57 results on '"Pankaj Jorwal"'
Search Results
2. Effectiveness of an inactivated virus-based SARS-CoV-2 vaccine, BBV152, in India: a test-negative, case-control study
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Pankaj Jorwal, Rakesh Lodha, Manish Soneja, Naveet Wig, Naveen R Gowda, Karan Madan, Parmeshwar Kumar, Randeep Guleria, Ankit Mittal, Arvind Kumar, Neeraj Nischal, Ganesh Tarachand Maher, Ayan Mandal, H Vikas, Sanjeev Sinha, Parul Kodan, Lalit Dar, Devashish Desai, Animesh Ray, R.M. Pandey, Shivam Pandey, Megha Brijwal, Rohit Kumar, Adil Rashid Khan, Shivdas Naik, Aashish Choudhary, and Ayush Agarwal
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Vaccines ,medicine.medical_specialty ,COVID-19 Vaccines ,SARS-CoV-2 ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,Context (language use) ,Articles ,Virus ,Test (assessment) ,Odds ,Vaccination ,Infectious Diseases ,Negative case ,Internal medicine ,Pandemic ,medicine ,Humans ,business - Abstract
Background BBV152 is a whole-virion inactivated SARS-CoV-2 vaccine that has been deployed in India. The results of the phase 3 trial have shown clinical efficacy of BBV152. We aimed to evaluate the effectiveness of BBV152 against symptomatic RT-PCR-confirmed SARS-CoV-2 infection. Methods We conducted a test-negative, case-control study among employees of the All India Institute of Medical Sciences (a tertiary care hospital in New Delhi, India), who had symptoms suggestive of COVID-19 and had an RT-PCR test for SARS-CoV-2 during the peak of the second wave of the COVID-19 pandemic in India between April 15 and May 15, 2021. Cases (test-positives) and controls (test-negatives) were matched (1:1) on the basis of age and gender. The odds of vaccination with BBV152 were compared between cases and controls and adjusted for level of occupational exposure (to COVID-19), previous SARS-CoV-2 infection, and calendar time, using conditional logistic regression. The primary outcome was effectiveness of two doses of BBV152 (with the second dose received at least 14 days before testing) in reducing the odds of symptomatic RT-PCR-confirmed SARS-CoV-2 infection, expressed as (1 – odds ratio) × 100%. Findings Between April 15 and May 15, 2021, 3732 individuals had an RT-PCR test. Of these, 2714 symptomatic employees had data on vaccination status, and 1068 matched case-control pairs were available for analysis. The adjusted effectiveness of BBV152 against symptomatic COVID-19 after two doses administered at least 14 days before testing was 50% (95% CI 33–62; p
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- 2022
3. A study on the morbid histopathological changes in COVID‐19 patients with or without comorbidities using minimally invasive tissue sampling
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Ayush Goel, Animesh Ray, Amitkumar Chavan, Shubham Sahni, Baidhnath K. Gupta, Shrawan K. Raut, Shubham Agarwal, Jagbir Nehra, Bharadhan Somu, Ragu Raja, null Aakansha, Chitrakshi Nagpal, Chaithra Rajanna, Anand Shahi, Anand Rajendran, Ashwin Varadrajan, Inamul Hasan, Pratheek Choppala, Megha Priyadarshi, Deepali Jain, Arulselvi Subramanian, Sudheer Arava, Geetika Singh, Prasenjit Das, Chitra Sarkar, Neeraj Nischal, Manish Soneja, Pankaj Jorwal, Anjan Trikha, and Naveet Wig
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Infectious Diseases ,Virology - Abstract
COVID-19 causes morbid pathological changes in different organs including lungs, kidneys, liver, etc., especially in those who succumb. Though clinical outcomes in those with comorbidities are known to be different from those without - not much is known about the differences at the histopathological level.To compare the morbid histopathological changes in COVID-19 patients between those who were immunocompromised (Gr 1), malignancy (Gr 2), or had cardiometabolic conditions (hypertension, diabetes, or coronary artery disease) (Gr 3).Post-mortem tissue sampling (MITS) was done from the lungs, kidney, heart, and liver using a biopsy gun within two hours of death. Routine (HE stain) and special stains (AFB, SM, PAS) were done besides immunohistochemistry.A total of 100 patients underwent MITS and data of 92 were included (immunocompromised: 27, maligancy:18, cardiometabolic conditions:71). In lung histopathology, capillary congestion was more in those with malignancy while others like diffuse alveolar damage, microthrombi, pneumocyte hyperplasia, etc were equally distributed. In liver histopathology, architecture distortion was significantly different in immunocompromised while steatosis, portal inflammation, Kupffer cell hypertrophy, and confluent necrosis were equally distributed. There was a trend towards higher acute tubular injury in those with cardiometabolic conditions as compared to the other groups. No significant histopathological difference in heart was discerned.Certain histopathological features are markedly different in different groups (Gr 1,2 and 3) of COVID-19 patients with fatal outcomes. This article is protected by copyright. All rights reserved.
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- 2022
4. Outcomes of HFNC Use in COVID-19 Patients in Non-ICU Settings: A Single-center Experience
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Naveet Wig, Anjan Trikha, Puneet Khanna, Manish Soneja, Animesh Ray, Pankaj Jorwal, Akhil K Singh, Anivita Aggarwal, Umang Arora, Ankit Mittal, Arunima Aggarwal, Komal Singh, and Neeraj Nischal
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Critical Care and Intensive Care Medicine - Published
- 2022
5. Post COVID-19 sequelae: A prospective observational study from Northern India
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Parul Kodan, Ankesh Gupta, Diksha Patidar, Swasthi S Kumar, Devashish Desai, Bharathi Arunan, Ankit Mittal, Chaithra Rajanna, Sayan Chakraborty, Neeraj Nischal, Praveen Kumar Trilangi, Sanjeev Sinha, Nazneen Nahar Begam, J Kirtana, Ashutosh Biswas, Pankaj Jorwal, Manish Soneja, Bisakh Bhattacharya, Niranjan Mahishi, Arvind Kumar, Ganesh Tarachand Maher, Shivdas Naik, Animesh Ray, Prerna Garg, Naveet Wig, Soumendra Nath Haldar, Prayas Sethi, and Netto George Mundadan
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Adult ,Male ,myalgia ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Coronavirus disease 2019 (COVID-19) ,India ,Acute illness ,Young Adult ,Post-Acute COVID-19 Syndrome ,Risk Factors ,Sleep Initiation and Maintenance Disorders ,Insomnia ,Humans ,Medicine ,Pharmacology (medical) ,Prospective Studies ,General Pharmacology, Toxicology and Pharmaceutics ,Fatigue ,Aged ,Aged, 80 and over ,North indian population ,business.industry ,COVID-19 ,Myalgia ,General Medicine ,Middle Aged ,Mood disturbances ,Dyspnea ,Cough ,Anxiety ,Female ,Observational study ,medicine.symptom ,business - Abstract
Post COVID-19 sequelae are a constellation of symptoms often reported after recovering from COVID-19. There is a need to better understand the clinical spectrum and long-term course of this clinical entity. The aim of this study is to describe the clinical features and risk factors of post COVID-19 sequelae in the North Indian population. This prospective observational study was conducted at a tertiary healthcare centre in Northern India between October 2020 and February 2021. Patients aged >18 years with laboratory-confirmed COVID-19 were recruited after at least two weeks of diagnosis, and details were captured. A total of 1234 patients were recruited and followed up for a median duration of 91 days (IQR: 45-181 days). Among them, 495 (40.1%) had persistent symptoms post-discharge or recovery. In 223 (18.1%) patients, the symptoms resolved within four weeks; 150 (12.1%) patients had symptoms till 12 weeks, and 122 (9.9%) patients had symptoms beyond 12 weeks of diagnosis/symptom-onset of COVID-19. Most common symptoms included myalgia (10.9%), fatigue (5.5%), shortness of breath (6.1%), cough (2.1%), insomnia (1.4%), mood disturbances (0.48%) and anxiety (0.6%). Patients who were hospitalized were more likely to report fatigue as a feature of long COVID. Hypothyroidism (OR: 4.13, 95% CI: 2.2-7.6, p-value < 0.001) and hypoxia (SpO2 ≤ 93%) (OR: 1.7, 95% CI: 1.1-2.4, p-value 0.012) were identified as risk factors for long COVID sequelae. In conclusion, long COVID symptoms were common (22%), and 9.9% had the post COVID-19 syndrome. Myalgias, fatigue and dyspnoea were common symptoms. Patients with hypothyroidism and hypoxia during acute illness were at higher risk of long COVID.
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- 2021
6. COVID‐19‐associated subacute invasive pulmonary aspergillosis
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Pankaj Jorwal, Surabhi Vyas, Sanjeev Sinha, Puneet Khanna, Animesh Ray, Immaculata Xess, Satish Swain, Naveet Wig, Radhika Sarda, Anjan Trikha, Gagandeep Singh, and Parul Kodan
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Adult ,medicine.medical_specialty ,Dermatology ,Aspergillosis ,Gastroenterology ,Galactomannan ,chemistry.chemical_compound ,Pseudoaneurysm ,COVID‐19 ,Internal medicine ,medicine.artery ,medicine ,Humans ,Antibodies, Fungal ,Invasive Pulmonary Aspergillosis ,Voriconazole ,Lung ,business.industry ,fungal infection ,steroid ,COVID-19 ,Original Articles ,General Medicine ,Middle Aged ,medicine.disease ,Pneumonia ,Aspergillus ,Infectious Diseases ,medicine.anatomical_structure ,chemistry ,Immunoglobulin G ,Pulmonary artery ,Original Article ,Complication ,business ,subacute invasive pulmonary aspergillosis ,medicine.drug - Abstract
Background Though invasive pulmonary aspergillosis is a well known complication of COVID‐19 pneumonia, indolent forms of aspergillosis have been rarely described. Methods We prospectively collected the clinico‐radio‐microbiological data of 10 patients of subacute invasive pulmonary aspergillosis (SAIA), who presented to our hospital with recent history of COVID‐19 pneumonia along with cavitary lung disease, positive IgG (against Aspergillus) with or without positive respiratory samples for Aspergillus spp. Result The mean age of presentation of SAIA was 50.7 ± 11.8 years. All the patients had recently recovered from severe COVID‐19 illness with a mean duration of 29.2 ± 12 days from COVID‐19 positivity. Cough was the predominant symptom seen in 8/10 (80%) patients followed by haemoptysis. 7/10 (70%) patients were known diabetic. While serum galactomannan was positive in 5/9 patients (55.5%), fungal culture was positive in 2/7 patients (28.5%) and polymerase chain reaction (PCR) for Aspergillus was positive in three patients. Eight (80%) patients presented with a single cavitary lesion; pseudoaneurysm of pulmonary artery was seen in two patients and post‐COVID‐19 changes were seen in all patients. All patients were treated with voriconazole, out of which four (40%) patients died during the follow‐up period. Conclusion SAIA should be considered in the differential diagnosis of cavitating lung lesions in patients with recent history of COVID‐19 in the background of steroid use with or without pre‐existing diabetes.
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- 2021
7. Species Identification of Non-tuberculous Mycobacteria (NTM) from Sputum Samples of TB Suspects in a Tertiary Care Centre from North India
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Manish Soneja, Indra Mani, Vishwanath Upadhyay, Naveet Wig, Pankaj Jorwal, George Sebastian, Ranjani Ramachandran, Rohini Sharma, P. Kumar, and Binit Kumar Singh
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medicine.medical_specialty ,business.industry ,Internal medicine ,General Engineering ,Medicine ,Species identification ,Sputum ,medicine.symptom ,business ,North india ,Tertiary care - Published
- 2021
8. Risk Factors of Severity and Mortality Among COVID-19 Patients: A Prospective Observational Study From a Tertiary Care Center
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Bharathi Arunan, Swasthi S Kumar, Piyush Ranjan, Upendra Baitha, Gaurav Gupta, Arvind Kumar, Krithika Rangarajan, Pankaj Jorwal, Manish Soneja, Mani Kalaivani, Naveet Wig, and Ashutosh Biswas
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General Engineering - Abstract
Introduction The COVID-19 pandemic has been a major public health threat for the past three years. The RNA virus has been constantly evolving, changing the manifestations and progression of the disease. Some factors which impact the progression to severe COVID-19 or mortality include comorbidities such as diabetes mellitus, hypertension, and obesity. In this study, we followed a cohort of patients to evaluate the risk factors leading to severe manifestations and mortality from COVID-19. Methodology We conducted a prospective observational study of 589 COVID-19 patients to assess the risk factors associated with the severity and mortality of the disease. Results In our cohort, 83.5% were male, with a median age (p25, p75) of 39.71 (30-48) years. The most common comorbidities included diabetes mellitus (7.8%) and hypertension (7.9%). About 41.7% had an asymptomatic disease, and of the symptomatic, 45% were mild, 6% moderate, and 7% severe. The mortality rate was 4.1%. Risk factors for severity included breathlessness (p=0.02), leukocytosis (p=0.02), and deranged renal function (p=0.04). Risk factors for mortality included older age (p=0.04), anemia (p=0.02), and leukocytosis (p=0.02). Conclusions COVID-19 commonly leads to asymptomatic or mild illness. The major factors we found that were associated with severity include breathlessness at presentation, leukocytosis, and deranged renal functions. The factors associated with mortality include older age, anemia, and leukocytosis.
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- 2022
9. Pulse corticosteroids for the management of extensive CNS tuberculosis presenting with acute-onset quadriparesis
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Umang, Arora, Prerna, Garg, Shrawan Kumar, Raut, Deepti, Vibha, Upendra, Baitha, Atin, Kumar, Pankaj, Jorwal, Manish, Soneja, and Ashutosh, Biswas
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Inflammation ,Adrenal Cortex Hormones ,Humans ,Female ,Pharmacology (medical) ,General Medicine ,Tuberculosis, Central Nervous System ,General Pharmacology, Toxicology and Pharmaceutics ,Quadriplegia ,Spinal Cord Diseases - Abstract
Myelopathy in central nervous system tuberculosis is notorious for poor outcomes, determined by the severity of inflammation and cord level involved. Acute-onset quadriplegia or paraplegia in these cases represents a neuro-emergency. We report a young female with disseminated tuberculosis who presented with acute onset flaccid quadriparesis with loss of bladder and bowel function. Imaging helped identify the extensive involvement of the neuraxis. We propose that, in addition to anti-tubercular therapy, high-dose corticosteroids such as pulse methylprednisolone may result in a meaningful improvement and show greater rapidity of response in cases of severe central nervous system inflammation such as arachnoiditis or myelopathy.
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- 2022
10. Novel Scoring Systems to Predict the Need for Oxygenation and ICU Care, and Mortality in Hospitalized COVID-19 Patients: A Risk Stratification Tool
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Vishakh C Keri, Pankaj Jorwal, Rohit Verma, Piyush Ranjan, Ashish D Upadhyay, Anivita Aggarwal, Radhika Sarda, Kunal Sharma, Shubham Sahni, and Chaithra Rajanna
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General Engineering - Abstract
A rapid surge in cases during the COVID-19 pandemic can overwhelm any healthcare system. It is imperative to triage patients who would require oxygen and ICU care, and predict mortality. Specific parameters at admission may help in identifying them.A prospective observational study was undertaken in a COVID-19 ward of a tertiary care center. All baseline clinical and laboratory data were captured. Patients were followed till death or discharge. Univariable and multivariable logistic regression was used to find predictors of the need for oxygen, need for ICU care, and mortality. Objective scoring systems were developed for the same using the predictors.The study included 209 patients. Disease severity was mild, moderate, and severe in 98 (46.9%), 74 (35.4%), and 37 (17.7%) patients, respectively. The neutrophil-to-lymphocyte ratio (NLR)4 was a common independent predictor of the need for oxygen (p0.001), need for ICU transfer (p=0.04), and mortality (p=0.06). Clinical risk scores were developed (10*c-reactive protein (CRP) + 14.8*NLR + 12*urea), (10*aspartate transaminase (AST) + 15.7*NLR + 14.28*CRP), (10*NLR + 10.1*creatinine) which, if ≥14.8, ≥25.7, ≥10.1 predicted need for oxygenation, need for ICU transfer and mortality with a sensitivity and specificity (81.6%, 70%), (73.3%, 75.7%), (61.1%, 75%), respectively. Conclusion: The NLR, CRP, urea, creatinine, and AST are independent predictors in identifying patients with poor outcomes. An objective scoring system can be used at the bedside for appropriate triaging of patients and utilization of resources.
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- 2022
11. Repurposing of FDA Approved Drugs Against SARS-CoV-2 Papain-Like Protease: Computational, Biochemical, and in vitro Studies
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Rajkumar Kulandaisamy, Tushar Kushwaha, Anu Dalal, Vikas Kumar, Deepa Singh, Kamal Baswal, Pratibha Sharma, Kokkula Praneeth, Pankaj Jorwal, Sarala R. Kayampeta, Tamanna Sharma, Srinivas Maddur, Manoj Kumar, Saroj Kumar, Aparoy Polamarasetty, Aekagra Singh, Deepak Sehgal, Shivajirao L. Gholap, Mohan B. Appaiahgari, Madhumohan R. Katika, and Krishna K. Inampudi
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Microbiology (medical) ,Microbiology - Abstract
The pandemic caused by SARS-CoV-2 (SCoV-2) has impacted the world in many ways and the virus continues to evolve and produce novel variants with the ability to cause frequent global outbreaks. Although the advent of the vaccines abated the global burden, they were not effective against all the variants of SCoV-2. This trend warrants shifting the focus on the development of small molecules targeting the crucial proteins of the viral replication machinery as effective therapeutic solutions. The PLpro is a crucial enzyme having multiple roles during the viral life cycle and is a well-established drug target. In this study, we identified 12 potential inhibitors of PLpro through virtual screening of the FDA-approved drug library. Docking and molecular dynamics simulation studies suggested that these molecules bind to the PLpro through multiple interactions. Further, IC50 values obtained from enzyme-inhibition assays affirm the stronger affinities of the identified molecules for the PLpro. Also, we demonstrated high structural conservation in the catalytic site of PLpro between SCoV-2 and Human Coronavirus 229E (HCoV-229E) through molecular modelling studies. Based on these similarities in PLpro structures and the resemblance in various signalling pathways for the two viruses, we propose that HCoV-229E is a suitable surrogate for SCoV-2 in drug-discovery studies. Validating our hypothesis, Mefloquine, which was effective against HCoV-229E, was found to be effective against SCoV-2 as well in cell-based assays. Overall, the present study demonstrated Mefloquine as a potential inhibitor of SCoV-2 PLpro and its antiviral activity against SCoV-2. Corroborating our findings, based on the in vitro virus inhibition assays, a recent study reported a prophylactic role for Mefloquine against SCoV-2. Accordingly, Mefloquine may further be investigated for its potential as a drug candidate for the treatment of COVID.
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- 2022
12. Leucocytosis and early organ involvement as risk factors of mortality in adults with dengue fever
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Manish Soneja, Parul Kodan, Pankaj Jorwal, Upendra Baitha, Piyush Ranjan, Anant Gupta, Sujay Halkur Shankar, Samagra Agarwal, Ashutosh Biswas, Paras Singla, Jatin Ahuja, Kalpana Baruah, and Arvind Kumar
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Leukocytosis ,030232 urology & nephrology ,India ,Disease ,Tachypnea ,Dengue fever ,Dengue ,Tertiary Care Centers ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Hospital Mortality ,030212 general & internal medicine ,General Pharmacology, Toxicology and Pharmaceutics ,Retrospective Studies ,business.industry ,Medical record ,Mortality rate ,Acute kidney injury ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Elevated serum creatinine ,Female ,medicine.symptom ,business - Abstract
The clinical profile and risk factors for mortality in dengue fever have evolved over the years. The all-cause mortality in admitted dengue patients is around 6%. We aimed to evaluate the recent change in trends of the clinical characteristics and risk factors for in-hospital mortality in adults with dengue fever. This is a retrospective study on adults with confirmed dengue fever admitted in a medical unit of a tertiary care center in North India. Medical records of confirmed dengue fever patients admitted between January 2011, and December 2016 were reviewed. Chi-squared tests with Bonferroni correction for multiple testing were used to identify risk factors for mortality. 232 records were included, of which 66.8% were males. The mean age was 31.6 ± 14 years. There were 17 deaths with an all-cause mortality rate of 7.3% with 76.5% being classified as severe dengue at admission. Among the 17 mortality cases, dyspnea (47%), tachypnea (86.7%), leucocytosis (58.8%), raised urea (80%), and elevated serum creatinine (52.9%) at presentation were significantly associated with mortality (p < 0.001). Shock at any time during the hospital stay (58.8%) was also found to be significantly associated with mortality (p < 0.001). We found that dyspnea, tachypnea, acute kidney injury, and leucocytosis at presentation was significantly associated with in-hospital mortality. Based on our results, we recommend aggressive management of patients with severe dengue and those with mild/moderate disease with the above risk factors.
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- 2020
13. Arsenic intoxication with renal failure managed with hemodialysis alone: A case report
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Ayush Agarwal, Santhosh Kumar KN, Pankaj Jorwal, Javed Ahsan Quadri, Gaurav Gupta, and Ashutosh Biswas
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Renal Dialysis ,SARS-CoV-2 ,Communicable Disease Control ,COVID-19 ,Humans ,Kidney Failure, Chronic ,Pharmacology (medical) ,Female ,General Medicine ,Renal Insufficiency ,General Pharmacology, Toxicology and Pharmaceutics ,Middle Aged ,Arsenic - Abstract
Arsenic has widespread use in agriculture, in alternative medicine and in treatment of certain malignancies, therefore it is vital to timely recognize and treat arsenic toxicity in a suspected patient. Hemodialysis conventionally is thought to play only a supportive role in managing arsenic toxicity but it can be life-saving when chelation is not possible or available. A middle-aged female with a history of non-dialysis-dependent chronic kidney disease (CKD) was brought to the emergency with altered sensorium. On presentation, she was hemodynamically stable with pallor and exfoliating lesions on palms, hyperkeratotic lesions on soles and hyperpigmented macules on the trunk. Investigations revealed pancytopenia and deranged kidney function tests. In view of skin lesions, the toxicological analysis was sent which revealed high levels of Arsenic (594 and 2,553 mcg/L in blood and urine respectively). Thus, a diagnosis of metabolic encephalopathy with the underlying cause being uremic or/and arsenic intoxication was made. Considering renal failure, she was managed with thrice-weekly hemodialysis. Chelation was not possible due to unavailability of agents during lockdown in Coronavirus disease (COVID-19) pandemic. Following dialysis, there was a significant improvement in sensorium, skin lesions, and pancytopenia depicting the utility of hemodialysis in such cases. Thus, hemodialysis is an effective and perhaps underutilized modality in the treatment of arsenic intoxication with impaired renal function.
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- 2022
14. Repurposing of FDA Approved Drugs Against SARS-CoV-2 Papain-Like Protease: Computational, Biochemical, and
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Rajkumar, Kulandaisamy, Tushar, Kushwaha, Anu, Dalal, Vikas, Kumar, Deepa, Singh, Kamal, Baswal, Pratibha, Sharma, Kokkula, Praneeth, Pankaj, Jorwal, Sarala R, Kayampeta, Tamanna, Sharma, Srinivas, Maddur, Manoj, Kumar, Saroj, Kumar, Aparoy, Polamarasetty, Aekagra, Singh, Deepak, Sehgal, Shivajirao L, Gholap, Mohan B, Appaiahgari, Madhumohan R, Katika, and Krishna K, Inampudi
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The pandemic caused by SARS-CoV-2 (SCoV-2) has impacted the world in many ways and the virus continues to evolve and produce novel variants with the ability to cause frequent global outbreaks. Although the advent of the vaccines abated the global burden, they were not effective against all the variants of SCoV-2. This trend warrants shifting the focus on the development of small molecules targeting the crucial proteins of the viral replication machinery as effective therapeutic solutions. The PLpro is a crucial enzyme having multiple roles during the viral life cycle and is a well-established drug target. In this study, we identified 12 potential inhibitors of PLpro through virtual screening of the FDA-approved drug library. Docking and molecular dynamics simulation studies suggested that these molecules bind to the PLpro through multiple interactions. Further, IC
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- 2022
15. Poor outcomes in patients with cirrhosis and Corona Virus Disease-19
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Pankaj Jorwal, Richa Aggarwal, Pragyan Acharya, Anoop Saraya, Manish Soneja, Puneet Khanna, Anjan Trikha, Baibaswata Nayak, Lalit Dar, Krithika Rangarajan, Shalimar, Piyush Pathak, Kapil Dev Soni, Arvind Kumar, Anant Mohan, Soumya Jagannath Mahapatra, Neeraj Nischal, Anshuman Elhence, Ramesh Kumar, Akhil Kant Singh, Govind K. Makharia, Pramod Kumar Garg, Deepak Gunjan, Manas Vaishnav, Ashutosh Biswas, and Aashish Choudhary
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Liver Cirrhosis ,Male ,Cirrhosis ,Comorbidity ,Autoimmune hepatitis ,Chronic liver disease ,Gastroenterology ,Cohort Studies ,Liver disease ,0302 clinical medicine ,Risk Factors ,Outcome Assessment, Health Care ,Liver function tests ,Medicine ,Hepatic failure ,medicine.diagnostic_test ,Hazard ratio ,Middle Aged ,Prognosis ,Liver ,030220 oncology & carcinogenesis ,Disease Progression ,Female ,Original Article ,030211 gastroenterology & hepatology ,Coronavirus Infections ,medicine.medical_specialty ,Pneumonia, Viral ,India ,Acute decompensation ,Betacoronavirus ,03 medical and health sciences ,Internal medicine ,Humans ,Decompensation ,Mortality ,Pandemics ,Inflammation ,Pandemic ,SARS-CoV-2 ,business.industry ,Acute-On-Chronic Liver Failure ,COVID-19 ,Length of Stay ,Hepatology ,medicine.disease ,business ,Acute-on-chronic liver failure - Abstract
Background and Aim There is a paucity of data on the clinical presentations and outcomes of Corona Virus Disease-19 (COVID-19) in patients with underlying liver disease. We aimed to summarize the presentations and outcomes of COVID-19-positive patients and compare with historical controls. Methods Patients with known chronic liver disease who presented with superimposed COVID-19 (n = 28) between 22 April 2020 and 22 June 2020 were studied. Seventy-eight cirrhotic patients without COVID-19 were included as historical controls for comparison. Results A total of 28 COVID-19 patients (two without cirrhosis, one with compensated cirrhosis, sixteen with acute decompensation [AD], and nine with acute-on-chronic liver failure [ACLF]) were included. The etiology of cirrhosis was alcohol (n = 9), non-alcoholic fatty liver disease (n = 2), viral (n = 5), autoimmune hepatitis (n = 4), and cryptogenic cirrhosis (n = 6). The clinical presentations included complications of cirrhosis in 12 (46.2%), respiratory symptoms in 3 (11.5%), and combined complications of cirrhosis and respiratory symptoms in 11 (42.3%) patients. The median hospital stay was 8 (7–12) days. The mortality rate in COVID-19 patients was 42.3% (11/26), as compared with 23.1% (18/78) in the historical controls (p = 0.077). All COVID-19 patients with ACLF (9/9) died compared with 53.3% (16/30) in ACLF of historical controls (p = 0.015). Mortality rate was higher in COVID-19 patients with compensated cirrhosis and AD as compared with historical controls 2/17 (11.8%) vs. 2/48 (4.2%), though not statistically significant (p = 0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully. Conclusion COVID-19 is associated with poor outcomes in patients with cirrhosis, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.
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- 2020
16. Role of systemic corticosteroids in preventing hypoxia among patients with mild COVID-19: An observational study
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Parul Kodan, Anivita Aggarwal, Ankit Mittal, Sujay Halkur Shankar, Animesh Ray, Shivdas Naik, Pankaj Jorwal, Naveet Wig, Manish Soneja, and Neeraj Nischal
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Adult ,Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.drug_class ,Administration, Oral ,Kaplan-Meier Estimate ,law.invention ,Randomized controlled trial ,law ,Adrenal Cortex Hormones ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,In patient ,General Pharmacology, Toxicology and Pharmaceutics ,Hypoxia ,Mild disease ,business.industry ,Disease progression ,COVID-19 ,General Medicine ,Hypoxia (medical) ,Middle Aged ,COVID-19 Drug Treatment ,Treatment Outcome ,Disease Progression ,Corticosteroid ,Observational study ,Female ,medicine.symptom ,business - Abstract
Use of systemic corticosteroids is well-established in COVID-19 patients with hypoxia; however, there is scant data on its role in patients with mild disease and prolonged symptoms as a measure to prevent disease progression. The aim of this study is to evaluate the role of systemic corticosteroids in preventing hypoxia (SpO2 ≤ 93% on room-air) among mild COVID-19 patients. An observational study was conducted among symptomatic COVID-19 patients taking oral corticosteroids and attending institute teleconsultation facility between 10th-30th June 2021. Patients who were already on corticosteroids for other indication or required oxygen supplementation before or within 24-hours of initiation of corticosteroids were excluded. A total of 140 consecutive symptomatic COVID-19 patients were included. Higher baseline C-reactive protein (OR: 1.03, 95% CI: 1.02-1.06, p < 0.001) and early systemic corticosteroid (within 7 days) initiation (OR: 6.5, 95% CI: 2.1-20.1, p = 0.001) were independent risk factors for developing hypoxia (SpO2 ≤ 93%). Progression to hypoxia was significantly higher in patients who received corticosteroids before day 7 of illness (36.7%, 95% CI, 23.4-51.7%) compared to ≥ 7 of illness (14.3%, 95% CI, 7.8-23.2%) for persistent fever. Systemic corticosteroids within 7 days from symptom-onset were harmful and increased the risk of progression to hypoxia, whereas it may decrease the risk of progression when administered on or beyond 7 days in patients with mild COVID-19 and persistent symptoms. A well-designed randomised controlled trial is required to validate the findings.
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- 2021
17. Risk factors for Coronavirus disease-associated mucormycosis
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Umang Arora, Megha Priyadarshi, Varidh Katiyar, Manish Soneja, Prerna Garg, Ishan Gupta, Vishwesh Bharadiya, Parul Berry, Tamoghna Ghosh, Lajjaben Patel, Radhika Sarda, Shreya Garg, Shubham Agarwal, Veronica Arora, Aishwarya Ramprasad, Amit Kumar, Rohit Kumar Garg, Parul Kodan, Neeraj Nischal, Gagandeep Singh, Pankaj Jorwal, Arvind Kumar, Upendra Baitha, Ved Prakash Meena, Animesh Ray, Prayas Sethi, Immaculata Xess, Naval Vikram, Sanjeev Sinha, Ashutosh Biswas, Alok Thakar, Sushma Bhatnagar, Anjan Trikha, and Naveet Wig
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Microbiology (medical) ,Infectious Diseases ,Risk Factors ,SARS-CoV-2 ,Case-Control Studies ,COVID-19 ,Humans ,Mucormycosis ,Article - Abstract
Background The epidemiology of the Coronavirus-disease associated mucormycosis (CAM) syndemic is poorly elucidated. We aimed to identify risk factors that may explain the burden of cases and help develop preventive strategies. Methods We performed a case-control study comparing cases diagnosed with CAM and taking controls as recovered COVID 19 patients who did not develop mucormycosis. Information on comorbidities, glycemic control, and practices related to COVID-19 prevention and treatment was recorded. Multivariate regression analysis was used to identify the independent predictors. Results A total of 352 patients (152 cases and 200 controls) diagnosed with COVID-19 during April-May 2021 were included. In the CAM group, symptoms of mucormycosis began a mean of 18.9 (SD 9.1) days after onset of COVID-19, and predominantly rhino-sinus and orbital involvement was present. All, but one, CAM cases had conventional risk factors of diabetes and steroid use. On multivariable regression, increased odds of CAM were associated with the presence of diabetes (adjusted OR 3.5, 95%CI 1.1-11), use of systemic steroids (aOR 7.7,95% CI 2.4-24.7), prolonged use of cloth and surgical masks (vs. no mask, aOR 6.9, 95%CI 1.5-33.1), and repeated nasopharyngeal swab testing during the COVID-19 illness (aOR 1.6,95% CI 1.2-2.2). Zinc therapy was found to be protective (aOR 0.05, 95%CI 0.01-0.19). Notably, the requirement of oxygen supplementation or hospitalization did not affect the risk of CAM. Conclusion Judicious use of steroids and stringent glycemic control are vital to preventing mucormycosis. Use of clean masks, preference for N95 masks if available, and minimizing swab testing after the diagnosis of COVID-19 may further reduce the incidence of CAM.
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- 2021
18. Novel risk factors for Coronavirus disease-associated mucormycosis (CAM): a case control study during the outbreak in India
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Lajjaben Patel, Radhika Sarda, Shubham Agarwal, Amit Kumar, Shreya Garg, Naval K. Vikram, Aishwarya Ramprasad, Naveet Wig, Veronica Arora, Sushma Bhatnagar, Vishwesh Bharadiya, Sanjeev Sinha, Rohit Garg, Animesh Ray, Ved Prakash Meena, Ishan Gupta, Prerna Garg, Pankaj Jorwal, Umang Arora, Prayas Sethi, Varidh Katiyar, Tamoghna Ghosh, Alok Thakar, Immaculata Xess, Manish Soneja, Megha Priyadarshi, Anjan Trikha, Parul Berry, Neeraj Nischal, Ashutosh Biswas, Arvind Kumar, Gagandeep Singh, Upendra Baitha, and Parul Kodan
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medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Mucormycosis ,Case-control study ,Disease ,medicine.disease ,Syndemic ,Diabetes mellitus ,Internal medicine ,Epidemiology ,medicine ,business ,Glycemic - Abstract
BackgroundThe epidemiology of the Coronavirus-disease associated mucormycosis (CAM) syndemic is poorly elucidated. We aimed to identify risk factors that may explain the burden of cases and help develop preventive strategies.MethodsWe performed a case-control study comparing cases diagnosed with CAM and those who had recovered from COVID-19 without developing mucormycosis (controls). Information on comorbidities, glycemic control, and practices related to COVID-19 prevention and treatment was recorded.Results352 patients (152 cases and 200 controls) diagnosed with COVID-19 during April-May 2021 were included. In the CAM group, symptoms of mucormycosis began a mean 18.9 (SD 9.1) days after onset of COVID-19, and predominantly rhino-sinus and orbital involvement was present. All, but one, CAM cases carried conventional risk factors of diabetes and steroid use. On multivariable regression, increased odds of CAM were associated with the presence of diabetes (adjusted OR 3.5, 95%CI 1.1-11), use of systemic steroids (aOR 7.7,95% CI 2.4-24.7), prolonged use of cloth and surgical masks (vs no mask, aOR 6.9, 95%CI 1.5-33.1), and repeated nasopharyngeal swab testing during the COVID-19 illness (aOR 1.6,95% CI 1.2-2.2). Zinc therapy, probably due to its utility in immune function, was found to be protective (aOR 0.05, 95%CI 0.01-0.19). Notably, the requirement of oxygen supplementation or hospitalization did not affect the risk of CAM.ConclusionJudicious use of steroids and stringent glycemic control are vital to preventing mucormycosis. Use of clean masks, preference for N95 masks if available, and minimizing swab testing after the diagnosis of COVID-19 may further reduce the incidence of CAM.
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- 2021
19. Post COVID-19 sequelae: A prospective observational study from Northern India
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Sayan Maharatna, Sameer A Samed, Sanjeev Sinha, Nazneen Nahar Begam, J Kirthana, Arvind Kumar, Bharathi Arunan, Niranjan Mahishi, Ashutosh Biswas, Ankesh Gupta, Animesh Ray, Manish Soneja, Neeren Ravela, B Premjeet, Ganesh Tarachand Maher, Vishakh C Keri, Pallavi Jagtap, Pratima Lalikar, Pankaj Jorwal, Ashok Dudhwal, Ashish Gupta, Shivdas Rajaram Naik, Bisakh Bhattacharya, Sayan Chakraborty, Ayush Agarwal, Akashneel Bhattacharya, Kartik Vedula, Prerna Garg, Rohit Anand, Shubham Agarwal, Imtiyaz Shareef, Prateek Parsoon, Neeraj Nischal, Ankit Mittal, Soumendra Nath Haldar, Praveen Kumar Trilangi, Chaitra Rajanna, Harshith B Kadnur, Parul Kodan, Devashish Desai, AK Adarsh, Radhika Sarda, Prayas Sethi, Swathi S Kumar, Netto George Mundadan, Nikhil Kumar, Naveet Wig, and Satish Swain
- Subjects
myalgia ,Moderate to severe ,North indian population ,Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Disease ,Mood disturbances ,Medicine ,Anxiety ,Observational study ,medicine.symptom ,business - Abstract
BackgroundLong COVID, or post-COVID-19 sequelae, is being seen in a growing number of patients reporting a constellation of symptoms, both pulmonary and extrapulmonary. Studies on COVID-19 recovered patients are scarce. Thus, there is a need to add granularity to our existing knowledge about the course and long-term effects of the infection.AimTo describe the clinical details and risk factors of post-COVID sequelae in the North Indian population.MethodThis prospective observational study was conducted at a tertiary healthcare centre in Northern India between October 2020 to February 2021. Patients aged >18 years with a confirmed COVID-19 disease were recruited after at least two weeks of diagnosis and interviewed for any post-COVID-19 symptoms.ResultsOf 1234 patients recruited, who were followed up for a median duration of 91 days (IQR: 45-181 days), 495 (40.11%) patients had symptoms. In 223 (18.1%) patients, the symptoms resolved within four weeks, 150 (12.1%) patients had symptoms till twelve weeks, and 122 (9.9%) patients had symptoms beyond twelve weeks of diagnosis of COVID-19. Most common long COVID-19 symptoms included myalgia (10.9%), fatigue (5.5%), shortness of breath (6.1%), cough (2.1%), disturbed sleep (1.4%), mood disturbances (0.48%) and anxiety (0.6%). The major determinants of developing post-COVID-19 symptoms in the patients were hypothyroidism and the severity of the disease.ConclusionMost often, patients complain of myalgias, fatigue, dyspnoea, cough and disturbed sleep. Patients who are hypothyroid or have recovered from moderate to severe COVID-19 are at higher risk of developing post-COVID sequelae. Therefore, a multidisciplinary approach is required to diagnose and manage COVID-19 recovered patients.
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- 2021
20. Use of HFNC in COVID-19 patients in non-ICU setting: Experience from a tertiary referral centre of north India and a systematic review of literature
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Anivita Aggarwal, Komal Singh, Pankaj Jorwal, Manish Soneja, Animesh Ray, Anjan Trikha, Puneet Khanna, Neeraj Nischal, Naveet Wig, Akhil Kant Singh, Umang Arora, Ankit Mittal, and A Aggarwal
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Mechanical ventilation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medical record ,MEDLINE ,Retrospective cohort study ,medicine.disease_cause ,Intensive care unit ,law.invention ,law ,Oxygen therapy ,Emergency medicine ,medicine ,Observational study ,business ,Nasal cannula - Abstract
IntroductionThe rapid surge of cases and insufficient numbers of intensive care unit (ICU) beds have forced hospitals to utilise their general wards for administration of non-invasive respiratory support including HFNC(High Flow Nasal Cannula) in severe COVID-19. However, there is a dearth of data on the success of such advanced levels of care outside the ICU setting. Therefore, we conducted an observational study at our centre, and systematically reviewed the literature, to assess the success of HFNC in managing severe COVID-19 cases outside the ICU.MethodsA retrospective cohort study was conducted in a tertiary referral centre where records of all adult COVID-19 patients (≥18 years) requiring HFNC support were between September and December 2020 were analysed. HFNC support was adjusted to target SpO2 ≥90% and respiratory rate ≤30 per min. The clinical, demographic, laboratory, and treatment details of these patients were retrieved from the medical records and entered in pre-designed proforma. Outcome parameters included duration of oxygen during hospital stay, duration of HFNC therapy, length of hospital stay and death or discharge. HFNC success was denoted when a patient did not require escalation of therapy to NIV or invasive mechanical ventilation, or shifting to the ICU, and was eventually discharged from the hospital without oxygen therapy; otherwise, the outcome was denoted as HFNC failure. Systematic review was also performed on the available literature on the experience with HFNC in COVID-19 patients outside of ICU settings using the MEDLINE, Web of Science and Embase databases. Statistical analyses were performed with the use of STATA software, version 12, OpenMeta[Analyst], and visualization of the risk of bias plot using robvis.ResultsThirty-one patients receiving HFNC in the ward setting, had a median age of 62 (50 – 69) years including 24 (77%) males. Twenty-one (68%) patients successfully tolerated HFNC and were subsequently discharged from the wards, while 10 (32%) patients had to be shifted to ICU for non-invasive or invasive ventilation, implying HFNC failure. Patients with HFNC failure had higher median D-dimer values at baseline (2.2 mcg/ml vs 0.6 mcg/ml, p=0.001) and lower initial SpO2 on room air at admission (70% vs 80%, p=0.026) as compared to those in whom HFNC was successful .A cut-off value of 1.7 mg/L carried a high specificity (90.5%) and moderate sensitivity (80%) for the occurrence of HFNC failure. Radiographic severity scoring as per the BRIXIA score was comparable in both the groups(11 vs 10.5 out of 18, p=0.78). After screening 98 articles, total of seven studies were included for synthesis in the systematic review with a total of 820 patients, with mean age of the studies ranging from 44 to 83 years and including 62% males. After excluding 2 studies from the analysis, the pooled rates of HFNC failure were 36.3% (95% CI 31.1% – 41.5%) with no significant heterogeneity (I2=0%, p=0.55).ConclusionsOur study demonstrated successful outcomes with use of HFNC in an outside of ICU setting among two-thirds of patients with severe COVID-19 pneumonia. Lower room air SpO2 and higher D-dimer levels at presentation were associated with failure of HFNC therapy leading to ICU transfer for endotracheal intubation or death. Also, the results from the systematic review demonstrated similar rates of successful outcomes concluding that HFNC is a viable option with failure rates similar to those of ICU settings in such patients.
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- 2021
21. Seroprevalence of COVID-19 in HIV Population
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Sanjay Ranjan, Satish Swain, Swasthi S Kumar, Naveet Wig, Shivdas Rajaram Naik, Manish Soneja, Sanjeev Sinha, Neeraj Nischal, Pankaj Jorwal, Ankit Mittal, and P. K. Chaturvedi
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education.field_of_study ,Coronavirus disease 2019 (COVID-19) ,biology ,business.industry ,Population ,Disease ,medicine.disease ,Acquired immunodeficiency syndrome (AIDS) ,biology.protein ,Medicine ,Seroprevalence ,Observational study ,Antibody ,business ,Prospective cohort study ,education ,Demography - Abstract
BackgroundSeroprevalence helps us to estimate the exact prevalence of a disease in a population. Although the world has been battling this pandemic for more than a year now, we still do not know about the burden of this disease in people living with HIV/AIDS (PLHA). Seroprevalence data in this population subset is scarce in most parts of the world, including India. The current study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among PLHA.AimTo determine the seroprevalence of SARS-CoV-2 antibodies in PLHA.MethodThis was a cross-sectional study conducted at a tertiary care hospital in North India. We recruited HIV positive patients following at the ART centre of the institute. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the chemiluminescent immunoassay method.ResultsA total of 164 patients were recruited in the study with a mean age (±SD) of 41.2 (±15.4) years, of which 55% were male. Positive serology against SARS CoV-2 was detected in 14% patients (95% CI: 9.1-20.3%).ConclusionThe seroprevalence of COVID-19 infection in PLHA was lower than the general population in the same region, which ranged from 23.48% to 28.3% around the study period.
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- 2021
22. Hydroxychloroquine pre-exposure prophylaxis for COVID-19 among healthcare workers: Initial experience from India
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Manish Soneja, HarshithB Kadnur, Anivita Aggarwal, Komal Singh, Ankit Mittal, Neeraj Nischal, Praveen Tirlangi, AdilRashid Khan, Devashish Desai, Ankesh Gupta, Arvind Kumar, Pankaj Jorwal, Ashutosh Biswas, RavindraMohan Pandey, Naveet Wig, and Randeep Guleria
- Abstract
Hydroxychloroquine (HCQ) had generated considerable interest for coronavirus disease 2019 (COVID-19) prophylaxis. We conducted a prospective observational study at a tertiary care hospital in India, with dedicated COVID-19 care facilities.Primary objective was incidence of adverse effects, secondary objective being efficacy in preventing COVID-19.Healthcare workers were recruited and grouped based on voluntary HCQ prophylaxis as per national guidelines. Side effects in HCQ group were graded in accordance with national cancer institute-common terminology criteria for adverse events (NCI-CTCAE) version 5.0. At 3-7-week follow-up, groups were compared for COVID-19 exposure, symptoms development and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR results.Among 358 participants recruited, 216 (60.3%) were males and mean age was 31.2 ± 6.6 years. Chemoprophylaxis was initiated by 258 (72%) participants. After loading dose, 7 (2.7%) reported grade 2 and 1 (0.4%) grade 3 adverse effects. Discontinuation of HCQ due to side effects was reported in 11 (4.3%) participants. Electrocardiogram was done by 50 (19.4%) participants on HCQ; no abnormalities were noted. A total of 106 (41%) among those taking and 63 (63%) among those not taking HCQ were tested for SARS-CoV-2 due to influenza-like illness or significant exposure. Among all participants, 25 (6.9%, 95% confidence interval [CI] 4.3-9.6) developed COVID-19 during the study period. In the group taking HCQ, 10 (3.9%) tested positive compared to 15 (15%) in the group not taking HCQ (HCQ is safe at the recommended dose for pre-exposure prophylaxis of COVID-19.
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- 2021
23. Presence of Fluoroquinolone mono-resistance among drug-sensitive Mycobacterium tuberculosis isolates: An alarming trend and implications
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P. Kumar, Pankaj Jorwal, Ranjani Ramachandran, Rohini Sharma, and Binit Kumar Singh
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Microbiology (medical) ,030219 obstetrics & reproductive medicine ,biology ,Epidemiology ,business.industry ,Isoniazid ,Public Health, Environmental and Occupational Health ,Drug resistance ,rpoB ,biology.organism_classification ,Virology ,Mycobacterium tuberculosis ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Streptomycin ,medicine ,030212 general & internal medicine ,Ofloxacin ,business ,Rifampicin ,Ethambutol ,medicine.drug - Abstract
Background The phenomenon of Drug Resistant Tuberculosis (DRTB) has been evolving aggressively and is posing great threat to tuberculosis control programs worldwide. But what really is fueling drug resistance in high disease burden countries apart from other well known risk factors, with this intent in mind the present study was developed and carried out to. The aim was to capture the presence of Fluoroquinolone (FQ) mono-resistance among drug-sensitive TB cases. Methods A total of 1280 sputum smear-positive patients were enrolled in the study and were subjected for Drug Susceptibility Testing (DST) using First-Line Drugs (FLD's; Rifampicin, Streptomycin, Isoniazid and Ethambutol) using liquid culture DST and Line Probe Assay. These samples were further subjected to second-line drugs DST (ofloxacin and kanamycin) and DNA sequencing to confirm FQ mono-resistance. Results The occurrence of FQ mono-resistance among FLD sensitive cases was found to be 3.2% (35/1099). Xpert MTB/RIF assay and rpoB gene sequencing were showed 100% concordance with FLD DST. A total of 35 FQ mono-resistant isolates were further sequenced for gyrA, gyrB and rrs genes. The gene sequencing was found to be in agreement with the DST results for 34 (3.1%) isolates with gyrA and gyrB genes. Conclusion Presence of FQ resistance among drug sensitive TB cases is a red flag sign. The findings of the present study suggest that, second-line DST should be routinely performed not only for drug-resistant cases but also for drug-sensitive cases so as to capture prevailing true drug resistance at an initial stage.
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- 2019
24. Positron-emission-tomography in tubercular lymphadenopathy: A study on its role in evaluating post-treatment response
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Pankaj Jorwal, Animesh Ray, Nitin Gupta, Neeraj Nischal, Naveet Wig, Arvind Kumar, Abhishek Singh, Madhavi Tripathi, Manish Soneja, and Parul Kodan
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Adult ,Male ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,Antitubercular Agents ,Partial Metabolic Response ,Lymphadenopathy ,Tuberculosis, Lymph Node ,Young Adult ,Positron Emission Tomography Computed Tomography ,Medicine ,Humans ,Pharmacology (medical) ,In patient ,Positron emission ,Prospective Studies ,General Pharmacology, Toxicology and Pharmaceutics ,Lymph Node Tuberculosis ,Lymph node ,Aged ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Treatment Outcome ,Positron emission tomography ,Female ,Radiology ,Post treatment ,business - Abstract
Lymph node tuberculosis is one of the most common forms of extrapulmonary tuberculosis worldwide. The study aimed to evaluate the role of positron emission tomography-computed tomography (PET-CT) in determining post-treatment response in lymph node tuberculosis. A PET-CT was done in all treatment naive tubercular lymphadenitis adults at baseline and after six months of therapy. The post-treatment clinical response was compared with the metabolic response on PET-CT. Of the 25 patients with tubercular lymphadenitis, 9/25 patients showed a complete metabolic response (CMR) at six months, while 16 patients had a partial metabolic response (PMR). All patients with CMR had a good clinical response. However, discordance between clinical and PET findings was noticed in those with PMR. The role of PET-CT in evaluating post-treatment response in patients with tubercular lymphadenitis needs further evaluation with a larger sample size.
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- 2021
25. Decentralizing COVID-19 care-Moving towards a COVID-19-capable healthcare system (CCHS)
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R.L Brunda, Prayas Sethi, Vishakh C Keri, Naveet Wig, and Pankaj Jorwal
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Health Policy ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Politics ,COVID-19 ,medicine.disease ,COVID‐19‐capable healthcare system (CCHS) ,COVID‐19 ,Models, Organizational ,Medicine ,Humans ,Medical emergency ,business ,Delivery of Health Care ,Letter to the Editor ,Healthcare system - Published
- 2021
26. Novel Risk Factors for Coronavirus Disease-Associated Mucormycosis (CAM): A Case Control Study During the Outbreak in India
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Veronica Arora, Naveet Wig, Immaculata Xess, Shubham Agarwal, Manish Soneja, Anjan Trikha, Parul Berry, Megha Priyadarshi, Arvind Kumar, Radhika Sarda, Sushma Bhatnagar, Aishwarya Ramprasad, Amit Kumar, Pankaj Jorwal, Varidh Katiyar, Alok Thakar, Animesh Ray, Neeraj Nischal, Sanjeev Sinha, Ashutosh Biswas, Prerna Garg, Prayas Sethi, Ishan Gupta, Lajja Patel, Rohit Kumar, Upendra Baitha, Shreya Garg, Tamoghna Ghosh, Naval K. Vikram, Vishwesh Bharadiya, Gagandeep Singh, Parul Kodan, and Umang Arora
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Mucormycosis ,Case-control study ,Outbreak ,Disease ,medicine.disease ,Syndemic ,Oxygen therapy ,Internal medicine ,Diabetes mellitus ,Epidemiology ,medicine ,business - Abstract
Background: The epidemiology of the Coronavirus-disease associated mucormycosis (CAM) syndemic is poorly elucidated. In this study, we aimed to analyse the risk factors for CAM, in addition to those established for mucormycosis prior to COVID-19 pandemic. Methods: We performed a case-control study comparing patients diagnosed with CAM with those who had recovered from COVID-19 without developing mucormycosis. Information on comorbidities, glycaemic control, and practices related to COVID-19 prevention and management was recorded. Findings: One hundred fifty-two cases of CAM and 200 controls diagnosed with COVID-19 during April–May 2021 were included. In the CAM group, symptoms of mucormycosis began a mean 18·9 ± 9·1 days after the symptom onset of COVID-19. All, but one patient, carried either of the conventional risk factors: diabetes and steroid use. On multivariate regression analysis, risk factors associated with increased odds of CAM included presence of diabetes (aOR 3·5, 95%CI 1·1–11), poor glycaemic control (p 200 mg/dL), use of systemic steroids (aOR 7·7,95% CI 2·4–24·7), prolonged use of cloth and surgical masks (vs N95 masks, aOR 17·5, 95% CI 4·6-66·7), and repeated nasopharyngeal swab testing (aOR 1·6,95% CI 1·2–2·2). Interpretation: CAM is strongly associated with diabetes, poor glycaemic control, and systemic steroid use. Novel risk factors identified in our study include prolonged use of cloth and surgical masks vis-a-vis N95 masks, and repeated nasopharyngeal swab testing. Oxygen therapy and need for hospitalization for COVID-19 did not affect the risk of CAM. Funding Information: This was an investigator-initiated non-funded study. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The study was approved by the Institute Ethics Committee, AIIMS, Delhi, India. [IECPG-353/28.05.21].
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- 2021
27. Mortality among COVID-19 Patients- A Retrospective Study
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Pankaj Jorwal
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Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine ,Retrospective cohort study ,business - Published
- 2020
28. Needle Stick Injury From a COVID-19 Patient-Fear It or Forget It?
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Vishakh C Keri, Pankaj Jorwal, Parul Kodan, and Anubhav Gupta
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Health (social science) ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Health Policy ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,Fear ,Cross-Sectional Studies ,Emergency medicine ,medicine ,Needle stick injury ,Humans ,business ,Needlestick Injuries ,Letter to the Editor - Published
- 2020
29. Intricate interplay between Covid‐19 and cardiovascular diseases
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Vishakh C Keri, Parul Kodan, Brunda R L, Naveet Wig, Amit Hooda, and Pankaj Jorwal
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0301 basic medicine ,medicine.medical_specialty ,Acute coronary syndrome ,Myocarditis ,030106 microbiology ,Cardiomyopathy ,Psychological intervention ,Disease ,Antiviral Agents ,QT interval ,03 medical and health sciences ,Virology ,medicine ,Humans ,Intensive care medicine ,business.industry ,COVID-19 ,Hydroxychloroquine ,medicine.disease ,COVID-19 Drug Treatment ,030104 developmental biology ,Infectious Diseases ,Cardiovascular Diseases ,Heart failure ,business ,medicine.drug - Abstract
Covid-19 disease can involve any organ system leading to myriad manifestations and complications. Cardiovascular manifestations are being increasingly recognised with the improved understanding of the disease. Acute coronary syndrome, myocarditis, arrhythmias, cardiomyopathy; heart failure and thromboembolic disease have all been described. The elderly and those with prior cardiac diseases are at an increased risk of mortality. Overlapping symptomatology, ability of drugs to cause QTc interval (start of Q wave to the end of T wave) prolongation on electrocardiogram and arrhythmias, potential drug interactions, the need to recognise patients requiring urgent definitive management and provide necessary bedside interventions without increasing the risk of nosocomial spread have made the management challenging. In the background of a pandemic, non-Covid-19 cardiac patients are affected by delayed treatment and nosocomial exposure. Triaging using telemedicine and artificial intelligence along with utilization of bedside rapid diagnostic tests to detect Covid-19 could prove helpful in this aspect.
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- 2020
30. Poor Outcomes in Patients with Cirrhosis and COVID-19
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null Shalimar, Anshuman Elhence, Manas Vaishnav, Ramesh Kumar, Piyush Pathak, Kapil Dev Soni, Richa Aggarwal, Manish Soneja, Pankaj Jorwal, Arvind Kumar, Puneet Khanna, Akhil Kant Singh, Ashutosh Biswas, Neeraj Nischal, Lalit Dhar, Aashish Choudhary, Krithika Rangarajan, Anant Mohan, Pragyan Acharya, Baibaswata Nayak, Deepak Gunjan, Anoop Saraya, Soumya Mahapatra, Govind Makharia, Anjan Trikha, and Pramod Garg
- Abstract
Background and AimThere is a paucity of data on the clinical presentations and outcomes of Coronavirus disease 2019(COVID-19) in patients with underlying liver disease. We aimed to summarize the presentations and outcomes of COVID-19 positive patients and compare with historical controls.MethodsPatients with known chronic liver disease who presented with superimposed COVID- 19(n=28) between 22nd April and 22nd June 2020 were studied. Seventy-eight cirrhotic patients from historical controls were taken as comparison group.ResultsA total of 28 COVID patients- two without cirrhosis, one with compensated cirrhosis, sixteen with acute decompensation (AD), and nine with acute-on-chronic liver failure(ACLF) were included. The etiology of cirrhosis was alcohol(n=9), non-alcoholic fatty liver disease(n=2), viral(n=5), autoimmune hepatitis(n=4), and cryptogenic cirrhosis(n=6). The clinical presentations included complications of cirrhosis in 12(46.2%), respiratory symptoms in 3(11.5%) and combined complications of cirrhosis and respiratory symptoms in 11(42.3%) patients. The median hospital stay was 8(7-12) days. The mortality rate in COVID-19 patients was 42.3%(11/26), as compared to 23.1%(18/78) in the historical controls(p=0.077). All COVID-19 patients with ACLF(9/9) died compared to 53.3%(16/30) in ACLF of historical controls(p=0.015). Mortality rate was higher in COVID patients with compensated cirrhosis and AD as compared to historical controls 2/17(11.8%) vs 2/48(4.2%), though not statistically significant (p=0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio, 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully.ConclusionCOVID-19 is associated with poor outcomes in patients with cirrhosis, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.
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- 2020
31. Evaluation of genotype MTBDRplus V2 and genotype MTBDRsl V2 for the diagnosis of extrapulmonary tuberculosis in India
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Rohini Sharma, Ranjani Ramachandran, Ashutosh Biswas, Neeraj Nischal, Binit Kumar Singh, Sanjay Sarin, Nitin Gupta, Manish Soneja, Naveet Wig, Jigyasa Chaubey, and Pankaj Jorwal
- Subjects
0301 basic medicine ,Microbiology (medical) ,Adult ,DNA, Bacterial ,Male ,medicine.medical_specialty ,Tuberculosis ,Genotype ,Liquid culture ,030106 microbiology ,Immunology ,Antitubercular Agents ,India ,Microbiology ,Gastroenterology ,Diagnostic modalities ,Mycobacterium tuberculosis ,03 medical and health sciences ,Internal medicine ,Tuberculosis, Multidrug-Resistant ,medicine ,Humans ,Retrospective Studies ,biology ,business.industry ,Extrapulmonary tuberculosis ,Drug susceptibility ,biology.organism_classification ,medicine.disease ,030104 developmental biology ,Infectious Diseases ,Mycobacterium tuberculosis complex ,Molecular Diagnostic Techniques ,Female ,Morbidity ,business - Abstract
Microbiological diagnosis of extra-pulmonary tuberculosis (EPTB) has been one of the most difficult aspects of tuberculosis (TB) management. Availability of better imaging and diagnostic modalities has led to an increase in the number of diagnosed cases. The current upsurge in multidrug-resistant tuberculosis warrants routine testing of EPTB samples for resistance at baseline with shorter turn-around time. A total of 369 EPTB specimens were subjected to Ziehl-Neelsen (ZN) stain, liquid culture (LC) with phenotypic drug susceptibility testing, MTBDRplus V.2 and MTBDRsl V.2. The molecular categorisation of resistant specimens was further reconfirmed with sequencing. The sensitivity and specificity of MTBDRplus V.2 to detect Mycobacterium tuberculosis (MTB) when compared to ZN stain was 97.9% and 89.2%, respectively while it was 73.4% and 83.8%, respectively when compared to LC. Similarly, for MTBDRsl V.2, the sensitivity and specificity for detection of MTB when compared with ZN was 95.6% and 91.9%, respectively and 75% and 89.2%, respectively when compared to LC. In smear-positive specimens, 94% (141/150) and 86% (129/150) valid results were observed in MTBDRplus V.2 and MTBDRsl V.2, respectively. The utilisation of both MTBDRplus V.2 and MTBDRsl V.2 for the diagnosis of smear-positive EPTB specimens would be useful in programmatic management of TB in high-burden settings.
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- 2020
32. Outcomes associated with standardized treatment regimens for extensively drug-resistant tuberculosis
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Neeraj Nischal, Pankaj Jorwal, Binit Kumar Singh, Parul Kodan, Manish Soneja, Naveet Wig, Nitin Gupta, Sudeshna Ghosh, and Anivita Aggarwal
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medicine.medical_specialty ,Treatment regimen ,business.industry ,Internal medicine ,lcsh:R ,medicine ,MEDLINE ,lcsh:Medicine ,Extensively drug-resistant tuberculosis ,medicine.disease ,business ,Letter to Editor - Published
- 2020
33. Brain abscess in patients with chronic kidney disease: A case-based approach to management in resource-limited settings
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Sundeep Malla, Pankaj Jorwal, Prashant Ramteke, Manish Soneja, Anivita Aggarwal, Prabhat Kumar, Gagandeep Singh, Nitin Gupta, Rohit Kumar, Netto George, Yogiraj Ray, Parul Kodan, Ashutosh Biswas, and Sayantan Banerjee
- Subjects
Adult ,Male ,medicine.medical_specialty ,Antifungal Agents ,medicine.drug_class ,Antibiotics ,Brain Abscess ,Meropenem ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Trimethoprim, Sulfamethoxazole Drug Combination ,medicine ,Humans ,Pharmacology (medical) ,In patient ,General Pharmacology, Toxicology and Pharmaceutics ,Renal Insufficiency, Chronic ,Intensive care medicine ,Brain abscess ,Voriconazole ,business.industry ,Nocardiosis ,Linezolid ,General Medicine ,Bacterial Infections ,bacterial infections and mycoses ,medicine.disease ,Kidney Transplantation ,Anti-Bacterial Agents ,chemistry ,Mycoses ,030220 oncology & carcinogenesis ,Female ,business ,030217 neurology & neurosurgery ,medicine.drug ,Kidney disease - 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.
- Published
- 2020
34. Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 Among Healthcare Workers: Initial Experience from India
- Author
-
Harshith B. Kadnur, Anivita Aggarwal, Manish Soneja, Komal Singh, Netto George, Neeraj Nischal, Praveen Trilangi, Adil Rashid Khan, Devashish Desai, Ankit Mittal, Bharathi Arunan, Diksha Patidar, Ankesh Gupta, Arvind Kumar, Kapil Dev Soni, Pankaj Jorwal, Richa Agarwal, Dalim K. Baidya, Purva Mathur, Sushma Bhatnagar, Anjan Trikha, S. Rajeshwari, Ashutosh Biswas, Ravindra Pandey, Naveet Wig, and Randeep Guleria
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Hydroxychloroquine ,medicine.disease_cause ,Pre-exposure prophylaxis ,Internal medicine ,Health care ,Medicine ,Observational study ,business ,Coronavirus ,medicine.drug - Abstract
Background: Hydroxychloroquine(HCQ) prophylaxis has been proposed for coronavirus disease-2019(COVID-19) This prospective observational study was conducted to
- Published
- 2020
35. Extensive intracranial tuberculosis
- Author
-
Megha Priyadarshi, Umang Arora, and Pankaj Jorwal
- Subjects
medicine.medical_specialty ,Visual acuity ,Tuberculosis ,genetic structures ,business.industry ,media_common.quotation_subject ,General Medicine ,Neck rigidity ,Audiology ,medicine.disease ,eye diseases ,Hand movements ,Left eye ,Perception ,Medicine ,medicine.symptom ,business ,Sign (mathematics) ,media_common - Abstract
A 20-year-old woman presented with a history of low-grade fever, headache and progressive diminution of vision for 2 months. She appeared drowsy, and on examination, neck rigidity and Kernig’s sign were positive. The patient’s relatives did not give any history of cough, shortness of breath, night sweats or contact with a known case of tuberculosis. Visual acuity at the time of admission was reduced to perception of hand movements close to the face in the right eye and 6/60 in the left eye. Cerebrospinal …
- Published
- 2022
36. 99mTc-ethambutol scintigraphy with single-photon emission computed tomography/computed tomography in lymph node tuberculosis: An initial experience
- Author
-
Piyush Ranjan, Bisakh Bhattacharya, Nishikant Damle, Geetanjali Arora, Sneha Prakash, Neeraj Nischal, Pankaj Jorwal, Arvind Kumar, Apoorva Tyagi, and Naveet Wig
- Subjects
Radiology, Nuclear Medicine and imaging - Published
- 2022
37. Diagnostic utility of chest computerized tomography in the diagnosis of recurrence among sputum scarce and sputum negative previously treated pulmonary tuberculosis suspects
- Author
-
Pankaj Jorwal, BG Bharath, Animesh Ray, Surabhi Vyas, Manish Soneja, Ashutosh Biswas, Sanjeev Sinha, and MaroofA Khan
- Subjects
Pulmonary and Respiratory Medicine - Abstract
The objective was to study the sensitivity, specificity, and diagnostic accuracy of various computed tomography (CT) chest findings in diagnosing recurrence among pulmonary tuberculosis (PTB) suspects.A prospective observational study was conducted in a tertiary care hospital in New Delhi. A total of 130 suspects with a past history of treatment for PTB, who presented with any of the symptoms suggestive of recurrence were included. Sputum-positive, HIV-positive patients, pregnant females, and patients aged18 years were excluded. Patients underwent CT chest followed by bronchoalveolar lavage (BAL).A total of 62 patients were there in the final analysis. The median age of the patients with recurrent PTB was 27.5 years. Cough was the universal symptom in all these patients (90%). Hemoptysis was the predominant symptom among patients with chronic pulmonary aspergillosis (66.6%). Necrotic mediastinal lymph nodes had good diagnostic accuracy of 88.71% with area under the curve of 0.806, P0.001 in diagnosing recurrent TB. BAL GeneXpert and mycobacteria growth indicator tube had good sensitivity (83.33% and 84.62%, respectively), specificity (100% for both), and excellent diagnostic accuracy (95.16% and 96.36%, respectively) for diagnosing recurrence in sputum negative and sputum scarce patient, (P0.001) when compared with composite reference standard. For culture-positive cases, BAL GeneXpert MTB/RIF had 100% sensitivity and 97.73% specificity in diagnosing recurrent PTB patients.The presence of mediastinal necrotic lymph node is the most accurate CT finding that can differentiate recurrent TB from post-TB sequelae. No other single chest CT scan finding had reliable diagnostic accuracy in comparison to microbiological tools in diagnosing recurrence among sputum negative or scarce previously treated PTB suspects.
- Published
- 2022
38. Clinical profile of ChAdOx1 nCoV-19- and BBV152-vaccinated individuals among hospitalized COVID-19 patients: a pair-matched study
- Author
-
Vishakh C. Keri, Bharathi Arunan, Parul Kodan, Manish Soneja, Neeraj Nischal, Ashwin Varadarajan, Akansha Didwania, Brunda R.L., Anivita Aggarwal, Pankaj Jorwal, Arvind Kumar, Animesh Ray, Prayas Sethi, Ved Prakash Meena, Puneet Khanna, Akhil Kant Singh, Richa Aggarwal, Kapil Dev Soni, Alpesh Goyal, Animesh Das, Anjan Trikha, and Naveet Wig
- Subjects
Oncology ,Drug Discovery ,Immunology ,Immunology and Allergy ,Pharmacology (medical) - Abstract
Background: COVID-19 infections among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-vaccinated individuals are of clinical concern, especially in those requiring hospitalization. Such real-world data on ChAdOx1 nCoV-19- and BBV152-vaccinated individuals are scarce. Hence, there is an urgent need to understand their clinical profile and outcomes. Methods: A 1:1 pair-matched study was performed among vaccinated and unvaccinated COVID-19 patients admitted between March 2021 and June 2021 at a tertiary care centre in New Delhi, India. The vaccinated group (received at least one dose of ChAdOx1 nCoV-19 or BBV152) was prospectively followed till discharge or death and matched [for age (±10 years), sex, baseline disease severity and comorbidities] with a retrospective group of unvaccinated patients admitted during the study period. Paired analysis was done to look for clinical outcomes between the two groups. Results: The study included a total of 210 patients, with 105 in each of the vaccinated and unvaccinated groups. In the vaccinated group, 47 (44.8%) and 58 (55.2%) patients had received ChAdOx1 nCoV-19 and BBV152, respectively. However, 73 patients had received one dose and 32 had received two doses of the vaccine. Disease severity was mild in 36.2%, moderate in 31.4% and severe in 32.4%. Two mortalities were reported out of 19 fully vaccinated individuals. All-cause mortality in the vaccinated group was 8.6% (9/105), which was significantly lower than the matched unvaccinated group mortality of 21.9% (23/105), p = 0.007. Vaccination increased the chances of survival (OR = 3.8, 95% CI: 1.42–10.18) compared to the unvaccinated group. Conclusion: In the second wave of the pandemic predominated by delta variant of SARS CoV-2, vaccination reduced all-cause mortality among hospitalized patients, although the results are only preliminary.
- Published
- 2022
39. Clinical spectrum and outcome of hospitalized patients with invasive fungal infections: a prospective study from a medical ward/intensive care unit of a teaching hospital in North India
- Author
-
Devada, Sindhu, Pankaj, Jorwal, Nitin, Gupta, Immaculata, Xess, Gagandeep, Singh, Manish, Soneja, Neeraj, Nischal, Prayas, Sethi, Animesh, Ray, Ashutosh, Biswas, and Naveet, Wig
- Subjects
Adult ,Male ,Intensive Care Units ,Young Adult ,Humans ,India ,Female ,Prospective Studies ,Middle Aged ,Hospitals, Teaching ,Hospital Units ,Invasive Fungal Infections - Abstract
The aim of the study was to determine the clinical spectrum and outcome of invasive fungal infections (IFIs) in hospitalized patients. A prospective study was conducted in a teaching hospital in North India between December 2016 and December 2018. Patients diagnosed with IFIs were enrolled. Their clinical and laboratory parameters were recorded using a pre-defined clinical report form. They were followed up till discharge or death and a 60-day outcome was recorded. A total of 110 IFI cases were identified, which included invasive aspergillosis (39%), invasive candidiasis (16%), cryptococcosis (14%) and mucormycosis (12%). Pneumonia (63%) was the most common final diagnosis in these patients. Diabetes mellitus, chronic kidney disease and chronic obstructive pulmonary disease were the most common risk factor for all four diseases. Additionally, most patients with cryptococcosis had human immunodeficiency virus infection. Mortality was observed in 73% of the patients. Overall, IFIs are an important cause of morbidity and mortality in critically ill patients admitted to medical wards and ICUs.
- Published
- 2019
40. Role of LDL apheresis in a case of homozygous familial hypercholesterolemia
- Author
-
Naveet Wig, Ashutosh Biswas, Paras Singla, Talakola Naveen, Manish Soneja, Charusmita Chaudhary, Chitikela Sindhura Durga, Upendra Baitha, and Pankaj Jorwal
- Subjects
medicine.medical_specialty ,Adolescent ,Familial hypercholesterolemia ,Disease ,Xanthoma ,Gastroenterology ,Hyperlipoproteinemia Type II ,Coronary artery disease ,chemistry.chemical_compound ,Internal medicine ,Humans ,Medicine ,Pharmacology (medical) ,General Pharmacology, Toxicology and Pharmaceutics ,business.industry ,Cholesterol ,Homozygote ,nutritional and metabolic diseases ,General Medicine ,medicine.disease ,Lipoproteins, LDL ,chemistry ,LDL apheresis ,LDL receptor ,Blood Component Removal ,Female ,lipids (amino acids, peptides, and proteins) ,Serum low density lipoprotein ,business - Abstract
Familial hypercholesterolemia (FH) is a form of primary hyperlipoproteinemia characterized by the presence of high concentrations of serum low density lipoprotein (LDL) cholesterol, increased tendency to form xanthomas and early onset of coronary artery disease. This disease is an autosomal dominant disorder caused by defects in the gene that encode for the LDL receptor. Homozygous familial hypercholesterolemia is a rare occurrence and here we report a case of an 18-year-old girl with familial hypercholesterolemia treated with anti-lipidemic drugs and controlled only with LDL apheresis. The patient expired after 3 months highlighting the difficulties in management due to economic constraints in a resource limited setting in spite of availability of effective therapy.
- Published
- 2019
41. Disseminated mucormycosis: A sinister cause of neutropenic fever syndrome
- Author
-
Prashant Ramteke, Manish Soneja, Ghazal Tansir, Sanchit Kumar, Upendra Baitha, Ashutosh Biswas, Prabhat Kumar, Pankaj Jorwal, and Neha Rastogi
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Chemotherapy ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,030106 microbiology ,Mucormycosis ,Case Report ,General Medicine ,medicine.disease ,Pancytopenia ,Surgery ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Bronchoalveolar lavage ,medicine.artery ,Biopsy ,medicine ,030212 general & internal medicine ,Embolization ,business ,Bronchial artery - Abstract
A 15 year old girl presented with complaints of prolonged fever and recurrent episodes of hemoptysis. Initial investigation showed pancytopenia and radiological imaging was suggestive of necrotizing pneumonia. Subsequently, mucor was isolated from bronchoalveolar lavage fluid, but even on appropriate medications her condition kept deteriorating. She had multiple bouts of hemoptysis and a repeat imaging of chest showed dissemination of mucormycosis to pulmonary vein and heart. Bone marrow biopsy identified acute lymphoblastic leukemia (ALL) as the cause of pancytopenia. She was planned for bronchial artery embolization and chemotherapy for ALL, but consent was not given and she left our institute against medical advice. Our case highlights the importance of keeping a high index of suspicion for disseminated mucormycosis in neutropenic patients, as any delay in diagnosis and treatment could have grave consequences.
- Published
- 2017
42. Parkes Weber syndrome
- Author
-
Vimal Kumar, Ashutosh Biswas, Pankaj Jorwal, and Vaibhav Deorari
- Subjects
Male ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Computed Tomography Angiography ,Sturge–Weber syndrome ,General Medicine ,medicine.disease ,Parkes Weber syndrome ,Arteriovenous Malformations ,Sturge-Weber Syndrome ,medicine ,Humans ,Radiology ,business ,Computed tomography angiography - Published
- 2019
43. Invasive fungal infections in critically ill patients: A prospective study from a tertiary care hospital in India
- Author
-
Chitikela Sindhura Durga, Neeraj Nischal, Ashutosh Biswas, Pankaj Jorwal, Animesh Ray, Manish Soneja, Gagandeep Singh, Piyush Ranjan, Nitin Gupta, Manasvini Bhatt, Naveet Wig, and Immaculata Xess
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Critical Illness ,030106 microbiology ,India ,Aspergillosis ,law.invention ,Sepsis ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,Epidemiology ,Intubation, Intratracheal ,Medicine ,Central Venous Catheters ,Humans ,Mucormycosis ,Pharmacology (medical) ,Candidiasis, Invasive ,030212 general & internal medicine ,Prospective Studies ,General Pharmacology, Toxicology and Pharmaceutics ,Mortality ,Prospective cohort study ,Aged ,Invasive Pulmonary Aspergillosis ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Intensive care unit ,Intensive Care Units ,Observational study ,Female ,business ,Central venous catheter ,Invasive Fungal Infections - Abstract
Invasive fungal infections (IFI) are commonly seen in immunosuppressed individuals but their epidemiology in critically ill patients has not been well described. The aim of this study was to determine the frequency, risk factors and outcome of invasive fungal infections in a medical intensive care unit. A prospective observational study was carried out between August 2016 and March 2018 in the medical intensive care unit. Patients above the age of 14 years with endotracheal intubation and/or central venous catheter for at-least three days and sepsis (not responding to 48 hours of intravenous antibiotic therapy) were included in the study. Suitable samples were collected and were subjected to fungal diagnostics. Invasive fungal disease was defined according to standard guidelines. Of the 100 recruited patients, a total of 11 patients had invasive aspergillosis, three patients had invasive candidiasis and one patient had both invasive aspergillosis and mucormycosis. IFI was more commonly seen in patients with auto-immune diseases (p = 0.002, odds ratio-10.13 (95% CI: 2.3-44)). A mortality of 73% was observed in patients with IFI. In conclusion, IFI, especially aspergillosis is grossly under-reported in critical settings. Early suspicion, thorough investigation and timely diagnosis may alleviate patients of significant mortality and morbidity.
- Published
- 2019
44. Two cases of Osteoarticular Mucor menace: A diagnostic and management conundrum
- Author
-
Farhan Fazal, Pankaj Jorwal, Prabhat Kumar, Ashutosh Biswas, Upendra Raj, Manish Soneja, Shah Alam, Janya Sachdev, Manasvini Bhatt, Gagandeep Singh, Immaculata Xess, and Surabhi Vyas
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Tuberculosis ,Antifungal Agents ,030106 microbiology ,Disease ,Delayed diagnosis ,Granulomatous Disease, Chronic ,Amputation, Surgical ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Chronic granulomatous disease ,medicine ,Humans ,Mucormycosis ,Pharmacology (medical) ,030212 general & internal medicine ,General Pharmacology, Toxicology and Pharmaceutics ,Pelvic Bones ,Pelvis ,business.industry ,Disease Management ,General Medicine ,medicine.disease ,Dermatology ,medicine.anatomical_structure ,Chronic osteomyelitis ,Debridement ,Lower Extremity ,Presentation (obstetrics) ,business ,Burns - Abstract
Mucormycosis is an uncommon aggressive fungal infection usually seen in immunocompromised hosts or patients with burns and trauma. The common presentations include rhino-orbital-cerebral and pulmonary involvement. Osteoarticular involvement is a rare presentation of this disease. We present two cases of osteoarticular mucormycosis of pelvis and long bones of the lower limb, one in a patient with burn injury and other one in a patient with chronic granulomatous disease, hitherto a rarely reported association. Delayed diagnosis in a setting where tuberculosis is a common cause of chronic osteomyelitis, challenges in medical and surgical management of these patients are discussed in this report.
- Published
- 2019
45. An Unusual Sequelae of Uncomplicated Vivax Malaria
- Author
-
Manasvini, Bhatt, Wasim, Khot, Manish, Soneja, Neeraj, Nischal, Pankaj, Jorwal, and Ashutosh, Biswas
- Subjects
Male ,Disease Progression ,Malaria, Vivax ,Humans ,Syndrome ,Malaria, Falciparum ,Middle Aged ,Plasmodium vivax ,Malaria - Abstract
Albeit malaria is a common health problem in many parts of the world, the entity of post-malaria neurological syndrome (PMNS) is not well recognized. This is a rare entity of neurological and psychiatric manifestations described in patients with falciparum malaria which usually develops within 2 months of recovery from the illness. It has been reported in 1.2/1000 falciparum malaria cases, more commonly in those with severe disease. We report case of a 62-yrs-old male presenting with recurrent generalized seizures following adequately treated vivax malaria. Relevant investigations were done to rule out other differentials. The patient recovered completely reiterating the self-limiting course of PMNS. Occurrence of PMNS following uncomplicated vivax malaria is peculiar in this report.
- Published
- 2018
46. Hearing loss in a post COVID-19 patient
- Author
-
Gaurav Gupta, Pankaj Jorwal, Chandra Shekar Reddy, Sayan Chakraborty, Upendra Baitha, Sayan Maharatna, and Ashutosh Biswas
- Subjects
Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Hearing loss ,business.industry ,Head injury ,medicine.disease ,Pandemic ,otorhinolaryngologic diseases ,medicine ,Hospital discharge ,Outpatient clinic ,Sensorineural hearing loss ,medicine.symptom ,business ,Sudden onset - Abstract
With the advent of COVID-19 pandemic, there has been a myriad of long-term complications in post-COVID patients. In these patients, one of the rare but dreaded symptoms reported is sudden onset sensorineural hearing loss (SNHL) that has been reported mostly during active infection. We followed up with these patients in our outpatient department and came across one patient of SNHL. We conducted a literature search in PubMed and Google Scholar but couldn’t come across any such care report from India. We are hereby reporting the first case of SNHL in a post-hospitalised COVID-19 from India presenting after 3 months of hospital discharge, with no history prior otologic illness, intake of ototoxic drugs or any head injury. Post-COVID patients can present with weird symptoms including hearing loss apart from other commonly reported post COVID 19 sequelae.
- Published
- 2021
47. Psychological health of caregivers of individuals with type 2 diabetes mellitus: A cross-sectional comparative study
- Author
-
Pankaj Jorwal, Rohit Verma, and Yatan Pal Singh Balhara
- Subjects
medicine.medical_specialty ,Family caregivers ,Type 2 Diabetes Mellitus ,Type 2 diabetes ,Hospital Anxiety and Depression Scale ,medicine.disease ,Diabetes mellitus ,medicine ,Anxiety ,medicine.symptom ,Psychiatry ,Psychology ,Depression (differential diagnoses) ,Anxiety disorder ,Clinical psychology - Abstract
Introduction: The quality-of-life in individuals with diabetes is also dependent upon the quality of family relationships and general well-being of caregivers because the patient depends on them to uphold in the community. Only limited studies have assessed the psychological health of caregivers to individuals with diabetes. Aims and Objective: The current study aims at comparison of depression and anxiety levels among patients with diabetes and their caregivers. Materials and Methods: Fifty consecutive patients-care giver dyads of subjects having type 2 diabetes were recruited at an out-patient clinic of medicine at a tertiary care center. The dyads were assessed using a semi-structured proforma for the socio-demographic details and for anxiety and depression levels using the Hospital Anxiety and Depression Scale (HADS). The data were analyzed using SPSS version 17.0. Correlation analysis was performed for multiple variables including blood glucose profile. Results: The mean duration of illness (4.93 3.53 years) and blood glucose parameters were not found to be associated to depressive or anxiety symptoms. Depressive and anxiety disorder was observed in 24% and 44% of patients and 10% and 18% of caregivers, respectively. Patients had significantly more HADS anxiety (HADS-A) scale scores than caregivers but not for HADS depression (HADS-D) scale. Female patients were found to be having more HADS-D scores than male patients (P = 0.02), but were not significantly different from caregivers. HADS-A scores were comparable among male and female gender in intragroup as well as intergroup comparison for patient and caregiver groups. Conclusion: Diabetes mellitus affects the psychological health of not only the patients but as well as the family caregivers and patients tend to be more anxious than the caregivers. Furthermore, it was seen that women with diabetes had higher rates of depression than their male counterparts.
- Published
- 2015
48. Nontuberculous mycobacteria: A report of eighteen cases from a tertiary care center in India
- Author
-
Sundeep Malla, Vettakkara Kandy Muhammed Niyas, Sayantan Banerjee, Binit Kumar Singh, Yogiraj Ray, Pankaj Jorwal, Neeraj Nischal, Nitin Gupta, Ankit Mittal, Naveet Wig, Parul Kodan, Manish Soneja, Wasim Khot, and Farhan Fazal
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Mycobacterium avium complex ,Mycobacterium chelonae ,Context (language use) ,Mycobacterium abscessus ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,030212 general & internal medicine ,lcsh:RC705-779 ,Mycobacterium kansasii ,Tuberculosis in India ,biology ,Mycobacterium fortuitum ,business.industry ,lcsh:Diseases of the respiratory system ,bacterial infections and mycoses ,biology.organism_classification ,Regimen ,030228 respiratory system ,Original Article ,Nontuberculous mycobacteria ,business - 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.
- Published
- 2020
49. One health approach and COVID-19: A perspective
- Author
-
Pooja Jorwal, Pankaj Jorwal, and Swati Bharadwaj
- Subjects
medicine.medical_specialty ,SARS-CoV-2 ,business.industry ,pandemic ,Social distance ,media_common.quotation_subject ,Public health ,lcsh:R ,lcsh:Medicine ,COVID-19 ,Ignorance ,Review Article ,Public relations ,World economy ,One Health ,Health care ,Pandemic ,Medicine ,zoonotic diseases ,business ,Health policy ,media_common - Abstract
One Health is a well-recognized concept; however, it has been at the fringe of most operational health policies rather than being the central theme. Although, global experts and policy makers have agreed on this theory, the transition from a vision to practical application is inconspicuous. COVID-19 pandemic has caused massive damage to the world economy and continues to peril human lives everywhere. Ignorance of the principles of One Health approach in the current health care system has proved to be the Achilles heel of our health policy. Social distancing, lockdown, and hand hygiene are short-term preventive measures imposed by nations worldwide but are difficult to sustain in the long run. Thus, it is long overdue that we change our unidimensional approach regarding the control and prevention of diseases. A rational practice of the One Health strategy should be our utmost priority to control the ongoing grave situation. The purpose of this article is to bring the attention of healthcare professionals and researchers toward the One Health paradigm for the betterment of public health while combating COVID-19 and to prepare for future emergence of infectious diseases. Our assessment for this review is based on the philosophy and views shared by recent publications on the One Health approach which emphasizes an integrated, multisectoral, and holistic concept (animal health-human health-environmental factors) and promotes a transdisciplinary-integrated tactic for disease prevention and control.
- Published
- 2020
50. An Interesting Case of Recurrent Pyelonephritis
- Author
-
Achintya Dinesh, Singh, Siddharth, Jain, Agrima, Mian, Surabhi, Vyas, Neeraj, Nischal, and Pankaj, Jorwal
- Subjects
Adult ,Male ,Pyelonephritis ,Recurrence ,Aortic Valve ,Enterococcus faecalis ,Humans ,Endocarditis, Bacterial ,Gram-Positive Bacterial Infections - Abstract
A 35-year-old male presented with repeated episodes of fever and abdominal pain of 3-month duration. He had been hospitalized twice with similar complaints in the past 3-month. He was diagnosed as pyelonephritis and managed with intravenous antibiotics. However, fever recurred after ten days of discharge from the hospital. With these complaints, he was referred to the Department of Medicine, AIIMS, New Delhi. After evaluation, he was diagnosed as pyelonephritis with right sided consolidation and was started on broad spectrum antibiotics. After a transient initial improvement, his dyspnea worsened, fever recurred and he developed a tender submandibular abscess. Further evaluation for the actual focus of infection, revealed a small mass attached to the right coronary aortic cusp on transthoracic ECHO. Diagnosis of native Aortic valve endocarditis was made and suitably treated. The patient became afebrile on the 8th day of therapy and was discharged after 20-day. He is doing well on subsequent follow-up.
- Published
- 2018
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