139 results on '"Ghose, Aniruddha"'
Search Results
102. Magnetic resonance imaging of the brain in adults with severe falciparum malaria
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Maude, Richard James, primary, Barkhof, Frederik, additional, Hassan, Mahtab Uddin, additional, Ghose, Aniruddha, additional, Hossain, Amir, additional, Abul Faiz, M, additional, Choudhury, Ehsan, additional, Rashid, Rehnuma, additional, Sayeed, Abdullah Abu, additional, Charunwatthana, Prakaykaew, additional, Plewes, Katherine, additional, Kingston, Hugh, additional, Maude, Rapeephan Rattanawongnara, additional, Silamut, Kamolrat, additional, Day, Nicholas Philip John, additional, White, Nicholas John, additional, and Dondorp, Arjen Mattheus, additional
- Published
- 2014
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103. Correlation of biomarkers for parasite burden and immune activation with acute kidney injury in severe falciparum malaria
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Plewes, Katherine, primary, Royakkers, Annick A, additional, Hanson, Josh, additional, Hasan, Md Mahtab Uddin, additional, Alam, Shamsul, additional, Ghose, Aniruddha, additional, Maude, Richard J, additional, Stassen, Pauline M, additional, Charunwatthana, Prakaykaew, additional, Lee, Sue J, additional, Turner, Gareth DH, additional, Dondorp, Arjen M, additional, and Schultz, Marcus J, additional
- Published
- 2014
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104. Randomized Controlled Trial of Levamisole Hydrochloride as Adjunctive Therapy in Severe Falciparum Malaria With High Parasitemia
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Maude, Richard J., primary, Silamut, Kamolrat, additional, Plewes, Katherine, additional, Charunwatthana, Prakaykaew, additional, Ho, May, additional, Abul Faiz, M., additional, Rahman, Ridwanur, additional, Hossain, Md Amir, additional, Hassan, Mahtab U., additional, Bin Yunus, Emran, additional, Hoque, Gofranul, additional, Islam, Faridul, additional, Ghose, Aniruddha, additional, Hanson, Josh, additional, Schlatter, Joel, additional, Lacey, Rachel, additional, Eastaugh, Alison, additional, Tarning, Joel, additional, Lee, Sue J., additional, White, Nicholas J., additional, Chotivanich, Kesinee, additional, Day, Nicholas P. J., additional, and Dondorp, Arjen M., additional
- Published
- 2013
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105. Sequestration and Red Cell Deformability as Determinants of Hyperlactatemia in Falciparum Malaria.
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Haruhiko Ishioka, Aniruddha Ghose, Charunwatthana, Prakaykaew, Maude, Richard, Plewes, Katherine, Kingston, Hugh, Intharabut, Benjamas, Woodrow, Charlie, Chotivanich, Kesinee, Sayeed, Abdullah Abu, Hasan, Mahtab Uddin, Day, Nicholas P., Faiz, Abul, White, Nicholas J., Hossain, Amir, Dondorp, Arjen M., Ishioka, Haruhiko, and Ghose, Aniruddha
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ERYTHROCYTE deformability ,RISK of malaria ,HYPERLACTATEMIA ,SEQUESTRATION (Chemistry) ,MALARIA prevention ,PLASMODIUM falciparum ,BLOOD sampling ,BLOOD-vessel physiology ,CARDIOVASCULAR system physiology ,LACTATES ,MALARIA ,RESEARCH funding - Abstract
Background: Hyperlactatemia is a strong predictor of mortality in severe falciparum malaria. Sequestered parasitized erythrocytes and reduced uninfected red blood cell deformability (RCD) compromise microcirculatory flow, leading to anaerobic glycolysis.Methods: In a cohort of patients with falciparum malaria hospitalized in Chittagong, Bangladesh, bulk RCD was measured using a laser diffraction technique, and parasite biomass was estimated from plasma concentrations of Plasmodium falciparum histidine-rich protein 2 (PfHRP2). A multiple linear regression model was constructed to examine their associations with plasma lactate concentrations.Results: A total of 286 patients with falciparum malaria were studied, of whom 224 had severe malaria, and 70 died. Hyperlactatemia (lactate level, ≥ 4 mmol/L) was present in 111 cases. RCD at shear stresses of 1.7 Pa and 30 Pa was reduced significantly in patients who died, compared with survivors, individuals with uncomplicated malaria, or healthy individuals (P < .05, for all comparisons). Multiple linear regression analysis showed that the plasma PfHRP2 level, parasitemia level, total bilirubin level, and RCD at a shear stress of 1.7 Pa were each independently correlated with plasma lactate concentrations (n = 278; R(2) = 0.35).Conclusions: Sequestration of parasitized red blood cells and reduced RCD both contribute to decreased microcirculatory flow in severe disease. [ABSTRACT FROM AUTHOR]- Published
- 2016
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106. Automated Detection of Malarial Retinopathy-Associated Retinal Hemorrhages
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Joshi, Vinayak S., primary, Maude, Richard J., additional, Reinhardt, Joseph M., additional, Tang, Li, additional, Garvin, Mona K., additional, Sayeed, Abdullah Abu, additional, Ghose, Aniruddha, additional, Hassan, Mahtab Uddin, additional, and Abràmoff, Michael D., additional
- Published
- 2012
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107. Seroepidemiological surveillance of Burkholderia pseudomallei in Bangladesh
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Maude, Rapeephan R., primary, Maude, Richard J., additional, Ghose, Aniruddha, additional, Amin, Md Robed, additional, Islam, Md Belalul, additional, Ali, Mohammad, additional, Bari, Md Shafiqul, additional, Majumder, Md Ishaque, additional, Wuthiekanan, Vanaporn, additional, Dondorp, Arjen M., additional, Bailey, Robin L., additional, Day, Nicholas P.J., additional, and Faiz, M. Abul, additional
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- 2012
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108. Training in infectious diseases in India
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Abu Sayeed, Abdullah, primary, Ghose, Aniruddha, additional, Amin, Robed, additional, Basher, Ariful, additional, and Faiz, Abul, additional
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- 2012
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109. Retraction Note to: Mass barium carbonate poisoning with fatal outcome, lessons learned: a case series
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Ghose, Aniruddha, primary, Sayeed, Abdullah Abu, additional, Hossain, Amir, additional, Rahman, Ridwanur, additional, Faiz, Abul, additional, and Haque, Gofranul, additional
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- 2010
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110. RETRACTED ARTICLE: Mass barium carbonate poisoning with fatal outcome, lessons learned: a case series
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Ghose, Aniruddha, primary, Sayeed, Abdullah Abu, additional, Hossain, Amir, additional, Rahman, Ridwanur, additional, Faiz, Abul, additional, and Haque, Gofranul, additional
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- 2009
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111. Mass barium carbonate poisoning with fatal outcome, lessons learned: a case series
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Ghose, Aniruddha, primary, Sayeed, Abdullah Abu, additional, Hossain, Amir, additional, Rahman, Ridwanur, additional, Faiz, Abul, additional, and Haque, Gofranul, additional
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- 2009
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112. Short Report: Serosurveillance of Orientia tsutsugamushi and Rickettsia typhi in Bangladesh.
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Maude, Rapeephan R., Maude, Richard J., Ghose, Aniruddha, Amin, M. Robed, Islam, M. Belalul, Ali, Mohammad, Bari, M. Shafiqul, Majumder, M. Ishaque, Tanganuchitcharnchai, Ampai, Dondorp, Arjen M., Paris, Daniel H., Bailey, Robin L., Faiz, M. Abul, Blacksell, Stuart D., and Day, Nicholas P. J.
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- 2014
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113. Clinically and Microbiologically Derived Azithromycin Susceptibility Breakpoints for Salmonella entericaSerovars Typhi and Paratyphi A
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Parry, Christopher M., Thieu, Nga Tran Vu, Dolecek, Christiane, Karkey, Abhilasha, Gupta, Ruchi, Turner, Paul, Dance, David, Maude, Rapeephan R., Ha, Vinh, Tran, Chinh Nguyen, Thi, Phuong Le, Be, Bay Pham Van, Phi, La Tran Thi, Ngoc, Rang Nguyen, Ghose, Aniruddha, Dongol, Sabina, Campbell, James I., Thanh, Duy Pham, Thanh, Tuyen Ha, Moore, Catrin E., Sona, Soeng, Gaind, Rajni, Deb, Monorama, Anh, Ho Van, Van, Sach Nguyen, Tinh, Hien Tran, Day, Nicholas P. J., Dondorp, Arjen, Thwaites, Guy, Faiz, Mohamed Abul, Phetsouvanh, Rattanaphone, Newton, Paul, Basnyat, Buddha, Farrar, Jeremy J., and Baker, Stephen
- Abstract
ABSTRACTAzithromycin is an effective treatment for uncomplicated infections with Salmonella entericaserovar Typhi and serovar Paratyphi A (enteric fever), but there are no clinically validated MIC and disk zone size interpretative guidelines. We studied individual patient data from three randomized controlled trials (RCTs) of antimicrobial treatment in enteric fever in Vietnam, with azithromycin used in one treatment arm, to determine the relationship between azithromycin treatment response and the azithromycin MIC of the infecting isolate. We additionally compared the azithromycin MIC and the disk susceptibility zone sizes of 1,640 S. Typhi and S. Paratyphi A clinical isolates collected from seven Asian countries. In the RCTs, 214 patients who were treated with azithromycin at a dose of 10 to 20 mg/ml for 5 to 7 days were analyzed. Treatment was successful in 195 of 214 (91%) patients, with no significant difference in response (cure rate, fever clearance time) with MICs ranging from 4 to 16 μg/ml. The proportion of Asian enteric fever isolates with an MIC of ≤16 μg/ml was 1,452/1,460 (99.5%; 95% confidence interval [CI], 98.9 to 99.7) for S. Typhi and 207/240 (86.3%; 95% CI, 81.2 to 90.3) (P< 0.001) for S. Paratyphi A. A zone size of ≥13 mm to a 5-μg azithromycin disk identified S. Typhi isolates with an MIC of ≤16 μg/ml with a sensitivity of 99.7%. An azithromycin MIC of ≤16 μg/ml or disk inhibition zone size of ≥13 mm enabled the detection of susceptible S. Typhi isolates that respond to azithromycin treatment. Further work is needed to define the response to treatment in S. Typhi isolates with an azithromycin MIC of >16 μg/ml and to determine MIC and disk breakpoints for S. Paratyphi A.
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- 2015
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114. International Advisory Board
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Akroush, Maisam Waid, Al-Heresh, Ala', Al-Majali, Mohammad Radwan, Amin, Robed, Andrews, M A, Bhat, Raghavendra, Bhosle, Deepak, Chauhan, Vivek, Chowdhury, Abdul Jalil, Dalus, D, Ghose, Aniruddha, Gnanathasan, Christeine Ariaranee, Gowda, Ambanna, Kakrani, A L, Mohan, Alladi, Mukhopadhyay, Jotideb, Prabhu, E, Ravindran, T., Selvam, M.D., and Uthman, I.
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- 2018
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115. Reproducible diagnostic metabolites in plasma from typhoid fever patients in Asia and Africa
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Näsström, Elin, Parry, Christopher M, Vu Thieu, Nga Tran, Maude, Rapeephan R, De Jong, Hanna K, Fukushima, Masako, Rzhepishevska, Olena, Marks, Florian, Panzner, Ursula, Im, Justin, Jeon, Hyonjin, Park, Seeun, Chaudhury, Zabeen, Ghose, Aniruddha, Samad, Rasheda, Van, Tan Trinh, Johansson, Anders, Dondorp, Arjen M, Thwaites, Guy E, Faiz, Abul, Antti, Henrik, and Baker, Stephen
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Bangladesh ,infectious disease ,microbiology ,biomarkers ,Salmonella typhi ,bacterial infections and mycoses ,complex mixtures ,two-dimensional gas chromatography ,Mass Spectrometry ,Senegal ,3. Good health ,Plasma ,diagnostics ,Metabolomics ,biochemistry ,Humans ,Typhoid Fever ,S. enterica serovar typhi - Abstract
Salmonella Typhi is the causative agent of typhoid. Typhoid is diagnosed by blood culture, a method that lacks sensitivity, portability and speed. We have previously shown that specific metabolomic profiles can be detected in the blood of typhoid patients from Nepal (Näsström et al., 2014). Here, we performed mass spectrometry on plasma from Bangladeshi and Senegalese patients with culture confirmed typhoid fever, clinically suspected typhoid, and other febrile diseases including malaria. After applying supervised pattern recognition modelling, we could significantly distinguish metabolite profiles in plasma from the culture confirmed typhoid patients. After comparing the direction of change and degree of multivariate significance, we identified 24 metabolites that were consistently up- or down regulated in a further Bangladeshi/Senegalese validation cohort, and the Nepali cohort from our previous work. We have identified and validated a metabolite panel that can distinguish typhoid from other febrile diseases, providing a new approach for typhoid diagnostics.
116. An evaluation of purified Salmonella Typhi protein antigens for the serological diagnosis of acute typhoid fever
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Tran Vu Thieu, Nga, Trinh Van, Tan, Tran Tuan, Anh, Klemm, Elizabeth J, Nguyen Ngoc Minh, Chau, Voong Vinh, Phat, Pham Thanh, Duy, Ho Ngoc Dan, Thanh, Pham Duc, Trung, Langat, Pinky, Martin, Laura B, Galan, Jorge, Liang, Li, Felgner, Philip L, Davies, D Huw, De Jong, Hanna K, Maude, Rapeephan R, Fukushima, Masako, Wijedoru, Lalith, Ghose, Aniruddha, Samad, Rasheda, Dondorp, Arjen M, Faiz, Abul, Darton, Thomas C, Pollard, Andrew J, Thwaites, Guy E, Dougan, Gordon, Parry, Christopher M, and Baker, Stephen
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Bangladesh ,Antigens, Bacterial ,Bacteriological Techniques ,IgM ,Febrile disease ,Polysaccharides, Bacterial ,Enteric fever ,Salmonella typhi ,bacterial infections and mycoses ,complex mixtures ,Antibodies, Bacterial ,3. Good health ,Immunoglobulin M ,Humans ,Typhoid Fever ,Diagnostics ,Vi polysaccharide - Abstract
OBJECTIVES: The diagnosis of typhoid fever is a challenge. Aiming to develop a typhoid diagnostic we measured antibody responses against Salmonella Typhi (S. Typhi) protein antigens and the Vi polysaccharide in a cohort of Bangladeshi febrile patients. METHODS: IgM against 12 purified antigens and the Vi polysaccharide was measured by ELISA in plasma from patients with confirmed typhoid fever (n = 32), other confirmed infections (n = 17), and healthy controls (n = 40). ELISAs with the most specific antigens were performed on plasma from 243 patients with undiagnosed febrile disease. RESULTS: IgM against the S. Typhi protein antigens correlated with each other (rho > 0.8), but not against Vi (rho < 0.6). Typhoid patients exhibited higher IgM against 11/12 protein antigens and Vi than healthy controls and those with other infections. Vi, PilL, and CdtB exhibited the greatest sensitivity and specificity. Specificity and sensitivity was improved when Vi was combined with a protein antigen, generating sensitivities and specificities of 0.80 and >0.85, respectively. Applying a dynamic cut-off to patients with undiagnosed febrile disease suggested that 34-58% had an IgM response indicative of typhoid. CONCLUSIONS: We evaluated the diagnostic potential of several S. Typhi antigens; our assays give good sensitivity and specificity, but require further assessment in differing patient populations.
117. Diagnostic accuracy of the InBios Scrub Typhus DetectTM ELISA for the detection of igm antibodies in Chittagong, Bangladesh
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Blacksell, Stuart D., Kingston, Hugh W. F., Tanganuchitcharnchai, Ampai, Phanichkrivalkosil, Meghna, Hossain, Mosharraf, Hossain, Amir, Ghose, Aniruddha, Leopold, Stije J., Dondorp, Arjen M., Day, Nicholas P. J., and Paris, Daniel H.
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3. Good health
118. Rickettsial illnesses as important causes of febrile illness in Chittagong, Bangladesh
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Kingston, Hugh W., Hossain, Mosharraf, Leopold, Stije, Anantatat, Tippawan, Tanganuchitcharnchai, Ampai, Sinha, Ipsita, Plewes, Katherine, Maude, Richard J., Chowdhury, M. A. Hassan, Paul, Sujat, Uddin, Rabiul Alam Mohammed Erfan, Siddiqui, Mohammed Abu Naser, Zahed, Abu Shahed, Abu Sayeed, Abdullah, Rahman, Mohammed Habibur, Barua, Anupam, Uddin, Mohammed Jasim, Sattar, Mohammed Abdus, Dondorp, Arjen M., Blacksell, Stuart D., Day, Nicholas P. J., Ghose, Aniruddha, Hossain, Amir, and Paris, Daniel H.
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3. Good health
119. Cell-free hemoglobin mediated oxidative stress is associated with acute kidney injury and renal replacement therapy in severe falciparum malaria: an observational study
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Plewes, Katherine, Kingston, Hugh W, Ghose, Aniruddha, Maude, Richard J, Herdman, M. T, Leopold, Stije J, Ishioka, Haruhiko, Hasan, Md. M U, Haider, Md. S, Alam, Shamsul, Piera, Kim A, Charunwatthana, Prakaykaew, Silamut, Kamolrat, Yeo, Tsin W, Faiz, Md. A, Lee, Sue J, Mukaka, Mavuto, Turner, Gareth D, Anstey, Nicholas M, Jackson Roberts, L., White, Nicholas J, Day, Nicholas P, Hossain, Md. A, and Dondorp, Arjen M
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3. Good health - Abstract
Background Intravascular hemolysis is an intrinsic feature of severe malaria pathophysiology but the pathogenic role of cell-free hemoglobin-mediated oxidative stress in severe malaria associated acute kidney injury (AKI) is unknown. Methods As part of a prospective observational study, enrolment plasma cell-free hemoglobin (CFH), lipid peroxidation markers (F₂-isoprostanes (F₂-IsoPs) and isofurans (IsoFs)), red cell deformability, and serum creatinine were quantified in Bangladeshi patients with severe falciparum malaria (n = 107), uncomplicated malaria (n = 80) and sepsis (n = 28). The relationships between these indices and kidney function and clinical outcomes were examined. Results AKI was diagnosed at enrolment in 58% (62/107) of consecutive patients with severe malaria, defined by an increase in creatinine ≥1.5 times expected baseline. Severe malaria patients with AKI had significantly higher plasma cell-free hemoglobin (geometric mean CFH: 8.8 μM; 95% CI, 6.2–12.3 μM), F₂-isoprostane (56.7 pg/ml; 95% CI, 45.3–71.0 pg/ml) and isofuran (109.2 pg/ml; 95% CI, 85.1–140.1 pg/ml) concentrations on enrolment compared to those without AKI (CFH: 5.1 μM; 95% CI, 4.0–6.6 μM; P = 0.018; F2-IsoPs: 27.8 pg/ml; 95% CI, 23.7–32.7 pg/ml; P < 0.001; IsoFs: 41.7 pg/ml; 95% CI, 30.2–57.6 pg/ml; P < 0.001). Cell-free hemoglobin correlated with markers of hemolysis, parasite burden (P. falciparum histidine rich protein 2 (PfHRP2)), and F₂-IsoPs. Plasma F₂-IsoPs and IsoFs inversely correlated with pH, positively correlated with creatinine, PfHRP2 and fractional excretion of sodium, and were higher in patients later requiring hemodialysis. Plasma F₂-IsoP concentrations also inversely correlated with red cell deformability and were higher in fatal cases. Mixed effects modeling including an interaction term for CFH and time showed that F₂-IsoPs, IsoFs, PfHRP2, CFH, and red cell rigidity were independently associated with increasing creatinine over 72 h. Multivariable logistic regression showed that admission F₂-IsoPs, IsoFs and red cell deformability were associated with the need for subsequent hemodialysis. Conclusions Cell-free hemoglobin and lipid peroxidation are associated with acute kidney injury and disease severity in falciparum malaria, suggesting a pathophysiological role in renal tubular injury. Evaluation of adjunctive therapies targeting cell-free hemoglobin-mediated oxidative stress is warranted.
120. CMCH and MORU: A Highly Successful Collaboration
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Maude, Richard J, primary, Yunus, Emran Bin, primary, Hoque, Md Gofranul, primary, Hassan, Md Mahtab Uddin, primary, Hossain, Md Amir, primary, Samad, Rasheda, primary, Rahman, Ridwanur, primary, Ghose, Aniruddha, primary, Day, Nicholas P, primary, White, Nicholas J, primary, Dondorp, Arjen M, primary, and Faiz, M Abul, primary
- Published
- 1970
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121. Measuring the Plasmodium falciparumHRP2 protein in blood from artesunate-treated malaria patients predicts post-artesunate delayed hemolysis
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Ndour, Papa Alioune, Larréché, Sébastien, Mouri, Oussama, Argy, Nicolas, Gay, Frédérick, Roussel, Camille, Jauréguiberry, Stéphane, Perillaud, Claire, Langui, Dominique, Biligui, Sylvestre, Chartrel, Nathalie, Mérens, Audrey, Kendjo, Eric, Ghose, Aniruddha, Hassan, Md. Mahtab Uddin, Hossain, Md. Amir, Kingston, Hugh W. F., Plewes, Katherine, Dondorp, Arjen M., Danis, Martin, Houzé, Sandrine, Bonnefoy, Serge, Thellier, Marc, Woodrow, Charles J., and Buffet, Pierre A.
- Abstract
Previously parasitized erythrocytes in patients with severe malaria retain the parasite protein HRP2, which can be used to predict hemolysis induced by the drug artesunate.
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- 2017
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122. Erratum for Parry et al., Clinically and Microbiologically Derived Azithromycin Susceptibility Breakpoints for Salmonella entericaSerovars Typhi and Paratyphi A
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Parry, Christopher M., Thieu, Nga Tran Vu, Dolecek, Christiane, Karkey, Abhilasha, Gupta, Ruchi, Turner, Paul, Dance, David, Maude, Rapeephan R., Ha, Vinh, Tran, Chinh Nguyen, Thi, Phuong Le, Be, Bay Pham Van, Phi, La Tran Thi, Ngoc, Rang Nguyen, Ghose, Aniruddha, Dongol, Sabina, Campbell, James I., Thanh, Duy Pham, Thanh, Tuyen Ha, Moore, Catrin E., Sona, Soeng, Gaind, Rajni, Deb, Monorama, Anh, Ho Van, Van, Sach Nguyen, Tinh, Hien Tran, Day, Nicholas P. J., Dondorp, Arjen, Thwaites, Guy, Faiz, Mohamed Abul, Phetsouvanh, Rattanaphone, Newton, Paul, Basnyat, Buddha, Farrar, Jeremy J., and Baker, Stephen
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- 2015
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123. Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?
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Inglis R, Leaver M, Pell C, Ahmad S, Akter S, Bhuia FIA, Ansary M, B S S, Begum M, Chakraborty SR, Chowdhury H, Chowdhury MAR, Deb P, Akhter Farzana N, Ghose A, Harun Or Roshid M, Hoque Tipu MR, Hosain S, Hossain MM, Moinul Islam M, Kumar Tirupakuzhi Vijayaraghavan B, Mohsin M, Mund M, Nasrin S, Kumar Nath R, Nayak S, Pani N, Ahmmad Sarker S, Dondorp A, Tripathy S, and Faiz MA
- Abstract
Patients' experiences in the intensive care unit (ICU) can enhance or impair their subsequent recovery. Improving patient and family experiences on the ICU is an important part of providing high quality care. There is little evidence to guide how to do this in a South Asian critical care context. This study addresses this gap by exploring the experiences of critically ill patients and their families in ICUs in Bangladesh and India. We elicit suggestions for improvements from patients, families and staff and highlight examples of practices that support person-centred care. This multi-site hospital ethnography was carried out in five ICUs in government hospitals in Bangladesh and India, selected using purposive sampling. Qualitative data were collected using non-participant observation and semi-structured interviews and analysed using reflexive thematic analysis. A total of 108 interviews were conducted with patients, families, and ICU staff. Over 1000 hours of observation were carried out across the five study sites. We identified important mediators of patient and family experience that span many different aspects of care. Factors that promote person-centred care include access to ICU for families, support for family involvement in care delivery, clear communication with patients and families, good symptom management for patients, support for rehabilitation, and measures to address the physical, environmental and financial needs of the family. This study has generated a list of recommendations that can be used by policy makers and practitioners who wish to implement person-centred principles in the ICU., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Inglis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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124. Lessons from the field: compound-specific management in acute pesticide poisoning.
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Verma VR, Lamb T, Sattar MA, Ghose A, and Eddleston M
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- Humans, Bangladesh, Female, Poisoning therapy, Male, Adult, Adolescent, Child, Quality Improvement, Acute Disease, Young Adult, Pesticides poisoning
- Abstract
Pesticide poisoning is a common medical emergency in the rural tropics, with significant associated mortality. Pesticide poisoning is an umbrella term that encompasses a wide variety of substances with differing clinical toxidromes and outcomes. Despite this, confirmation of the specific compound ingested is rarely performed. In this Lessons from the Field, we argue that pesticide-specific management is integral to optimise management. Using data from a quality improvement project in Chittagong, Bangladesh, we demonstrate that identifying the specific compound is possible in most patients through careful history taking and examination of the pesticide bottle. Identification of the specific compound is essential for anticipating and reducing complications, administering appropriate and timely management and reducing the length of hospital stay and cost of unnecessary medical intervention., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)
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- 2024
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125. Combining species distribution models and big datasets may provide finer assessments of snakebite impacts.
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Chowdhury MAW, Müller J, Ghose A, Amin R, Sayeed AA, Kuch U, and Faiz MA
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- Humans, Bangladesh epidemiology, Male, Female, Animals, Adult, Adolescent, Seasons, Young Adult, Middle Aged, Child, Child, Preschool, Incidence, Snake Bites epidemiology
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Background: Snakebite is a major poverty-related neglected tropical disease. An integrated scientific approach is needed to understand the dynamics of this important health issue. Our objective was to estimate snakebite occurrence in a tropical area by using a blend of ecological modelling and robust statistical analysis., Methods: The present study used climatic, environmental, and human population density data to determine the area with snakebite occurrence-probability for the first time in Bangladesh. We also analysed a large, 16-year dataset of hospitalized snakebite cases to reveal the epidemiology of snakebite in the south-eastern zone of the country., Findings: Our results show that cobra bite is the most commonly occurring venomous snakebite in humans (around ~12% of the total yearly snakebite records), and men are more frequently bitten than women (2/3 of human victims are men). Most bites occur during the rainy season for cobra and green pit viper, while krait bites are not restricted to any particular season. As snakebite incidents are closely related to climate conditions, we can model snakebite risk using temperature and precipitation variables. Whereas there is a lack of snakebite reports from several parts of the study area in official records, our models predict that the entire study area is favourable for snakebite incidents. Based on the combined evidence we estimate that about 200,000 snakebite events occur every year in the south-eastern part of Bangladesh alone. Considering future global climate change, our model projections show that snakebite incidence in Bangladesh might not significantly decrease in the future (- 2070-); however, the distribution of probabilities might change, with a predicted increase of snakebite incidence in the hilly areas of the country., Conclusions: Using climatic data to predict snakebite incidence in Bangladesh allowed us to provide estimations of the total annual number of snakebite cases in the study area. As in most countries, the scarcity of accurate epidemiological data in official records might have masked the real magnitude of this problem. Our analysis suggests that the problem of snakebite envenoming in Bangladesh might be worse than currently perceived. A long-term sustainable snakebite program plan should be designed and institutionalized, considering climatic, geographical and human demographic variables, to obtain better data and facilitate the implementation of accurate snakebite management programs for this country., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chowdhury et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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126. Personalized mechanical ventilation guided by ultrasound in patients with acute respiratory distress syndrome (PEGASUS): study protocol for an international randomized clinical trial.
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Sinnige JS, Smit MR, Ghose A, de Grooth HJ, Itenov TS, Ischaki E, Laffey J, Paulus F, Póvoa P, Pierrakos C, Pisani L, Roca O, Schultz MJ, Szuldrzynski K, Tuinman PR, Zimatore C, and Bos LDJ
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- Humans, Treatment Outcome, Time Factors, Multicenter Studies as Topic, Predictive Value of Tests, Precision Medicine methods, Respiratory Distress Syndrome therapy, Respiratory Distress Syndrome diagnostic imaging, Respiratory Distress Syndrome mortality, Respiration, Artificial methods, Randomized Controlled Trials as Topic, Lung diagnostic imaging, Lung physiopathology, Ultrasonography, Interventional methods
- Abstract
Background: Acute respiratory distress syndrome (ARDS) is a frequent cause of hypoxemic respiratory failure with a mortality rate of approximately 30%. Identifying ARDS subphenotypes based on "focal" or "non-focal" lung morphology has the potential to better target mechanical ventilation strategies of individual patients. However, classifying morphology through chest radiography or computed tomography is either inaccurate or impractical. Lung ultrasound (LUS) is a non-invasive bedside tool that can accurately distinguish "focal" from "non-focal" lung morphology. We hypothesize that LUS-guided personalized mechanical ventilation in ARDS patients leads to a reduction in 90-day mortality compared to conventional mechanical ventilation., Methods: The Personalized Mechanical Ventilation Guided by UltraSound in Patients with Acute Respiratory Distress Syndrome (PEGASUS) study is an investigator-initiated, international, randomized clinical trial (RCT) that plans to enroll 538 invasively ventilated adult intensive care unit (ICU) patients with moderate to severe ARDS. Eligible patients will receive a LUS exam to classify lung morphology as "focal" or "non-focal". Thereafter, patients will be randomized within 12 h after ARDS diagnosis to receive standard care or personalized ventilation where the ventilation strategy is adjusted to the morphology subphenotype, i.e., higher positive end-expiratory pressure (PEEP) and recruitment maneuvers for "non-focal" ARDS and lower PEEP and prone positioning for "focal" ARDS. The primary endpoint is all-cause mortality at day 90. Secondary outcomes are mortality at day 28, ventilator-free days at day 28, ICU length of stay, ICU mortality, hospital length of stay, hospital mortality, and number of complications (ventilator-associated pneumonia, pneumothorax, and need for rescue therapy). After a pilot phase of 80 patients, the correct interpretation of LUS images and correct application of the intervention within the safe limits of mechanical ventilation will be evaluated., Discussion: PEGASUS is the first RCT that compares LUS-guided personalized mechanical ventilation with conventional ventilation in invasively ventilated patients with moderate and severe ARDS. If this study demonstrates that personalized ventilation guided by LUS can improve the outcomes of ARDS patients, it has the potential to shift the existing one-size-fits-all ventilation strategy towards a more individualized approach., Trial Registration: The PEGASUS trial was registered before the inclusion of the first patient, https://clinicaltrials.gov/ (ID: NCT05492344)., (© 2024. The Author(s).)
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- 2024
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127. Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study.
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McLarty J, Litton E, Beane A, Aryal D, Bailey M, Bendel S, Burghi G, Christensen S, Christiansen CF, Dongelmans DA, Fernandez AL, Ghose A, Hall R, Haniffa R, Hashmi M, Hashimoto S, Ichihara N, Kumar Tirupakuzhi Vijayaraghavan B, Lone NI, Arias López MDP, Mat Nor MB, Okamoto H, Priyadarshani D, Reinikainen M, Soares M, Pilcher D, and Salluh J
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- Humans, Retrospective Studies, Critical Care methods, Intensive Care Units, Registries, Pandemics, COVID-19 epidemiology, COVID-19 therapy
- Abstract
Background: The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment., Methods: We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry., Findings: Among 1 642 632 non-COVID-19 admissions, there was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes., Interpretation: Increased ICU mortality occurred among non-COVID-19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles., Competing Interests: Competing interests: DP and Dr EL are members of the Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resources Evaluation management committee. AB is funded by Wellcome. JS and MS are cofounders and shareholders of Epimed Solutions, a healthcare cloud-based analytics company. They are also supported in part by individual research grants from CNPq and FAPERJ. SB is the current chair, and MR is the past chair of the Finnish Intensive Care Consortium (both unpaid). DAD is unpaid chair of NICE foundation. NI's primary affiliation is the Department of Healthcare Quality Assessment, which is a social collaboration department at the University of Tokyo supported by National Clinical Database, Johnson & Johnson K.K., and Nipro corporation. BKTV is the National Coordinator for the Indian Registry of IntenSive care (IRIS) and is supported for 0.5 FTE by funding from the Wellcome Trust, UK. The remaining authors have no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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128. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units.
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Rashan A, Beane A, Ghose A, Dondorp AM, Kwizera A, Vijayaraghavan BKT, Biccard B, Righy C, Thwaites CL, Pell C, Sendagire C, Thomson D, Done DG, Aryal D, Wagstaff D, Nadia F, Putoto G, Panaru H, Udayanga I, Amuasi J, Salluh J, Gokhale K, Nirantharakumar K, Pisani L, Hashmi M, Schultz M, Ghalib MS, Mukaka M, Mat-Nor MB, Siaw-Frimpong M, Surenthirakumaran R, Haniffa R, Kaddu RP, Pereira SP, Murthy S, Harris S, Moonesinghe SR, Vengadasalam S, Tripathy S, Gooden TE, Tolppa T, Pari V, Waweru-Siika W, and Minh YL
- Abstract
Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes., Methods: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be led by local stakeholders, performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam., Conclusions: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 The Collaboration for Research, Implementation and Training in Critical Care in Asia and Africa (CCAA) et al.)
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- 2023
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129. Survey on sea snakebite and related morbidity and mortality among Bangladeshi fishermen in the Bay of Bengal: A pilot study.
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Ghose A, Alam MS, Abu Sayeed A, Shah Jahan M, Akter F, Md Erfan Uddin RA, Sarkar S, Zahed ASM, Das KK, Rahman MH, Rashid R, Nasrin H, Dutta AK, Khan MI, Kuch U, and Faiz MA
- Abstract
Around two million people are engaged in marine fishing in the Bay of Bengal. Bites by sea snakes were common hazards feared by millions fishing at sea in earlier days. Current morbidity and mortality are also not known. This study was conducted to document and describe sea snake bites among selected communities of sea-going fishermen in Bangladesh. A questionnaire-based cross-sectional survey was conducted from May to October 2019 among three communities of sea-going fishermen living along the coast of the Bay of Bengal in Cox's Bazar district. Fishermen were first asked by trained interviewers to recall any sea snakebites to themselves and among their fellows on board within the last year, then within the last 5 years and at any time before that. For any bite, related information including outcome was noted. Overall, 25.4% of respondents (62 out of 244) had been bitten by sea-snakes. Mean age was 37.6(±14) years; all males. 51.6% received some sort of treatment locally; 71% hot compress and 48% tourniquets. In 80.6% the affected limb was not immobilized. The bitten site was incised in 29%. 22.6% received treatment from traditional healers, 48.4% from local hospitals, 29% from district hospital. Six victims (9.7%) suffered from severe life-threatening consequences of the sea snakebite but none died. 32% of the fishermen had seen the offending snake. Sea snakebites are potentially dangerous; therefore, educating fishermen to avoid contact with sea snakes would dramatically reduce the incidence of sea snakebites. Most bites are treated initially by local measures which are often not scientific. Provision of proper first aid and treatment might reduce mortality and morbidity. A larger survey on sea snake bites among the fishermen in all coastal areas of Bangladesh is needed to determine the nationwide burden of morbidity and mortality related to sea snakebite., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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- 2023
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130. Evaluation of the properties of Bungarus caeruleus venom and checking the efficacy of antivenom used in Bangladesh for its bite treatment.
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Alam MJ, Maruf MMH, Iqbal MA, Hasan M, Sohan MSR, Shariar MR, Haidar IKA, Chowdhury MAW, Ghose A, Hoque KMF, and Reza MA
- Abstract
As a disaster-prone country with unique geographical features, snake biting is a major public health concern in Bangladesh. The primary reasons of mortality from snakebite include late presentation to the hospital, low efficacy of antivenom, and a lack of adequate management facilities. Because snake venom characteristics vary depending on geographical location, antivenom should be manufactured from snakes native to the region in which it would be administered. Bungarus caeruleus is a highly venomous snake contributing to the major snakebite issue in Bangladesh. Therefore, the neutralization efficacy of the antivenom against B. caeruleus venom was evaluated in the current study along with the characterization of venom. For biological characterization of venom, RP-HPLC and SDS-PAGE profiling, hemolytic activity, hemorrhagic activity, phospholipases A
2 (PLA2 ) activity, edema inducing activity and histopathological observations were carried out following standard protocol. LD50 of the venom was calculated along with neutralization potency of Incepta antivenom through probit analysis. Results showed that venom possesses phospholipase A2 activity, hemolytic activity and edema inducing activity while hemorrhagic activity was absent in the skin of envenomed mice. Histopathological alterations including necrosis, congestion and infiltrations were observed in envenomed mice organs after hematoxylin and eosin staining. Neutralization study showed that Incepta polyvalent antivenom could neutralize (potency 0.53 mg/ml) the lethal effect in in vitro study on mice. Further investigation on snakebite epidemiology and clinical observations of the envenomed patients will help in combating the snakebite problem more efficiently., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)- Published
- 2023
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131. Performance evaluation of a multinational data platform for critical care in Asia.
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Pisani L, Rashan T, Shamal M, Ghose A, Kumar Tirupakuzhi Vijayaraghavan B, Tripathy S, Aryal D, Hashmi M, Nor B, Lam Minh Y, Dondorp AM, Haniffa R, and Beane A
- Abstract
Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries of critically ill patients established in seven Asian low- and middle-income countries (LMICs). Methods: The Critical Care Asia federated registry platform enables ICUs to collect clinical, outcome and process data for aggregate and unit-level analysis. The evaluation used the standardised criteria of the Directory of Clinical Databases (DoCDat) and a framework for data quality assurance in medical registries. Six reviewers assessed structure, coverage, reliability and validity of the ICU registry data. Case mix and process measures on patient episodes from June to December 2020 were analysed. Results: Data on 20,507 consecutive patient episodes from 97 ICUs in Afghanistan, Bangladesh, India, Malaysia, Nepal, Pakistan and Vietnam were included. The quality level achieved according to the ten prespecified DoCDat criteria was high (average score 3.4 out of 4) as was the structural and organizational performance -- comparable to ICU registries in high-income countries. Identified strengths were types of variables included, reliability of coding, data completeness and validation. Potential improvements included extension of national coverage, optimization of recruitment completeness validation in all centers and the use of interobserver reliability checks. Conclusions: The Critical Care Asia platform evaluates well using standardised frameworks for data quality and equally to registries in resource-rich settings., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 Collaboration for Research, Implementation and Training in Critical Care - Asia Investigators et al.)
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- 2022
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132. Field evaluation of the diagnostic performance of EasyScan GO: a digital malaria microscopy device based on machine-learning.
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Das D, Vongpromek R, Assawariyathipat T, Srinamon K, Kennon K, Stepniewska K, Ghose A, Sayeed AA, Faiz MA, Netto RLA, Siqueira A, Yerbanga SR, Ouédraogo JB, Callery JJ, Peto TJ, Tripura R, Koukouikila-Koussounda F, Ntoumi F, Ong'echa JM, Ogutu B, Ghimire P, Marfurt J, Ley B, Seck A, Ndiaye M, Moodley B, Sun LM, Archasuksan L, Proux S, Nsobya SL, Rosenthal PJ, Horning MP, McGuire SK, Mehanian C, Burkot S, Delahunt CB, Bachman C, Price RN, Dondorp AM, Chappuis F, Guérin PJ, and Dhorda M
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- Diagnostic Tests, Routine methods, Humans, Machine Learning, Microscopy methods, Parasitemia diagnosis, Parasitemia parasitology, Plasmodium falciparum, Reproducibility of Results, Sensitivity and Specificity, Malaria diagnosis, Malaria parasitology, Malaria, Falciparum parasitology
- Abstract
Background: Microscopic examination of Giemsa-stained blood films remains the reference standard for malaria parasite detection and quantification, but is undermined by difficulties in ensuring high-quality manual reading and inter-reader reliability. Automated parasite detection and quantification may address this issue., Methods: A multi-centre, observational study was conducted during 2018 and 2019 at 11 sites to assess the performance of the EasyScan Go, a microscopy device employing machine-learning-based image analysis. Sensitivity, specificity, accuracy of species detection and parasite density estimation were assessed with expert microscopy as the reference. Intra- and inter-device reliability of the device was also evaluated by comparing results from repeat reads on the same and two different devices. This study has been reported in accordance with the Standards for Reporting Diagnostic accuracy studies (STARD) checklist., Results: In total, 2250 Giemsa-stained blood films were prepared and read independently by expert microscopists and the EasyScan Go device. The diagnostic sensitivity of EasyScan Go was 91.1% (95% CI 88.9-92.7), and specificity 75.6% (95% CI 73.1-78.0). With good quality slides sensitivity was similar (89.1%, 95%CI 86.2-91.5), but specificity increased to 85.1% (95%CI 82.6-87.4). Sensitivity increased with parasitaemia rising from 57% at < 200 parasite/µL, to ≥ 90% at > 200-200,000 parasite/µL. Species were identified accurately in 93% of Plasmodium falciparum samples (kappa = 0.76, 95% CI 0.69-0.83), and in 92% of Plasmodium vivax samples (kappa = 0.73, 95% CI 0.66-0.80). Parasite density estimates by the EasyScan Go were within ± 25% of the microscopic reference counts in 23% of slides., Conclusions: The performance of the EasyScan Go in parasite detection and species identification accuracy fulfil WHO-TDR Research Malaria Microscopy competence level 2 criteria. In terms of parasite quantification and false positive rate, it meets the level 4 WHO-TDR Research Malaria Microscopy criteria. All performance parameters were significantly affected by slide quality. Further software improvement is required to improve sensitivity at low parasitaemia and parasite density estimations. Trial registration ClinicalTrials.gov number NCT03512678., (© 2022. The Author(s).)
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- 2022
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133. Performance evaluation of a multinational data platform for critical care in Asia.
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Pisani L, Rashan T, Shamal M, Ghose A, Kumar Tirupakuzhi Vijayaraghavan B, Tripathy S, Aryal D, Hashmi M, Nor B, Lam Minh Y, Dondorp AM, Haniffa R, and Beane A
- Abstract
Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries of critically ill patients established in seven Asian low- and middle-income countries (LMICs). Methods: The Critical Care Asia federated registry platform enables ICUs to collect clinical, outcome and process data for aggregate and unit-level analysis. The evaluation used the standardised criteria of the Directory of Clinical Databases (DoCDat) and a framework for data quality assurance in medical registries. Six reviewers assessed structure, coverage, reliability and validity of the ICU registry data. Case mix and process measures on patient episodes from June to December 2020 were analysed. Results: Data on 20,507 consecutive patient episodes from 97 ICUs in Afghanistan, Bangladesh, India, Malaysia, Nepal, Pakistan and Vietnam were included. The quality level achieved according to the ten prespecified DoCDat criteria was high (average score 3.4 out of 4) as was the structural and organizational performance -- comparable to ICU registries in high-income countries. Identified strengths were types of variables included, reliability of coding, data completeness and validation. Potential improvements included extension of national coverage, optimization of recruitment completeness validation in all centers and the use of interobserver reliability checks. Conclusions: The Critical Care Asia platform evaluates well using standardised frameworks for data quality and equally to registries in resource-rich settings., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Collaboration for Research, Implementation and Training in Critical Care - Asia Investigators et al.)
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- 2021
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134. Mapping the travel patterns of people with malaria in Bangladesh.
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Sinha I, Sayeed AA, Uddin D, Wesolowski A, Zaman SI, Faiz MA, Ghose A, Rahman MR, Islam A, Karim MJ, Saha A, Rezwan MK, Shamsuzzaman AKM, Jhora ST, Aktaruzzaman MM, Chang HH, Miotto O, Kwiatkowski D, Dondorp AM, Day NPJ, Hossain MA, Buckee C, and Maude RJ
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- Adolescent, Adult, Bangladesh, Female, Humans, India, Male, Prospective Studies, Young Adult, Malaria epidemiology, Travel trends
- Abstract
Background: Spread of malaria and antimalarial resistance through human movement present major threats to current goals to eliminate the disease. Bordering the Greater Mekong Subregion, southeast Bangladesh is a potentially important route of spread to India and beyond, but information on travel patterns in this area are lacking., Methods: Using a standardised short survey tool, 2090 patients with malaria were interviewed at 57 study sites in 2015-2016 about their demographics and travel patterns in the preceding 2 months., Results: Most travel was in the south of the study region between Cox's Bazar district (coastal region) to forested areas in Bandarban (31% by days and 45% by nights), forming a source-sink route. Less than 1% of travel reported was between the north and south forested areas of the study area. Farmers (21%) and students (19%) were the top two occupations recorded, with 67 and 47% reporting travel to the forest respectively. Males aged 25-49 years accounted for 43% of cases visiting forests but only 24% of the study population. Children did not travel. Women, forest dwellers and farmers did not travel beyond union boundaries. Military personnel travelled the furthest especially to remote forested areas., Conclusions: The approach demonstrated here provides a framework for identifying key traveller groups and their origins and destinations of travel in combination with knowledge of local epidemiology to inform malaria control and elimination efforts. Working with the NMEP, the findings were used to derive a set of policy recommendations to guide targeting of interventions for elimination.
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- 2020
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135. Acetaminophen as a Renoprotective Adjunctive Treatment in Patients With Severe and Moderately Severe Falciparum Malaria: A Randomized, Controlled, Open-Label Trial.
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Plewes K, Kingston HWF, Ghose A, Wattanakul T, Hassan MMU, Haider MS, Dutta PK, Islam MA, Alam S, Jahangir SM, Zahed ASM, Sattar MA, Chowdhury MAH, Herdman MT, Leopold SJ, Ishioka H, Piera KA, Charunwatthana P, Silamut K, Yeo TW, Lee SJ, Mukaka M, Maude RJ, Turner GDH, Faiz MA, Tarning J, Oates JA, Anstey NM, White NJ, Day NPJ, Hossain MA, Roberts Ii LJ, and Dondorp AM
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- Acetaminophen administration & dosage, Acetaminophen pharmacokinetics, Adolescent, Adult, Analgesics, Non-Narcotic administration & dosage, Analgesics, Non-Narcotic pharmacokinetics, Analgesics, Non-Narcotic therapeutic use, Antimalarials adverse effects, Antimalarials therapeutic use, Area Under Curve, Female, Humans, Male, Young Adult, Acetaminophen therapeutic use, Acute Kidney Injury chemically induced, Acute Kidney Injury prevention & control, Artesunate adverse effects, Artesunate therapeutic use, Malaria, Falciparum drug therapy
- Abstract
Background: Acute kidney injury independently predicts mortality in falciparum malaria. It is unknown whether acetaminophen's capacity to inhibit plasma hemoglobin-mediated oxidation is renoprotective in severe malaria., Methods: This phase 2, open-label, randomized controlled trial conducted at two hospitals in Bangladesh assessed effects on renal function, safety, pharmacokinetic (PK) properties and pharmacodynamic (PD) effects of acetaminophen. Febrile patients (>12 years) with severe falciparum malaria were randomly assigned to receive acetaminophen (1 g 6-hourly for 72 hours) or no acetaminophen, in addition to intravenous artesunate. Primary outcome was the proportional change in creatinine after 72 hours stratified by median plasma hemoglobin., Results: Between 2012 and 2014, 62 patients were randomly assigned to receive acetaminophen (n = 31) or no acetaminophen (n = 31). Median (interquartile range) reduction in creatinine after 72 hours was 23% (37% to 18%) in patients assigned to acetaminophen, versus 14% (29% to 0%) in patients assigned to no acetaminophen (P = .043). This difference in reduction was 37% (48% to 22%) versus 14% (30% to -71%) in patients with hemoglobin ≥45000 ng/mL (P = .010). The proportion with progressing kidney injury was higher among controls (subdistribution hazard ratio, 3.0; 95% confidence interval, 1.1 to 8.5; P = .034). PK-PD analyses showed that higher exposure to acetaminophen increased the probability of creatinine improvement. No patient fulfilled Hy's law for hepatotoxicity., Conclusions: In this proof-of-principle study, acetaminophen showed renoprotection without evidence of safety concerns in patients with severe falciparum malaria, particularly in those with prominent intravascular hemolysis., Clinical Trials Registration: NCT01641289.
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- 2018
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136. Diagnostic Accuracy of the InBios Scrub Typhus Detect™ ELISA for the Detection of IgM Antibodies in Chittagong, Bangladesh.
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Blacksell SD, Kingston HWF, Tanganuchitcharnchai A, Phanichkrivalkosil M, Hossain M, Hossain A, Ghose A, Leopold SJ, Dondorp AM, Day NPJ, and Paris DH
- Abstract
Here we estimated the accuracy of the InBios Scrub Typhus Detect™ immunoglobulin M (IgM) ELISA to determine the optimal optical density (OD) cut-off values for the diagnosis of scrub typhus. Patients with undifferentiated febrile illness from Chittagong, Bangladesh, provided samples for reference testing using (i) qPCR using the Orientia spp. 47-kDa htra gene, (ii) IFA ≥1:3200 on admission, (iii) immunofluorescence assay (IFA) ≥1:3200 on admission or 4-fold rise to ≥3200, and (iv) combination of PCR and IFA positivity. For sero-epidemiological purposes (ELISA vs. IFA ≥1:3200 on admission or 4-fold rise to ≥3200), the OD cut-off for admission samples was ≥1.25, resulting in a sensitivity (Sn) of 91.5 (95% confidence interval (95% CI: 96.8⁻82.5) and a specificity (Sp) of 92.4 (95% CI: 95.0⁻89.0), while for convalescent samples the OD cut-off was ≥1.50 with Sn of 66.0 (95% CI: 78.5⁻51.7) and Sp of 96.0 (95% CI: 98.3⁻92.3). Comparisons against comparator reference tests (ELISA vs. all tests including PCR) indicated the most appropriate cut-off OD to be within the range of 0.75⁻1.25. For admission samples, the best Sn/Sp compromise was at 1.25 OD (Sn 91.5%, Sp 92.4%) and for convalescent samples at 0.75 OD (Sn 69.8%, Sp 89.5%). A relatively high (stringent) diagnostic cut-off value provides increased diagnostic accuracy with high sensitivity and specificity in the majority of cases, while lowering the cut-off runs the risk of false positivity. This study underlines the need for regional assessment of new diagnostic tests according to the level of endemicity of the disease given the high levels of residual or cross-reacting antibodies in the general population.
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- 2018
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137. An evaluation of purified Salmonella Typhi protein antigens for the serological diagnosis of acute typhoid fever.
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Tran Vu Thieu N, Trinh Van T, Tran Tuan A, Klemm EJ, Nguyen Ngoc Minh C, Voong Vinh P, Pham Thanh D, Ho Ngoc Dan T, Pham Duc T, Langat P, Martin LB, Galan J, Liang L, Felgner PL, Davies DH, de Jong HK, Maude RR, Fukushima M, Wijedoru L, Ghose A, Samad R, Dondorp AM, Faiz A, Darton TC, Pollard AJ, Thwaites GE, Dougan G, Parry CM, and Baker S
- Subjects
- Bangladesh, Humans, Immunoglobulin M blood, Polysaccharides, Bacterial immunology, Typhoid Fever immunology, Antibodies, Bacterial blood, Antigens, Bacterial immunology, Bacteriological Techniques methods, Salmonella typhi immunology, Typhoid Fever diagnosis
- Abstract
Objectives: The diagnosis of typhoid fever is a challenge. Aiming to develop a typhoid diagnostic we measured antibody responses against Salmonella Typhi (S. Typhi) protein antigens and the Vi polysaccharide in a cohort of Bangladeshi febrile patients., Methods: IgM against 12 purified antigens and the Vi polysaccharide was measured by ELISA in plasma from patients with confirmed typhoid fever (n = 32), other confirmed infections (n = 17), and healthy controls (n = 40). ELISAs with the most specific antigens were performed on plasma from 243 patients with undiagnosed febrile disease., Results: IgM against the S. Typhi protein antigens correlated with each other (rho > 0.8), but not against Vi (rho < 0.6). Typhoid patients exhibited higher IgM against 11/12 protein antigens and Vi than healthy controls and those with other infections. Vi, PilL, and CdtB exhibited the greatest sensitivity and specificity. Specificity and sensitivity was improved when Vi was combined with a protein antigen, generating sensitivities and specificities of 0.80 and >0.85, respectively. Applying a dynamic cut-off to patients with undiagnosed febrile disease suggested that 34-58% had an IgM response indicative of typhoid., Conclusions: We evaluated the diagnostic potential of several S. Typhi antigens; our assays give good sensitivity and specificity, but require further assessment in differing patient populations., (Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2017
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138. The role of previously unmeasured organic acids in the pathogenesis of severe malaria.
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Herdman MT, Sriboonvorakul N, Leopold SJ, Douthwaite S, Mohanty S, Hassan MM, Maude RJ, Kingston HW, Plewes K, Charunwatthana P, Silamut K, Woodrow CJ, Ghose A, Chotinavich K, Hossain MA, Faiz MA, Mishra S, Leepipatpiboon N, White NJ, Day NP, Tarning J, and Dondorp AM
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- 3-Hydroxybutyric Acid blood, Acidosis complications, Adolescent, Adult, Aged, Chromatography, Liquid, Female, Humans, Hydroxybutyrates blood, Ketoglutaric Acids urine, Lactic Acid blood, Malaria, Falciparum blood, Malaria, Falciparum metabolism, Malaria, Falciparum mortality, Malaria, Falciparum urine, Male, Malonates urine, Mass Spectrometry, Methylmalonic Acid urine, Middle Aged, Phenylpropionates blood, Prospective Studies, Severity of Illness Index, Young Adult, Malaria, Falciparum etiology
- Abstract
Introduction: Severe falciparum malaria is commonly complicated by metabolic acidosis. Together with lactic acid (LA), other previously unmeasured acids have been implicated in the pathogenesis of falciparum malaria., Methods: In this prospective study, we characterised organic acids in adults with severe falciparum malaria in India and Bangladesh. Liquid chromatography-mass spectrometry was used to measure organic acids in plasma and urine. Patients were followed until recovery or death., Results: Patients with severe malaria (n=138), uncomplicated malaria (n=102), sepsis (n=32) and febrile encephalopathy (n=35) were included. Strong ion gap (mean ± SD) was elevated in severe malaria (8.2 mEq/L ± 4.5) and severe sepsis (8.6 mEq/L ± 7.7) compared with uncomplicated malaria (6.0 mEq/L ± 5.1) and encephalopathy (6.6 mEq/L ± 4.7). Compared with uncomplicated malaria, severe malaria was characterised by elevated plasma LA, hydroxyphenyllactic acid (HPLA), α-hydroxybutyric acid and β-hydroxybutyric acid (all P<0.05). In urine, concentrations of methylmalonic, ethylmalonic and α-ketoglutaric acids were also elevated. Multivariate logistic regression showed that plasma HPLA was a strong independent predictor of death (odds ratio [OR] 3.5, 95 % confidence interval [CI] 1.6-7.5, P=0.001), comparable to LA (OR 3.5, 95 % CI 1.5-7.8, P=0.003) (combined area under the receiver operating characteristic curve 0.81)., Conclusions: Newly identified acids, in addition to LA, are elevated in patients with severe malaria and are highly predictive of fatal outcome. Further characterisation of their sources and metabolic pathways is now needed.
- Published
- 2015
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139. CMCH and MORU: a Highly Successful Collaboration.
- Author
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Maude RJ, Yunus EB, Hoque G, Hassan MU, Hossain A, Samad R, Rahman R, Ghose A, Day NP, White NJ, Dondorp AM, and Faiz MA
- Abstract
Chittagong Medical College and Hospital (CMCH) in Chittagong, Bangladesh, and Mahidol-Oxford Tropical Medicine Research Unit (MORU) of Bangkok, Thailand, are partners in a highly successful and productive research collaboration that is now heading into its tenth year. It produced arguably one of the most important clinical trials in tropical medicine this decade, the South-East-Asia-Quinine-Artesuante-Malaria-Trial (SEAQUAMAT) study, and has continued to evolve and grow ever since. The collaboration has successfully completed a number of significant clinical studies which have given important new insights into the management and pathogenesis of malaria and, to date, generated 14 peer-reviewed international journal publications. With each passing year, the size of the collaboration continues to increase along with the number and complexity of research studies undertaken. It has also helped to provide valuable postgraduate training to develop clinical services and increase capacity for high quality research in Bangladesh. The partners have complementary knowledge, skills and expertise and share common goals and it is hoped that this will remain a highly successful collaboration long into the future., Competing Interests: Conflicts of interest None declared.
- Published
- 2010
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