 10.3390/v15020549] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/19/2023] Open
Abstract
Severe COVID-19 frequently features a systemic deluge of cytokines. Circulating cytokines that can stratify risks are useful for more effective triage and management. Here, we ran a machine-learning algorithm on a dataset of 36 plasma cytokines in a cohort of severe COVID-19 to identify cytokine/s useful for describing the dynamic clinical state in multiple regression analysis. We performed RNA-sequencing of circulating blood cells collected at different time-points. From a Bayesian Information Criterion analysis, a combination of interleukin-8 (IL-8), Eotaxin, and Interferon-γ (IFNγ) was found to be significantly linked to blood oxygenation over seven days. Individually testing the cytokines in receiver operator characteristics analyses identified IL-8 as a strong stratifier for clinical outcomes. Circulating IL-8 dynamics paralleled disease course. We also revealed key transitions in immune transcriptome in patients stratified for circulating IL-8 at three time-points. The study identifies plasma IL-8 as a key pathogenic cytokine linking systemic hyper-inflammation to the clinical outcomes in COVID-19.
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Affiliation(s)
- Ranit D’Rozario
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata 700091, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Deblina Raychaudhuri
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata 700091, India
| | - Purbita Bandopadhyay
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata 700091, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Jafar Sarif
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata 700091, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Priyanka Mehta
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology, New Delhi 110007, India
| | - Chinky Shiu Chen Liu
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata 700091, India
| | - Bishnu Prasad Sinha
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata 700091, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Jayasree Roy
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata 700091, India
| | | | - Monidipa Das
- Indian Statistical Institute, Kolkata 700108, India
| | | | | | - Shilpak Chatterjee
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata 700091, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Rajesh Pandey
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology, New Delhi 110007, India
| | - Yogiraj Ray
- Department of Medicine, ID & BG Hospital, Kolkata 700010, India
- Department of Infectious Diseases, Institute of Postgraduate Medical Education and Research, Kolkata 700020, India
| | - Dipyaman Ganguly
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata 700091, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
- Correspondence:
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Mukherjee A, Kumar G, Turuk A, Bhalla A, Bingi TC, Bhardwaj P, Baruah TD, Mukherjee S, Talukdar A, Ray Y, John M, Khambholja JR, Patel AH, Bhuniya S, Joshi R, Menon GR, Sahu D, Rao VV, Bhargava B, Panda S. Vaccination saves lives: a real-time study of patients with chronic diseases and severe COVID-19 infection. QJM 2023; 116:47-56. [PMID: 36053197 PMCID: PMC9494346 DOI: 10.1093/qjmed/hcac202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC). METHODS NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined. RESULTS Analysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculosis, presenting with dyspnoea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6-7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4-0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3-0.7)] were protected from in-hospital mortality. CONCLUSIONS WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.
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Affiliation(s)
| | | | - Alka Turuk
- Indian Council of Medical Research, New Delhi, India
| | - Ashish Bhalla
- Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Pankaj Bhardwaj
- All Indian Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Subhasis Mukherjee
- College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | | | - Yogiraj Ray
- Infectious Disease And Beliaghata Hospital, Kolkata, West Bengal, India
| | - Mary John
- Christian Medical College, Ludhiana, Punjab, India
| | | | | | - Sourin Bhuniya
- All India Institute Of Medical Sciences, Bhubaneswar, India
| | - Rajnish Joshi
- All India Institute Of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Geetha R Menon
- National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | - Damodar Sahu
- National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | - Vishnu Vardhan Rao
- National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | | | | | - NCRC Study team
MishraPuspendraMCANational Institute of Medical Statistics, Indian Council of Medical Research, Delhi, IndiaPanchalYashminPGDISADNational Institute of Medical Statistics, Indian Council of Medical Research, Delhi, IndiaSharmaLokesh KumarPhDIndian Council of Medical Research, New Delhi, IndiaAgarwalAnupMBBSMedstar Health, Baltimore, Maryland, United States of AmericaPuriG DMDPostgraduate Institute of Medical Education & Research, Chandigarh, IndiaSuriVikasMDPostgraduate Institute of Medical Education & Research, Chandigarh, IndiaSinglaKaranMDPostgraduate Institute of Medical Education & Research, Chandigarh, IndiaMesipoguRajaraoMDGandhi Medical College, Telangana, IndiaAedulaVinaya SekharMDGandhi Medical College, Telangana, IndiaMohiuddinMohammed AyazMDGandhi Medical College, Telangana, IndiaKumarDeepakMDAll Indian Institute of Medical Sciences, Jodhpur, Rajasthan, IndiaSaurabhSumanMDAll Indian Institute of Medical Sciences, Jodhpur, Rajasthan, IndiaMisraSanjeevMChAll Indian Institute of Medical Sciences, Jodhpur, Rajasthan, IndiaKannaujePankaj KumarMDAll Indian Institute of Medical Sciences, Raipur Chhattisgarh, IndiaKumarAjitMDAll Indian Institute of Medical Sciences, Raipur Chhattisgarh, IndiaShuklaArvindPhDAll Indian Institute of Medical Sciences, Raipur Chhattisgarh, IndiaPalAmitavaMDCollege of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, IndiaChakrabortyShreetamaMScCollege of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, IndiaDuttaMoumitaMScCollege of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, IndiaMondalTanushreeMDMedical College, Kolkata, West Bengal, IndiaChakravortySarmisthaMScMedical College, Kolkata, West Bengal, IndiaBhattacharjeeBoudhyanMDMedical College, Kolkata, West Bengal, IndiaPaulShekhar RanjanDTCDInfectious Disease And Beliaghata Hospital, Kolkata, West Bengal, IndiaMajumderDebojyotiMDInfectious Disease And Beliaghata Hospital, Kolkata, West Bengal, IndiaChatterjeeSubhrangaMBBSInfectious Disease And Beliaghata Hospital, Kolkata, West Bengal, IndiaAbrahamAbinMDChristian Medical College, Ludhiana, Punjab, IndiaVargheseDivyaMDChristian Medical College, Ludhiana, Punjab, IndiaThomasMariaMDChristian Medical College, Ludhiana, Punjab, IndiaShahNiteshMDCIMS Hospital, Ahmedabad, IndiaPatelMineshMDCIMS Hospital, Ahmedabad, IndiaMadanSurabhiMDCIMS Hospital, Ahmedabad, IndiaDesaiAnitaPhDNational Institute Of Mental Health And Neurosciences, Bangalore, Karnataka, IndiaM LKala YadhavMDBowring & Lady Curzon Medical College & Research Institute, Bangalore, Karnataka, IndiaRMadhumathiMDBowring & Lady Curzon Medical College & Research Institute, Bangalore, Karnataka, IndiaG SChetnaMDBowring & Lady Curzon Medical College & Research Institute, Bangalore, Karnataka, IndiaOjhaU KMDShaheed Nirmal Mahato Medical College, Dhanbad, Jharkahnd, IndiaJhaRavi RanjanShaheed Nirmal Mahato Medical College, Dhanbad, Jharkahnd, IndiaKumarAvinashMDShaheed Nirmal Mahato Medical College, Dhanbad, Jharkahnd, IndiaPathakAshishPhDRD Gardi Medical College, Ujjain, Madhya Pradesh, IndiaSharmaAshishMDRD Gardi Medical College, Ujjain, Madhya Pradesh, IndiaPurohitManjuMDRD Gardi Medical College, Ujjain, Madhya Pradesh, IndiaSarangiLisaMDHi Tech Medical College and Hospital, Bhubaneswar, IndiaRathMaheshMDHi Tech Medical College and Hospital, Bhubaneswar, IndiaShahArti DDNBDhiraj Hospital & Sumandeep Vidyapeeth, Vadodara, Ahmedabad, IndiaKumarLavleshMDDhiraj Hospital & Sumandeep Vidyapeeth, Vadodara, Ahmedabad, IndiaPatelPrinceeMBBSDhiraj Hospital & Sumandeep Vidyapeeth, Vadodara, Ahmedabad, IndiaDulhaniNaveenMDLate BRK Memorial Medical College, Jagdalpur, Chhattisgarh, IndiaDubeSimmiMDGandhi Medical College, Bhopal, Madhya Pradesh, IndiaShrivastavaJyotsnaMDGandhi Medical College, Bhopal, Madhya Pradesh, IndiaMittalArvindMDGandhi Medical College, Bhopal, Madhya Pradesh, IndiaPatnaikLipilekhaMDInstitute of Medical Sciences & SUM Hospital, Siksha ‘O’ Anusandhan deemed to be University, Bhubaneswar, IndiaSahooJagdish PrasadDMInstitute of Medical Sciences & SUM Hospital, Siksha ‘O’ Anusandhan deemed to be University, Bhubaneswar, IndiaSharmaSumitaInstitute of Medical Sciences & SUM Hospital, Siksha ‘O’ Anusandhan deemed to be University, Bhubaneswar, IndiaKatyalV KMD, FACCPandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, IndiaKatyalAshimaMDPandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, IndiaYadavNidhiMDPandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, IndiaUpadhyayRashmiMDGovernment Institute of Medical Sciences, Noida, Uttar Pradesh, IndiaSrivastavaSaurabhMDGovernment Institute of Medical Sciences, Noida, Uttar Pradesh, IndiaSrivastavaAnuragMDGovernment Institute of Medical Sciences, Noida, Uttar Pradesh, IndiaSutharNilay NMDSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaShahNehal MMDSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaRajvanshKrutiMDSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaPurohitHemangMScSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaMohapatraPrasanta RaghabMDAll India Institute Of Medical Sciences, Bhubaneswar, IndiaPanigrahiManoj KumarMDAll India Institute Of Medical Sciences, Bhubaneswar, IndiaSaigalSaurabhMD, EDICAll India Institute Of Medical Sciences, Bhopal, Madhya Pradesh, IndiaKhuranaAlkeshMDAll India Institute Of Medical Sciences, Bhopal, Madhya Pradesh, IndiaPanchalManishaMDGMERS Medical College Himmatnagar, Gujarat, IndiaAnderpaMayankMDGMERS Medical College Himmatnagar, Gujarat, IndiaPatelDhruvMBBSGMERS Medical College Himmatnagar, Gujarat, IndiaSalgarVeereshMDGulbarga Institute of Medical Sciences, Kalburagi, Karnataka, IndiaAlgurSantoshMBBSGulbarga Institute of Medical Sciences, Kalburagi, Karnataka, IndiaChoudhuryRatnamalaMDSt. Johns Medical College, Bengaluru, Karnataka, IndiaRaoMangalaMDSt. Johns Medical College, Bengaluru, Karnataka, IndiaDNithyaMScSt. Johns Medical College, Bengaluru, Karnataka, IndiaGuptaBal KishanMDS.P.Medical College, Bikaner, Rajasthan, IndiaKumarBhuvaneshMDS.P.Medical College, Bikaner, Rajasthan, IndiaGuptaJigyasaMBBSS.P.Medical College, Bikaner, Rajasthan, IndiaBhandariSudhirMDSMS Medical College, Jaipur, Rajasthan, IndiaAgrawalAbhishekMDSMS Medical College, Jaipur, Rajasthan, IndiaShameemMohammadMD, FRCPJN Medical College Aligarh Muslim University, Aligarh, Uttar Pradesh, IndiaFatimaNazishMDJN Medical College Aligarh Muslim University, Aligarh, Uttar Pradesh, IndiaPalaStarMDNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, IndiaNongpiurVijayDMNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, IndiaChatterjiSoumyadipDMTata Medical Centre, Kolkata, West Bengal, IndiaMukherjeeSudiptaFNBTata Medical Centre, Kolkata, West Bengal, IndiaShivnitwarSachin KMDDr D Y Patil Medical college Hospital and Research centre, Pune, Maharashtra, IndiaTripathySrikanthMDDr D Y Patil Medical college Hospital and Research centre, Pune, Maharashtra, IndiaLokhandePrajaktaMPHDr D Y Patil Medical college Hospital and Research centre, Pune, Maharashtra, IndiaDanduHimanshuMDKing George Medical University, Lucknow, Uttar Pradesh, IndiaGuptaAmitMDKing George Medical University, Lucknow, Uttar Pradesh, IndiaKumarVivekMDKing George Medical University, Lucknow, Uttar Pradesh, IndiaSharmaNikitaMDMahatma Gandhi Medical College, Jaipur, Rajasthan, IndiaVohraRajatMDMahatma Gandhi Medical College, Jaipur, Rajasthan, IndiaPaliwalArchanaMDMahatma Gandhi Medical College, Jaipur, Rajasthan, IndiaKumarM PavanMDKakatiya Medical College, MGM Hospital Warangal, Telangana, IndiaRaoA BikshapathiMDKakatiya Medical College, MGM Hospital Warangal, Telangana, IndiaKikonNyanthungPGDPHMDepartment of Health & Family Welfare, Government of Nagaland, Nagaland, IndiaKikonRhondemoMScIHCommunity Health Initiative, Nagaland, IndiaManoharKMDNizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, IndiaRajuY SathyanarayanaMDNizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, IndiaMadhariaArunMSESI Hospital and Gayatri Hospital, Raipur, Chhattisgarh, IndiaChakravartyJayaMDInstitute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaChaubeyManaswiMDInstitute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaBandaruRajiv KumarMDESIC medical College, Sanathnagar, Hyderabad. IndiaMirzaMehdi AliDMESIC medical College, Sanathnagar, Hyderabad. IndiaKatariaSushilaMDMedanta-The Medicity, Gurugram, Haryana, IndiaSharmaPoojaMedanta-The Medicity, Gurugram, Haryana, IndiaGhoshSoumitraMDInstitute of Postgraduate Medical Education & Research, Kolkata, West BengalHazraAvijitMDInstitute of Postgraduate Medical Education & Research, Kolkata, West Bengal
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7
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Raychaudhuri D, Bandopadhyay P, D'Rozario R, Sarif J, Ray Y, Paul SR, Singh P, Chaudhuri K, Bhaduri R, Pandey R, Bhattacharya P, Sengupta S, Chatterjee S, Ganguly D. Clinical Trial Sub-Group Analyses to Investigate Clinical and Immunological Outcomes of Convalescent Plasma Therapy in Severe COVID-19. Mayo Clin Proc Innov Qual Outcomes 2022; 6:511-524. [PMID: 36117954 PMCID: PMC9472644 DOI: 10.1016/j.mayocpiqo.2022.09.001] [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] [Indexed: 11/25/2022] Open
Abstract
Objective To assess the clinical and immunological benefits of passive immunization using convalescent plasma therapy (CPT). Materials and Methods A series of subclass analyses were performed on the previously published outcome data and accompanying clinical metadata from a completed randomized controlled trial (RCT) (Clinical Trial Registry of India, number CTRI/2020/05/025209). The subclass analyses were performed on the outcome data and accompanying clinical metadata from a completed RCT (patient recruitment between May 15, 2020 and October 31, 2020). Data on the plasma abundance of a large panel of cytokines from the same cohort of patients were also used to characterize the heterogeneity of the putative anti-inflammatory function of convalescent plasma (CP) in addition to passively providing neutralizing antibodies. Results Although the primary clinical outcomes were not significantly different in the RCT across all age groups, significant immediate mitigation of hypoxia, reduction in hospital stay, and significant survival benefit were registered in younger (<67 years in our cohort) patients with severe coronavirus disease 2019 and acute respiratory distress syndrome on receiving CPT. In addition to neutralizing the antibody content of CP, its anti-inflammatory proteome, by attenuation of the systemic cytokine deluge, significantly contributed to the clinical benefits of CPT. Conclusion Subgroup analyses revealed that clinical benefits of CPT in severe coronavirus disease 2019 are linked to the anti-inflammatory protein content of CP apart from the anti–severe acute respiratory syndrome coronavirus 2 neutralizing antibody content.
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Key Words
- ARDS, Acute respiratory distress syndrome
- AUC, Area under curve
- CFHR1, Complement factor H related protein 1
- COVID-19, Coronavirus disease of 2019
- CP, Convalescent plasma
- CPT, Convalescent plasma therapy
- FiO2, Fraction of oxygen in inhaled air
- HTN, Hypertension
- IgG, Immunoglobulin G
- PaO2, Partial pressure of oxygen in blood
- RCT, Randomised control trial
- RT-PCR, Reverse transcriptase- polymerase chain reaction
- SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2
- SERPINA1, Serine protease inhibitors A1 (or alpha 1 anti-trypsin)
- SERPIND1, Serine protease inhibitors D1 (or heparin cofactor 2)
- SOC, Standard of care
- SpO2, Saturation of oxygen in capillary blood
- T2DM, Type 2 diabetes mellitus
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Affiliation(s)
- Deblina Raychaudhuri
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Purbita Bandopadhyay
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India.,Academy of Scientific and Innovative Research, India
| | - Ranit D'Rozario
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India.,Academy of Scientific and Innovative Research, India
| | - Jafar Sarif
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India.,Academy of Scientific and Innovative Research, India
| | - Yogiraj Ray
- Infectious Disease & Beleghata General Hospital, Kolkata, India.,Department of Infectious Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | | | - Praveen Singh
- CSIR-Institute of Genomics and Integrative Biology, Delhi, India.,Academy of Scientific and Innovative Research, India
| | | | | | - Rajesh Pandey
- CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Prasun Bhattacharya
- Department of Immunohematology & Blood Transfusion, Medical College Hospital, Kolkata, India
| | - Shantanu Sengupta
- CSIR-Institute of Genomics and Integrative Biology, Delhi, India.,Academy of Scientific and Innovative Research, India
| | - Shilpak Chatterjee
- Department of Infectious Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, India.,Academy of Scientific and Innovative Research, India
| | - Dipyaman Ganguly
- Department of Infectious Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, India
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8
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Jena B, Bajish CC, Turner J, Ravichandran M, Kshitija S, Anilkumar N, Singh AK, Pradhan PK, Ray Y, Saini S. Mechanisms associated with the rapid decline in sea ice cover around a stranded ship in the Lazarev Sea, Antarctica. Sci Total Environ 2022; 821:153379. [PMID: 35085627 DOI: 10.1016/j.scitotenv.2022.153379] [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: 11/02/2021] [Revised: 01/07/2022] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
In the satellite data era starting from 1979, the extent of Antarctic sea ice increased moderately for the first 37 years. However, the extent decreased to record low levels from 2016 to 2020, with the drop being greatest in the Weddell and Lazarev Seas of the Southern Ocean. An important question for the scientific fraternity and policymakers is to understand what ocean-atmospheric processes triggered such a rapid decline in sea ice. We employ in-situ, satellite, and atmospheric reanalysis data to examine the causative mechanism of anomalous sea ice variability in the Lazarev Sea at a time of ice growth in the annual cycle (March-April 2019), when a cargo ship was stuck in extensive ice cover and freed following the unusual decline in sea ice. High-resolution Sentinel-1 synthetic aperture radar captured a distinct view of the ship location and track within extensive ice cover of fast sea ice, dense pack ice, and icebergs in the Lazarev Sea on 27 March 2019. Subsequently, the sea ice cover declined and reached the fourth lowest extent in the entire satellite record during April 2019 which was 25.6% lower than the long-term mean value of 2.65 × 106 km2. We show that the anomalous sea ice variability was due to the occurrence of eastward-moving polar cyclones, including a quasi-stationary explosive development that impacted sea ice through extreme changes in ocean-atmospheric conditions. The cyclone-induced dynamic (poleward propagation of ocean waves and ice motion) and thermodynamic (heat and moisture plumes from midlatitudes, ocean mixed layer warming) processes coupled with high tides provided a conducive environment for an exceptional decline in sea ice over the region of ship movement.
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Affiliation(s)
- B Jena
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Government of India, Vasco-da-Gama, India.
| | - C C Bajish
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Government of India, Vasco-da-Gama, India
| | - J Turner
- British Antarctic Survey, Natural Environment Research Council, Cambridge, UK
| | - M Ravichandran
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Government of India, Vasco-da-Gama, India
| | - S Kshitija
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Government of India, Vasco-da-Gama, India
| | - N Anilkumar
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Government of India, Vasco-da-Gama, India
| | - A K Singh
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Government of India, Vasco-da-Gama, India
| | - P K Pradhan
- Department of Physics, Sri Venkateswara University, Tirupati, India
| | - Y Ray
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Government of India, Vasco-da-Gama, India
| | - S Saini
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Government of India, Vasco-da-Gama, India
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9
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Park H, Tarpey T, Liu M, Goldfeld K, Wu Y, Wu D, Li Y, Zhang J, Ganguly D, Ray Y, Paul SR, Bhattacharya P, Belov A, Huang Y, Villa C, Forshee R, Verdun NC, Yoon HA, Agarwal A, Simonovich VA, Scibona P, Burgos Pratx L, Belloso W, Avendaño-Solá C, Bar KJ, Duarte RF, Hsue PY, Luetkemeyer AF, Meyfroidt G, Nicola AM, Mukherjee A, Ortigoza MB, Pirofski LA, Rijnders BJA, Troxel A, Antman EM, Petkova E. Development and Validation of a Treatment Benefit Index to Identify Hospitalized Patients With COVID-19 Who May Benefit From Convalescent Plasma. JAMA Netw Open 2022; 5:e2147375. [PMID: 35076698 PMCID: PMC8790670 DOI: 10.1001/jamanetworkopen.2021.47375] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/15/2021] [Indexed: 12/20/2022] Open
Abstract
Importance Identifying which patients with COVID-19 are likely to benefit from COVID-19 convalescent plasma (CCP) treatment may have a large public health impact. Objective To develop an index for predicting the expected relative treatment benefit from CCP compared with treatment without CCP for patients hospitalized for COVID-19 using patients' baseline characteristics. Design, Setting, and Participants This prognostic study used data from the COMPILE study, ie, a meta-analysis of pooled individual patient data from 8 randomized clinical trials (RCTs) evaluating CCP vs control in adults hospitalized for COVID-19 who were not receiving mechanical ventilation at randomization. A combination of baseline characteristics, termed the treatment benefit index (TBI), was developed based on 2287 patients in COMPILE using a proportional odds model, with baseline characteristics selected via cross-validation. The TBI was externally validated on 4 external data sets: the Expanded Access Program (1896 participants), a study conducted under Emergency Use Authorization (210 participants), and 2 RCTs (with 80 and 309 participants). Exposure Receipt of CCP. Main Outcomes and Measures World Health Organization (WHO) 11-point ordinal COVID-19 clinical status scale and 2 derivatives of it (ie, WHO score of 7-10, indicating mechanical ventilation to death, and WHO score of 10, indicating death) at day 14 and day 28 after randomization. Day 14 WHO 11-point ordinal scale was used as the primary outcome to develop the TBI. Results A total of 2287 patients were included in the derivation cohort, with a mean (SD) age of 60.3 (15.2) years and 815 (35.6%) women. The TBI provided a continuous gradation of benefit, and, for clinical utility, it was operationalized into groups of expected large clinical benefit (B1; 629 participants in the derivation cohort [27.5%]), moderate benefit (B2; 953 [41.7%]), and potential harm or no benefit (B3; 705 [30.8%]). Patients with preexisting conditions (diabetes, cardiovascular and pulmonary diseases), with blood type A or AB, and at an early COVID-19 stage (low baseline WHO scores) were expected to benefit most, while those without preexisting conditions and at more advanced stages of COVID-19 could potentially be harmed. In the derivation cohort, odds ratios for worse outcome, where smaller odds ratios indicate larger benefit from CCP, were 0.69 (95% credible interval [CrI], 0.48-1.06) for B1, 0.82 (95% CrI, 0.61-1.11) for B2, and 1.58 (95% CrI, 1.14-2.17) for B3. Testing on 4 external datasets supported the validation of the derived TBIs. Conclusions and Relevance The findings of this study suggest that the CCP TBI is a simple tool that can quantify the relative benefit from CCP treatment for an individual patient hospitalized with COVID-19 that can be used to guide treatment recommendations. The TBI precision medicine approach could be especially helpful in a pandemic.
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Affiliation(s)
- Hyung Park
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Thaddeus Tarpey
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York
| | - Keith Goldfeld
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Yinxiang Wu
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Danni Wu
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Yi Li
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Jinchun Zhang
- Biostatistics and Research Decision Sciences, Merck Research Labortory, Merck & Co Inc, Rahway, New Jersey
| | - Dipyaman Ganguly
- Translational Research Unit of Excellence, Council Of Scientific And Industrial Research–Indian Institute of Chemical Biology, Kolkata, India
| | - Yogiraj Ray
- Infectious Disease, Beleghata General Hospital, Kolkata, India
- School of Tropical Medicine, Kolkata, India
| | | | | | - Artur Belov
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Analytics and Benefit-Risk Assessment Team, US Food and Drug Administration, Silver Spring, Maryland
| | - Yin Huang
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Analytics and Benefit-Risk Assessment Team, US Food and Drug Administration, Silver Spring, Maryland
| | - Carlos Villa
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Analytics and Benefit-Risk Assessment Team, US Food and Drug Administration, Silver Spring, Maryland
| | - Richard Forshee
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Analytics and Benefit-Risk Assessment Team, US Food and Drug Administration, Silver Spring, Maryland
| | - Nicole C. Verdun
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Hyun ah Yoon
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Anup Agarwal
- Indian Council of Medical Research, New Delhi, India
| | - Ventura Alejandro Simonovich
- Clinical Pharmacology Section, Department of Internal Medicine and Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Paula Scibona
- Clinical Pharmacology Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Leandro Burgos Pratx
- Transfusional Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Waldo Belloso
- Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Katharine J Bar
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rafael F. Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Priscilla Y. Hsue
- Zuckerberg San Francisco General, University of California, San Francisco
| | | | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - André M. Nicola
- Hospital Universitário de Brasília, University of Brasília, Brasília, Brazil
| | | | - Mila B. Ortigoza
- Departments of Medicine and Microbiology, New York University Grossman School of Medicine, New York
| | - Liise-anne Pirofski
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Bart J. A. Rijnders
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Andrea Troxel
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Elliott M. Antman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eva Petkova
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
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10
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Sarif J, Raychaudhuri D, D'Rozario R, Bandopadhyay P, Singh P, Mehta P, Hoque MA, Sinha BP, Kushwaha M, Sahni S, Devi P, Chattopadhyay P, Paul SR, Ray Y, Chaudhuri K, Banerjee S, Majumdar D, Saha B, Sarkar BS, Bhattacharya P, Chatterjee S, Paul S, Ghosh P, Pandey R, Sengupta S, Ganguly D. Plasma Gradient of Soluble Urokinase-Type Plasminogen Activator Receptor Is Linked to Pathogenic Plasma Proteome and Immune Transcriptome and Stratifies Outcomes in Severe COVID-19. Front Immunol 2021; 12:738093. [PMID: 34777349 PMCID: PMC8581406 DOI: 10.3389/fimmu.2021.738093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/08/2021] [Accepted: 10/06/2021] [Indexed: 12/11/2022] Open
Abstract
Disease caused by SARS-CoV-2 coronavirus (COVID-19) led to significant morbidity and mortality worldwide. A systemic hyper-inflammation characterizes severe COVID-19 disease, often associated with acute respiratory distress syndrome (ARDS). Blood biomarkers capable of risk stratification are of great importance in effective triage and critical care of severe COVID-19 patients. Flow cytometry and next-generation sequencing were done on peripheral blood cells and urokinase-type plasminogen activator receptor (suPAR), and cytokines were measured from and mass spectrometry-based proteomics was done on plasma samples from an Indian cohort of COVID-19 patients. Publicly available single-cell RNA sequencing data were analyzed for validation of primary data. Statistical analyses were performed to validate risk stratification. We report here higher plasma abundance of suPAR, expressed by an abnormally expanded myeloid cell population, in severe COVID-19 patients with ARDS. The plasma suPAR level was found to be linked to a characteristic plasma proteome, associated with coagulation disorders and complement activation. Receiver operator characteristic curve analysis to predict mortality identified a cutoff value of suPAR at 1,996.809 pg/ml (odds ratio: 2.9286, 95% confidence interval 1.0427-8.2257). Lower-than-cutoff suPAR levels were associated with a differential expression of the immune transcriptome as well as favorable clinical outcomes, in terms of both survival benefit (hazard ratio: 0.3615, 95% confidence interval 0.1433-0.912) and faster disease remission in our patient cohort. Thus, we identified suPAR as a key pathogenic circulating molecule linking systemic hyperinflammation to the hypercoagulable state and stratifying clinical outcomes in severe COVID-19 patients with ARDS.
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Affiliation(s)
- Jafar Sarif
- Indian Institute of Chemical Biology (IICB)-Translational Research Unit of Excellence, Council of Scientific & Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, India.,Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Deblina Raychaudhuri
- Indian Institute of Chemical Biology (IICB)-Translational Research Unit of Excellence, Council of Scientific & Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, India
| | - Ranit D'Rozario
- Indian Institute of Chemical Biology (IICB)-Translational Research Unit of Excellence, Council of Scientific & Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, India.,Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Purbita Bandopadhyay
- Indian Institute of Chemical Biology (IICB)-Translational Research Unit of Excellence, Council of Scientific & Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, India.,Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Praveen Singh
- Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.,Cardiorespiratory Disease Biology, Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Priyanka Mehta
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Md Asmaul Hoque
- Indian Institute of Chemical Biology (IICB)-Translational Research Unit of Excellence, Council of Scientific & Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, India.,Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Bishnu Prasad Sinha
- Indian Institute of Chemical Biology (IICB)-Translational Research Unit of Excellence, Council of Scientific & Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, India.,Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Manoj Kushwaha
- Cardiorespiratory Disease Biology, Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Shweta Sahni
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Priti Devi
- Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.,INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Partha Chattopadhyay
- Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.,INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Shekhar Ranjan Paul
- Department of Medicine, Infectious Diseases and Beliaghata General (ID & BG) Hospital, Kolkata, India
| | - Yogiraj Ray
- Department of Medicine, Infectious Diseases and Beliaghata General (ID & BG) Hospital, Kolkata, India.,Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Kausik Chaudhuri
- Department of Medicine, Infectious Diseases and Beliaghata General (ID & BG) Hospital, Kolkata, India
| | - Sayantan Banerjee
- Department of Medicine, Infectious Diseases and Beliaghata General (ID & BG) Hospital, Kolkata, India
| | - Debajyoti Majumdar
- Department of Medicine, Infectious Diseases and Beliaghata General (ID & BG) Hospital, Kolkata, India.,Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Bibhuti Saha
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Biswanath Sharma Sarkar
- Department of Medicine, Infectious Diseases and Beliaghata General (ID & BG) Hospital, Kolkata, India
| | - Prasun Bhattacharya
- Department of Immunohematology and Blood Transfusion, Medical College, Kolkata, India
| | - Shilpak Chatterjee
- Indian Institute of Chemical Biology (IICB)-Translational Research Unit of Excellence, Council of Scientific & Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, India
| | - Sandip Paul
- Indian Institute of Chemical Biology (IICB)-Translational Research Unit of Excellence, Council of Scientific & Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, India
| | - Pramit Ghosh
- Department of Community Medicine, Deben Mahata Government Medical College & Hospital, Purulia, India
| | - Rajesh Pandey
- Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.,INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Shantanu Sengupta
- Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.,Cardiorespiratory Disease Biology, Council of Scientific & Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Dipyaman Ganguly
- Indian Institute of Chemical Biology (IICB)-Translational Research Unit of Excellence, Council of Scientific & Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, India.,Department of Biological Sciences, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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11
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Nag S, Sengupta M, Sarkar S, Ray Y, Chattopadhyay D, Sengupta M. Isolation, characterization and acyclovir susceptibility of herpes simplex virus isolates among immunocompromised patients. Indian J Sex Transm Dis AIDS 2021; 42:19-23. [PMID: 34765933 PMCID: PMC8579594 DOI: 10.4103/ijstd.ijstd_60_17] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/13/2017] [Accepted: 07/20/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Herpes simplex virus (HSV) Type 2 primarily causes genital herpes, while HSV Type 1 is responsible for oral and facial lesions. The objective of this study was to isolate and characterize HSV from herpetic lesions among human immunodeficiency virus (HIV) infected patients and to evaluate their acyclovir susceptibility pattern. Materials and Methods Blister fluid and swabs from ulcers were collected from patients with clinical diagnosis of HSV infection among patients attending the HIV clinic of two tertiary care centers - Medical College, Kolkata, and School of Tropical Medicine, Kolkata. These samples were cultured in the Vero cell line. Growth of virus was noted by observing the characteristic cytopathic effect of HSV, which was further confirmed by immunofluorescence and polymerase chain reaction (PCR). These isolates were then subjected to the Vero cells with serial dilutions of acyclovir for determining the susceptibility pattern. Results Among the 52 samples received, 8 (15.38%) showed growth of HSV. After confirmation by immunofluorescence and PCR, all seven isolates from genital samples were identified as HSV-2 and the lone isolate from oral lesion was confirmed as HSV 1. Out of the eight isolates, 25% showed resistance to acyclovir. The overall isolation rate was more from genital blister than genital ulcer which was 46.15% and 2.86%, respectively. Conclusion HSV was isolated in 15.38% of cases of clinical herpes. There was a higher isolation rate of virus from blister fluid as compared to ulcer scrapings. Acyclovir resistance in 25% of cases is alarmingly high.
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Affiliation(s)
- Soumyabrata Nag
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, West Bengal, India
| | - Mallika Sengupta
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Kalyani, West Bengal, India
| | - Soma Sarkar
- Department of Microbiology, Medical College, Kolkata, West Bengal, India
| | - Yogiraj Ray
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India
| | | | - Manideepa Sengupta
- Department of Microbiology, Medical College, Kolkata, West Bengal, India
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12
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Bandopadhyay P, Rozario RD, Lahiri A, Sarif J, Ray Y, Paul SR, Roy R, Maiti R, Chaudhuri K, Bagchi S, Maiti A, Perwez MM, Sharma Sarkar B, Roy D, Chakraborty R, Vasudevan JS, Sharma S, Biswas D, Maiti C, Saha B, Bhattacharya P, Pandey R, Chatterjee S, Paul S, Ganguly D. Nature and Dimensions of Systemic Hyperinflammation and its Attenuation by Convalescent Plasma in Severe COVID-19. J Infect Dis 2021; 224:565-574. [PMID: 34398242 PMCID: PMC7928875 DOI: 10.1093/infdis/jiab010] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/11/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), has led to significant morbidity and mortality. While most suffer from mild symptoms, some patients progress to severe disease with acute respiratory distress syndrome (ARDS) and associated systemic hyperinflammation. METHODS First, to characterize key cytokines and their dynamics in this hyperinflammatory condition, we assessed abundance and correlative expression of a panel of 48 cytokines in patients progressing to ARDS as compared to patients with mild disease. Then, in an ongoing randomized controlled trial of convalescent plasma therapy (CPT), we analyzed rapid effects of CPT on the systemic cytokine dynamics as a correlate for the level of hypoxia experienced by the patients. RESULTS We identified an anti-inflammatory role of CPT independent of its neutralizing antibody content. CONCLUSIONS Neutralizing antibodies, as well as reductions in circulating interleukin-6 and interferon-γ-inducible protein 10, contributed to marked rapid reductions in hypoxia in response to CPT. CLINICAL TRIAL REGISTRY OF INDIA CTRI/2020/05/025209. http://www.ctri.nic.in/.
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Affiliation(s)
- Purbita Bandopadhyay
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Ranit D’ Rozario
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Abhishake Lahiri
- Division of Structural Biology & Bioinformatics, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Jafar Sarif
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Yogiraj Ray
- Department of Medicine, ID & BG Hospital, Kolkata, India
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | | | - Rammohan Roy
- Department of Medicine, ID & BG Hospital, Kolkata, India
| | - Rajshekhar Maiti
- Department of Medicine, ID & BG Hospital, Kolkata, India
- Department of Pediatrics, Sagar Dutta Hospital & College of Medicine, Kolkata, India
| | | | - Saugata Bagchi
- Department of Medicine, ID & BG Hospital, Kolkata, India
| | - Ayan Maiti
- Department of Medicine, ID & BG Hospital, Kolkata, India
| | | | | | - Devlina Roy
- Department of Medicine, ID & BG Hospital, Kolkata, India
| | | | | | - Sachin Sharma
- CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Durba Biswas
- Department of Immunohematology & Blood Transfusion, Medical College Hospital, Kolkata, India
| | - Chikam Maiti
- Department of Immunohematology & Blood Transfusion, Medical College Hospital, Kolkata, India
| | - Bibhuti Saha
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Prasun Bhattacharya
- Department of Immunohematology & Blood Transfusion, Medical College Hospital, Kolkata, India
| | - Rajesh Pandey
- CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Shilpak Chatterjee
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Sandip Paul
- Division of Structural Biology & Bioinformatics, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Dipyaman Ganguly
- IICB-Translational Research Unit of Excellence, CSIR-Indian Institute of Chemical Biology, Kolkata, India
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13
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Biswas D, Maiti C, Talukder B, Azharuddin M, Saha S, Pandey S, Das A, Adhikari SD, Ray Y, Sarkar BS, Paul SR, Saha B, Paul S, Chatterjee S, Ganguly D, Bhattacharya P. A prospective study on COVID-19 convalescent plasma donor (CCP) recruitment strategies in a resource constrained blood centre. ACTA ACUST UNITED AC 2021; 16:276-283. [PMID: 34226835 PMCID: PMC8242402 DOI: 10.1111/voxs.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/11/2021] [Revised: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 12/27/2022]
Abstract
Background and Objectives The COVID-19 pandemic has spread across 87 million people with more than 1·8 million deaths in the world. As there is no definite treatment modality, the use of convalescent plasma has become increasingly popular worldwide. This study aimed to identify an appropriate strategy of donor recruitment and to evaluate the appropriateness of pre-set plasma donation guidelines. Material and Methods In this prospective study conducted from May to September 2020, the donors were recruited under the following two circumstances: Group I, patients in the post-COVID-19 follow-up in the clinic, and Group II, patients recovered from COVID-19 recruited through mass and electronic media. A pre-set donor selection criteria and laboratory investigation was designed according to national and international guidelines. Approximately 500 ml of COVID-19 convalescent plasma (CCP) was collected from recovered individuals in each group by two different cell separators. The overall donor's attendance rate, deferral rate, adverse events and donor compliance was analysed and compared between the two groups. Results There was a significant difference in attendance in relation to registration between the groups (P < 0·0001). Donor deferral was significantly higher in group II compared with group I. The single most frequent cause of donor deferral was low antibody index (P = 0·0001). The total donor adverse event rate in CCP donation was significantly lower compared with routine plateletpheresis procedures. The donor's compliance to blood centre's protocol was satisfactory in both the groups. Conclusion Recruitment of patients in the post-COVID-19 follow-up in the clinic was more effective than the general recruitment through mass and electronic media for convalescence plasma donation in a resource-constrained blood centre.
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Affiliation(s)
- Durba Biswas
- Department of Immunohematology and Blood Transfusion Medical College and Hospital Kolkata India
| | - Chikam Maiti
- Department of Immunohematology and Blood Transfusion Medical College and Hospital Kolkata India
| | - Biplabendu Talukder
- Department of Immunohematology and Blood Transfusion Medical College and Hospital Kolkata India
| | - Md Azharuddin
- Department of Immunohematology and Blood Transfusion Medical College and Hospital Kolkata India
| | - Sayantan Saha
- Department of Immunohematology and Blood Transfusion Medical College and Hospital Kolkata India
| | - Sumita Pandey
- Department of Immunohematology and Blood Transfusion Medical College and Hospital Kolkata India
| | - Arijit Das
- Department of Immunohematology and Blood Transfusion Medical College and Hospital Kolkata India
| | - Setu Das Adhikari
- Department of Immunohematology and Blood Transfusion Medical College and Hospital Kolkata India
| | - Yogiraj Ray
- Department of Medicine I.D&B.G Hospital Kolkata India
| | | | - Sekhar R Paul
- Department of Medicine I.D&B.G Hospital Kolkata India
| | - Bibhuti Saha
- Department of Tropical Medicine Calcutta School of Tropical Medicine Kolkata India
| | - Sandip Paul
- CSIR-Indian Institute of Chemical Biology Kolkata India
| | - Shilpak Chatterjee
- Department of Immunohematology and Blood Transfusion Medical College and Hospital Kolkata India.,Department of Medicine I.D&B.G Hospital Kolkata India.,Department of Tropical Medicine Calcutta School of Tropical Medicine Kolkata India.,CSIR-Indian Institute of Chemical Biology Kolkata India
| | | | - Prasun Bhattacharya
- Department of Immunohematology and Blood Transfusion Medical College and Hospital Kolkata India
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14
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Dash A, Gupta N, Ray Y, Kodan P, Singh BK, Soneja M. Choosing the therapy for neurological infection with rapidly growing mycobacteria. Drug Discov Ther 2020; 14:211-212. [PMID: 32830168 DOI: 10.5582/ddt.2020.03026] [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: 11/05/2022]
Abstract
The management of neurological infections due to non-tubercular mycobacteria is extremely challenging because of scarce literature, issues with penetration, lack of easily available susceptibility platforms and adverse effects associated with long term therapy. We report a case of a young girl with neurological infection due to rapidly growing mycobacteria to discuss the factors that should be considered while choosing the therapy for such rare and persistent infections.
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Affiliation(s)
- Atman Dash
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Yogiraj Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parul Kodan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Binit Kumar Singh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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15
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Banerjee S, Gupta N, Ray Y, Kodan P, Khot WY, Fazal F, Nyas VKM, Soneja M, Vikram N, Biswas A, Kapil A, Wig N. Impact of trainee-driven Antimicrobial Stewardship Program in a high burden resource-limited setting. Infez Med 2020; 28:367-372. [PMID: 32920572] [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: 06/11/2023]
Abstract
Antimicrobial Stewardship Program (ASP) is one of the most critical interventions required to halt the growing global antimicrobial resistance. The study aimed to evaluate the effect of trainee driven ASP implementation with limited available resources on outcome variables. An ASP team comprising of infectious diseases trainees and consultants was constituted to conduct stewardship activities in the Department of Medicine, All India Institute of Medical Sciences, a tertiary care apex institute in north India. Prospective audit and feedback were conducted by the team, and the following outcome variables were recorded and analyzed: the practice of sending cultures, appropriateness of prescribed empiric antibiotics, gross antimicrobial consumption and mortality. ASP intervention led to an increase in blood culture positivity rates by two folds (p<0.001). The trend of empiric prescription choices gradually shifted over time towards the use of more effective antibiotics according to the local antibiogram. Redundant usage of antibiotics substantially reduced over time. There was no impact of the antimicrobial stewardship program on the all-cause mortality rate. ASP had a significant effect on the practice of sending cultures and appropriateness of antibiotic usage. In resource-limited settings, trainee-driven antimicrobial stewardship program can succeed in inculcating rational practices among fellow residents and practicing physicians.
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Affiliation(s)
- Sayantan Banerjee
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Yogiraj Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parul Kodan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Wasim Yunus Khot
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Farhan Fazal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - NavalKishore Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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16
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Samajdar SS, Sam PA, Moitra S, Ray Y, Pal J, Joshi SR, Tripathi SK. Risk Benefit Analysis in Reference to use of LMWH in COVID-19. J Assoc Physicians India 2020; 68:52-61. [PMID: 32798346] [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: 06/11/2023]
Abstract
Venous thromboembolism (VTE) and disseminated intravascular coagulation (DIC) are frequent cardiovascular and/or respiratory complications among hospitalized patients of COVID-19 infection. A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, and the application of heparin in COVID-19 has been assessed and recommended with some expert consensus because of the risk of DIC and venous thromboembolism. However, "Risk Benefit Analysis" on the aspect of safety in using low molecular weight heparin (LMWH) in COVID-19 patients for thrombosis prophylaxis has been explained below with a few case studies and detailed information from various clinical evidence. COVID-19 infection has been associated with inflammation and a prothrombotic state, with increase in fibrin, fibrin degradation products, fibrinogen, and D-dimers. Heparin treatment including unfractionated and low molecular weight heparin appears to be associated with better prognosis in severe COVID-19 patients with coagulopathy. Major studies since the onset of this pandemic, found better prognosis in severe COVID-19 patients meeting SIC criteria or with markedly elevated D-dimer, by approaching thrombosis prophylaxis with LMWH.
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Affiliation(s)
| | | | - Saibal Moitra
- Adjunct Professor and Senior Consultant, Department of Allergy and Immunology, Apollo Gleneagles Hospital, Kolkata
| | - Yogiraj Ray
- Assistant Professor Tropical Medicine, School of Tropical Medicine, Kolkata and COVID CCU in charge ID and BG Hospital
| | - Jyotirmoy Pal
- Professor, Department of Internal Medicine, R G Kar Medical College and Hospital, Kolkata
| | | | - Santanu K Tripathi
- Professor and Head, Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata
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17
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Affiliation(s)
- Farhan Fazal
- Department of Medicine, Kasturba Medical College, Mangalore, India
| | - Nitin Gupta
- Department of Infectious diseases, Kasturba Medical College, Manipal, India
| | - Wasim Khot
- Department of Medicine, King Edward Memorial Hospital, Mumbai, India
| | - Yogiraj Ray
- Department of Tropical Medicine, Calcutta 76063School of Tropical Medicine, India
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18
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Gupta N, Kumar R, Banerjee S, Singh G, Malla S, Ray Y, Ramteke P, George N, Kodan P, Aggarwal A, Kumar P, Jorwal P, Soneja M, Biswas A. Brain abscess in patients with chronic kidney disease: A case-based approach to management in resource-limited settings. Drug Discov Ther 2020; 14:93-97. [PMID: 32321877 DOI: 10.5582/ddt.2019.01062] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The management of patients with brain abscess poses a significant challenge to clinicians in patients with chronic kidney disease. Obtaining a biopsy sample from the affected area is the mainstay in the diagnosis, but it is often unavailable. In most cases, therapy is guided by clinical findings and imaging alone. We discuss three cases of brain abscess- each with a different scenario and discuss the issues faced in management. The first case was a 32-year-old post-renal transplant male patient with a brain abscess due to dematiaceous fungi and was treated with amphotericin. The second case was a 42-year-old female patient with stage 5 chronic kidney disease on maintenance hemodialysis who presented with a brain abscess due to suspected fungal infection based on imaging findings and was managed with antibiotics and voriconazole. The third case was a 42-year-old post-renal transplant male patient who presented with a brain abscess due to nocardiosis and was managed with cotrimoxazole, meropenem and linezolid. We also summarize the approach to the management of brain abscess in resource-limited settings.
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Affiliation(s)
- Nitin Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sayantan Banerjee
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sundeep Malla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Yogiraj Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Ramteke
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Netto George
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parul Kodan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anivita Aggarwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Jorwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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19
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Affiliation(s)
- A Mittal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Y Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - M Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - M Chatterjee
- Department of Pharmacology, Institute of Post-Graduate Medical Education and Research, Kolkata, India
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20
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Gupta N, Mittal A, Niyas VKM, Banerjee S, Ray Y, Kodan P, Malla S, Khot W, Fazal F, Singh BK, Jorwal P, Nischal N, Soneja M, Wig N. Nontuberculous mycobacteria: A report of eighteen cases from a tertiary care center in India. Lung India 2020; 37:495-500. [PMID: 33154211 PMCID: PMC7879861 DOI: 10.4103/lungindia.lungindia_365_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Context Nontuberculous mycobacteria (NTM) are ubiquitous mycobacteria present in environment and generally affect patients with either structural lung disease or immunosuppression and commonly involve lungs, lymph node, or skin. Materials and Methods Between July 2016 and February 2019, 18 cases of NTM were diagnosed and their relevant clinical, diagnostic, and treatment details were recorded after taking informed consent. Results We report 18 cases of NTM involving lungs (n = 11), skin and soft tissue (n = 3), joint (n = 2), genitourinary (n = 1), and central nervous system (n = 1). History of immunosuppression was present in two patients, whereas history of some form of intervention was seen in six patients. Mycobacterium fortuitum group (n = 5) was the most commonly isolated organism, followed by Mycobacterium avium complex (n = 4), Mycobacterium abscessus (n = 3), Mycobacterium kansasii (n = 2), and Mycobacterium chelonae (n = 1). In two patients, M. chelonae and M. abscessus were isolated in succession. Of these 18 patients, clinical response was present in 15 of the patients. Diagnosis and treatment of NTM in resource limited settings is extremely challenging. Conclusion Most of the patients with NTM are misdiagnosed and are treated as tuberculosis in India, sometimes with a multidrug resistance regimen, which results in significant morbidity and mortality. We present these cases to shed some light on the epidemiology of NTM in this part of India.
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Affiliation(s)
- Nitin Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Mittal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sayantan Banerjee
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Yogiraj Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parul Kodan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sundeep Malla
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Wasim Khot
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Farhan Fazal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Binit Kumar Singh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Jorwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Biswas S, Goel A, Ray Y, Sethi P, Kumar A, Nischal N, Sinha S, Wig N. Human trichinosis and febrile myositis. QJM 2019; 112:449-450. [PMID: 30968127 DOI: 10.1093/qjmed/hcz081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 03/26/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Biswas
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A Goel
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Y Ray
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - P Sethi
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A Kumar
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - N Nischal
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Sinha
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - N Wig
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Abstract
Nipah virus, an enveloped ribonucleic acid virus, has been a major cause of encephalitis out-breaks with high mortality, primarily in the Indo-Bangladesh regions. Except for the first outbreak in Malaysia-Singapore, which was related to contact with pigs and the outbreak in Philippines associated with horse slaughter, most other outbreaks have affected the Indo- Bangladesh regions. The Indo-Bangladesh outbreaks were associated with consumption of raw date palm sap contaminated by fruit bats and had a very high secondary attack rate. The patient usually presents with fever, encephalitis and/or respiratory involvement with or without thrombocytopenia, leukopenia and transaminitis. Diagnosis can be confirmed by isolation and nucleic acid amplification in the acute phase or antibody detection during the convalescent phase. Treatment is mostly limited to supportive care and syndromic management of acute encephalitis syndrome. Ribavirin, m102.4 monoclonal antibody and favipiravir are the only anti-virals with some activity against Nipah virus. Standard precautions, hand hygiene and personal protective equipments are the cornerstone of comprehensive infection prevention and control strategy. With the recent outbreaks affecting newer geographical areas, there is a need for physicians to be aware of this disease and keep abreast of its current detection and management strategies.
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Affiliation(s)
| | | | | | | | | | | | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
- Address correspondence to:Dr. Manish Soneja, Department of Medicine, All India Institute of Medical Sciences, New Delhi 11029, India. E-mail:
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Kumar P, Kumar R, Kirtana J, Kodan P, Ray Y, Biswas A. Culture-negative fungal endocarditis. Heart Mind 2019. [DOI: 10.4103/hm.hm_31_19] [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
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Gupta N, Soneja M, Ray Y, Sahu M, Vinod KS, Kapil A, Biswas A, Wig N, Sood R. Nosocomial pneumonia: Search for an empiric and effective antibiotic regimen in high burden tertiary care centre. Drug Discov Ther 2018; 12:97-100. [PMID: 29669956 DOI: 10.5582/ddt.2017.01070] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The clinical practice guidelines on nosocomial pneumonia recommends an empirical regimen that would work in 95% of the patients based on the local antibiogram. The aim of the study was development of an antibiogram for guiding empiric therapy in settings with high prevalence of multi-drug resistant organisms. A retrospective review of electronic health records (e-hospital portal) was done to analyze all respiratory isolates from patients admitted in medical wards and intensive care unit between May 2016 and May 2017. The samples included brocho-alveolar lavage (BAL), mini broncho-alveolar lavage (mini-BAL) and endotracheal aspirate. The sensitivity pattern (combined and individual) of all bacterial isolates were analysed for commonly used antibiotics and their combinations. Out of the 269 isolates, the most common organisms were Pseudomonas aeruginosa (125, 46%), Acinetobacter baumanni (74, 27%) and Klebsiella pneumoniae (50, 19%). Cefoperazone-sulbactam (43%) had the best sensitivity pattern overall. Cefoperazone-sulbactam plus amikacin (56%) was the combination with the best combined sensitivity overall. There is a high prevalence of resistance in the commonly implicated organisms to the available antibiotics. There is an urgent need for implementation of effective anti-microbial stewardship programmes and development of newer antimicrobials.
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Affiliation(s)
- Nitin Gupta
- Department of Medicine, All India Institute of Medical Sciences
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences
| | - Yogiraj Ray
- Department of Medicine, All India Institute of Medical Sciences
| | - Monalisa Sahu
- Department of Medicine, All India Institute of Medical Sciences
| | | | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences
| | - Rita Sood
- Department of Medicine, All India Institute of Medical Sciences
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Basu A, Ray Y, Bhowmik P, Rahman M, Goswami RP. SLE in a Male Patient Presented Initially as Rowell's Syndrome. J Assoc Physicians India 2018; 66:98-99. [PMID: 30341854] [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: 06/08/2023]
Abstract
A 22 year old male Indian patient presented with high grade fever, multiple joint pain, low back pain, generalized body ache since 6 months and erythematous pruritic rashes and atypical annular target like lesions over face, arm, leg and back and ulcers on hard palate and buccal mucosa for 2 months. Laboratory investigations showed a speckled pattern anti-nuclear antibody with a titer >1:160 and positive SS-A, dsDNA auto-antibodies and Rheumatoid factor. Diagnosis of Rowell's syndrome was made based on clinical and laboratory finding and the patient was treated with oral prednisolone (50 mg/day), hydroxychloroquine (200 mg q12h) and pulse cyclophosphamide (700 mg) chemotherapy. Majority of skin lesions and oral ulcerations subsided after 4 weeks of therapy. Till date only 11 male patients out of the total 71 cases of Rowell's syndrome were reported in the world's literature.
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Affiliation(s)
- Ayan Basu
- Former RMO cum Clinical Tutor, Tropical Medicine; Currently working as Post Doctoral Trainee,Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi
| | | | | | | | - Rama Prosad Goswami
- Professor, Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal
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Basu A, Kundu S, Rahman M, Ray Y, Goswami RP. Scleroderma-like Initial Presentation of Multiple Myeloma. J Assoc Physicians India 2017; 65:93-95. [PMID: 31556280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Systemic sclerosis (SSc) is a multisystem connective tissue disease affecting skin and internal organs. Certain drugs, environmental toxins and some viruses have been implicated in SSc-like illnesses. Scleroderma may be associated with some connective tissue disorders or autoimmune diseases but coexistence of scleroderma with multiple myeloma (MM) is an unusual finding. We here report a case of a 59 years old female patient with 5 months history of progressive thickening of skin all over the body. Multiple myeloma was diagnosed by osteolytic lesion in skull X-ray, increase in clonal plasma cells by bone marrow biopsy, very high Kappa light chain in serum light chain assay and detection of M band by serum protein electrophoresis.
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Affiliation(s)
| | | | | | | | - Rama Prosad Goswami
- Professor, Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal
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Goswami RP, Goswami RP, Basu A, Ray Y, Rahman M, Tripathi SK. Protective Efficacy of Secondary Prophylaxis Against Visceral Leishmaniasis in Human Immunodeficiency Virus Coinfected Patients Over the Past 10 Years in Eastern India. Am J Trop Med Hyg 2017; 96:285-291. [PMID: 27879457 PMCID: PMC5303025 DOI: 10.4269/ajtmh.16-0432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/19/2016] [Indexed: 12/14/2022] Open
Abstract
Coinfection with visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) leads to frequent treatment failure, relapse, and death. In this retrospective analysis from eastern India (2005-2015), our primary objective was to ascertain the protective efficacy of secondary prophylaxis with monthly amphotericin B (AmB) given in patients with HIV-VL coinfection toward reducing relapse and mortality rates. The secondary objective was to compare clinical features, laboratory findings, and treatment outcomes in HIV-VL patients in contrast to VL monoinfection. Overall, 53 cases of HIV-VL and 460 cases of VL monoinfection were identified after excluding incomplete records. Initial cure rate was 96.23% in HIV-VL (27 received liposomal AmB and 26 AmB deoxycholate). All patients with initial cure (N = 51) were given antiretroviral therapy. Secondary prophylaxis (N = 27) was provided with monthly 1 mg/kg AmB (15 liposomal, 12 deoxycholate). No relapse or death was noted within 6 months in the secondary prophylaxis group (relapse: none versus 18/24 [75%]; mortality: none versus 11/24 [45.8%]; P < 0.001 for both). Secondary prophylaxis remained the sole significant predictor against death in multivariate Cox regression model (hazard ratio = 0.09 [95% confidence interval = 0.03-0.31]; P < 0.001). HIV-VL patients had higher 6-month relapse rate, less relapse-free 12-month survival, and higher mortality (P < 0.001 each) than VL monoinfection. In conclusion, it appears from this study that secondary prophylaxis with monthly AmB might be effective in preventing relapse and mortality in HIV-VL.
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Affiliation(s)
- Rama P Goswami
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Rudra P Goswami
- Department of Rheumatology, Institution of Post Graduate Medical Education and Research, Kolkata, India.
| | - Ayan Basu
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Yogiraj Ray
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Mehebubar Rahman
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Santanu K Tripathi
- Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, India
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Basu A, Wali M, Bhattacharya B, Rahman M, Ray Y, Goswami RP. Nephritic syndrome and anasarca in a case of lymphatic filariasis: A rare association. Asian Pacific Journal of Tropical Disease 2016. [DOI: 10.1016/s2222-1808(16)61073-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goswami RP, Goswami RP, Rahman M, Ray Y, Tripathi SK. Alternative treatment approach to cerebral toxoplasmosis in HIV/AIDS: experience from a resource-poor setting. Int J STD AIDS 2014; 26:864-9. [PMID: 25411350 DOI: 10.1177/0956462414560594] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/26/2014] [Indexed: 11/17/2022]
Abstract
The current standard treatment for cerebral toxoplasmosis (pyrimethamine/sulfadiazine) often encounters problems of poor tolerability, adverse effects, frequent dropouts and non-availability of pyrimethamine/sulfadiazine in some parts of India. We have had to use the combination of two effective alternative agents for toxoplasmosis, cotrimoxazole and clindamycin, on compassionate grounds. This retrospective observational study reports superior efficacy and better tolerability of cotrimoxazole/clindamycin compared to the recommended regimen. Primary end-point (complete response) was defined as more than 50% improvement of clinical status or more than 50% decrease in the size of brain lesions after two weeks of treatment initiation. Complete response occurred more commonly with cotrimoxazole/clindamycin than with pyrimethamine/sulfadiazine group (80% vs. 31.25%, respectively, relative risk 2.56, 95% confidence interval: 1.21-5.43). There was a trend towards higher on-treatment mortality in the pyrimethamine/sulfadiazine group in comparison to the cotrimoxazole/clindamycin (mortality rate 37.5% in pyrimethamine/sulfadiazine vs 12% in cotrimoxazole/clindamycin, p = 0.07, relative risk = 3.125, 95% confidence interval: 0.91-10.75). Overall, 62.5% (10/16) of patients on pyrimethamine/sulfadiazine suffered drug-related adverse reactions compared to 24% (6/25) on cotrimoxazole/clindamycin (p = 0.02, relative risk = 2.60, 95% confidence interval: 1.17-5.76). The commonest complication of pyrimethamine/sulfadiazine was severe thrombocytopenia with major bleeding (4/16, 25%). We propose that the new combination chemotherapy, which is widely available, effective and safe, can be used in developing countries.
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Affiliation(s)
- Rama Prosad Goswami
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Rudra Prosad Goswami
- Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Mehebubar Rahman
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Yogiraj Ray
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
| | - Santanu Kumar Tripathi
- Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, West Bengal, India
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Basu A, Ray Y, Bowmik P, Rahman M, Dikshit N, Goswami RP. Rare association of coeliac disease with aplastic anaemia: report of a case from India. Indian J Hematol Blood Transfus 2014; 30:208-11. [PMID: 25332580 DOI: 10.1007/s12288-014-0331-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 09/02/2013] [Accepted: 01/03/2014] [Indexed: 12/15/2022] Open
Abstract
Coeliac disease is a systemic autoimmune disorder with major intestinal manifestations. It has multiple hematologic associations including anaemia (mostly due to iron, folate and/or vitamin B12 malabsorption), other cytopenias, coagulation abnormalities, hyposplenism, IgA deficiency and lymphomas. Aplastic anaemia has however, only rarely been described with celiac disease in published literature. We here present a case of atypical coeliac disease in a 40 year male Indian patient, with insignificant gastrointestinal symptoms, presenting with aplastic anaemia manifested by pancytopenia with hypocellular bone marrow. On gluten free diet, his symptoms like weakness, fatigue and malaise were relieved-blood and platelet transfusion requirement also diminished.
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Affiliation(s)
- Ayan Basu
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, Kolkata, India ; 46/27A, Becharam Chatterjee Road, Behala, Kolkata, West Bengal 700034 India
| | - Yogiraj Ray
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, Kolkata, India
| | - Pratik Bowmik
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, Kolkata, India
| | - Mehebubar Rahman
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, Kolkata, India
| | - Nidhi Dikshit
- Department of Haematology, Calcutta School of Tropical Medicine, Kolkata, India
| | - Rama Prosad Goswami
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, Kolkata, India ; Department of Haematology, Calcutta School of Tropical Medicine, Kolkata, India
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Goswami RP, Pal D, Das S, Ray Y, Rahman M. Multiple intramuscular and hepatic echinococcosis. J Assoc Physicians India 2013; 61:907-908. [PMID: 24968549] [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: 06/03/2023]
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Goswami RP, Goswami RP, Das S, Ray Y, Rahman M. Testing urine samples with rK39 strip as the simplest non-invasive field diagnosis for visceral leishmaniasis: an early report from eastern India. J Postgrad Med 2013; 58:180-4. [PMID: 23023349 DOI: 10.4103/0022-3859.101378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Diagnosis of visceral leishmaniasis (VL) is a major obstacle in the control of this disease. The rK39 strip-test using patient's blood is a breakthrough; however, it still requires a blood sample, which is a concern for safety in the field. We tried to simplify the test using the patient's urine instead of blood. AIMS To observe the sensitivity and specificity of the urine test in comparison with the blood test. MATERIALS AND METHODS We tested active and post-treatment VL patients, Post Kala azar dermal leishmaniasis (PKDL), VL/HIV and control subjects (healthy, disease suspects and diseased other than VL) with the rK39 strip-test using blood and urine samples. STATISTICAL ANALYSIS The level of agreement between the urine and blood testing was calculated by inter-rater agreement (kappa) statistics. RESULTS Forty-two active VL, 40 treated VL, six PKDL, three VL/HIV and 139 controls (54 healthy, 21 disease suspects and 64 diseased other than VL) were tested. All VL-related cases showed positive results with urine as well as blood samples (100%). The urine testing was found to have 100% sensitivity and 86.33% specificity for the diagnosis of VL. Kappa statistic between the two methods was 0.916 (P<0.001). Urine testing had more false-positive results in comparison with blood testing (13.67% vs. 9.45%), but the test subjects were from VL-endemic areas and they might be exposed to Leishmania donovani infection. CONCLUSIONS The present study has the potentiality of providing a new, yet simplest non-invasive screening tool for VL in remote rural areas.
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Affiliation(s)
- R P Goswami
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India
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Goswami RP, Goswami RP, Ray Y, Rahman M. Absolute CD4 counts in monoinfected chronic hepatitis B patients in the advanced immune-active stage. Eur J Gastroenterol Hepatol 2012; 24:214-5. [PMID: 22138686 DOI: 10.1097/meg.0b013e32834f15fb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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