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Article: The Outbreak of SARS-CoV-2 in a Medical Ward and Its Containment: An Experience From a Tertiary Care Centre in North India.

Begam, Nazneen N / Mondal, Saikat / Afroz, Eram / Das, Arghya / Biswas, Ashutosh / Wig, Naveet

2023 Volume 15, Issue 7, Page(s) e41795

Abstract: Background Periodic outbreaks of SARS-CoV-2 in hospital settings amidst the recent pandemic are well known. However, the timely control of such outbreaks was key to preventing morbidity among vulnerable patients as well as reducing sickness absenteeism ... ...

Abstract	Background Periodic outbreaks of SARS-CoV-2 in hospital settings amidst the recent pandemic are well known. However, the timely control of such outbreaks was key to preventing morbidity among vulnerable patients as well as reducing sickness absenteeism among healthcare workers. This is the first study of its kind in India. Methods An outbreak investigation was conducted between June 12 and July 18, 2020, at the All India Institute of Medical Sciences, New Delhi, India, during the first wave of COVID-19. Results A total of 27 individuals were infected during this time, including people visiting the hospital and healthcare workers. A thorough investigation led us to the epidemiological link between cases and allowed us to bring reforms to the existing hospital policy of screening and admission of COVID-19 patients and those suspected to have the infection. This experience helped us avoid future outbreaks during the second wave of COVID-19 in our hospital. Conclusion The SARS-CoV-2 virus is highly transmissible, especially in hospital settings due to the high burden of patients and close proximity between patients. Timely intervention is the key to effective control of hospital outbreaks, as it can avoid morbidity in patients and reduce sickness absenteeism among healthcare workers.
Language	English
Publishing date	2023-07-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.41795
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Article: Early Surgical Intervention Followed by Antifungals in Rhino-Orbital Mucormycosis in Patients With COVID-19 Favors Clinical Outcome: A Case Series.

Barman Roy, Debarchan / Gupta, Vandana / Biswas, Ashutosh / Verma, Mansi

Cureus

2021 Volume 13, Issue 8, Page(s) e17178

Abstract: Mucormycosis is an invasive fungal infection occurring in patients with or without preexisting medical illnesses. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal coinfections ... ...

Abstract	Mucormycosis is an invasive fungal infection occurring in patients with or without preexisting medical illnesses. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal coinfections among some COVID-19 patients with preexisting comorbid illnesses such as diabetes and hypertension, with mucormycosis being one of them. The management of this dreaded fungal infection demands early and prompt surgical intervention to thoroughly remove the infected tissue and necrotic material to reduce the tissue burden of this invasive organism. This should be accompanied by expeditious initiation of amphotericin B along with supportive therapy. Here we present five cases of rhino-orbital mucormycosis in patients with COVID-19, all of whom presented with orbital and facial swelling (three had symptoms of impending blindness) under the backdrop of COVID-19 symptoms in the form of intermittent fever and slight dyspnea. Our treatment strategy comprised an expeditious use of early surgical intervention and amphotericin B along with the control of cytokine storm and hyperglycemia. This treatment strategy eventually resulted in an improved clinical outcome.
Language	English
Publishing date	2021-08-14
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.17178
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Article ; Online: Arsenic intoxication with renal failure managed with hemodialysis alone: A case report.

Agarwal, Ayush / Kumar Kn, Santhosh / Jorwal, Pankaj / Quadri, Javed Ahsan / Gupta, Gaurav / Biswas, Ashutosh

Drug discoveries & therapeutics

2022 Volume 16, Issue 1, Page(s) 49–51

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 ... ...

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.
MeSH term(s)	Arsenic/toxicity ; COVID-19 ; Communicable Disease Control ; Female ; Humans ; Kidney Failure, Chronic/therapy ; Middle Aged ; Renal Dialysis ; Renal Insufficiency ; SARS-CoV-2
Chemical Substances	Arsenic (N712M78A8G)
Language	English
Publishing date	2022-03-09
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	2568828-5
ISSN	1881-784X ; 1881-784X
ISSN (online)	1881-784X
ISSN	1881-784X
DOI	10.5582/ddt.2021.01110
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Article: Central Line-Associated Bloodstream Infections: Effect of Patient and Pathogen Factors on Outcome.

Arunan, Bharathi / Ahmed, Nishat H / Kapil, Arti / Vikram, Naval K / Sinha, Sanjeev / Biswas, Ashutosh / Satpathy, Gita / Wig, Naveet

Journal of global infectious diseases

2023 Volume 15, Issue 2, Page(s) 59–65

Abstract: Introduction: Patients on central lines are often having multiple morbidities, and invasive devices provide a niche for biofilm formation, which makes central line-associated bloodstream infections (CLABSIs), a serious concern in health-care settings, ... ...

Abstract	Introduction: Patients on central lines are often having multiple morbidities, and invasive devices provide a niche for biofilm formation, which makes central line-associated bloodstream infections (CLABSIs), a serious concern in health-care settings, as the infections difficult to treat. In this study, we evaluated the common bacteria causing CLABSI, and various patient and pathogen factors affecting the clinical outcome. Methods: In the prospective observational study, patients diagnosed with CLABSI were recruited. Extensive clinical, microbiological, and other laboratory workup was done, and observations were recorded. Congo red agar method, tube test, and microtiter plate assay were used for eliciting the biofilm-forming attributes of the bacterial pathogens. Results: Klebsiella pneumoniae Conclusion: The study throws light on various host and pathogen factors determining the cause and outcome of CLABSI patients. To the best of our knowledge, this is the first study trying to decipher the role of biofilm formation in the virulence of pathogens and the prognosis of CLABSI.
Language	English
Publishing date	2023-05-31
Publishing country	India
Document type	Journal Article
ZDB-ID	2545454-7
ISSN	0974-8245 ; 0974-777X
ISSN (online)	0974-8245
ISSN	0974-777X
DOI	10.4103/jgid.jgid_213_22
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Article ; Online: Panophthalmitis in a patient with dengue fever.

Kumar, Vimal / Deorari, Vaibhav / Swaroop, Shekhar / Biswas, Ashutosh

BMJ case reports

2019 Volume 12, Issue 6

Abstract: Dengue fever is known for its life-threatening complications of bleeding and capillary leak syndrome. We report an unusual complication of dengue fever causing panophthalmitis, leading to rapidly progressive painful visual loss within days. Later on, the ...

Abstract	Dengue fever is known for its life-threatening complications of bleeding and capillary leak syndrome. We report an unusual complication of dengue fever causing panophthalmitis, leading to rapidly progressive painful visual loss within days. Later on, the patient developed secondary bacterial infection of the eyeball and developed multiple brain abscesses due to spread of infection from the eyeball. Culture from pus swab of the right eye grew
MeSH term(s)	Adult ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/therapeutic use ; Dengue/complications ; Dengue/diagnosis ; Dengue/diagnostic imaging ; Dengue/drug therapy ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Panophthalmitis/complications ; Panophthalmitis/diagnosis ; Panophthalmitis/diagnostic imaging ; Panophthalmitis/drug therapy ; Staphylococcal Infections/complications ; Staphylococcal Infections/diagnosis ; Staphylococcal Infections/diagnostic imaging ; Staphylococcal Infections/drug therapy ; Staphylococcus epidermidis/isolation & purification ; Vision, Low/etiology
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-06-03
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2019-229588
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Article ; Online: Case Report: Cardiac Tamponade in Dengue Hemorrhagic Fever: An Unusual Manifestation of a Common Disease.

Biswas, Sagnik / Kumar, Prabhat / Tansir, Ghazal / Biswas, Ashutosh

The American journal of tropical medicine and hygiene

2019 Volume 101, Issue 2, Page(s) 448–450

Abstract: Dengue hemorrhagic fever is one of the most commonly encountered mosquito-borne viral infections of humans worldwide with multiple reported outbreaks. Cardiac involvement is a known manifestation of the disease usually presenting as rhythm abnormalities, ...

Abstract	Dengue hemorrhagic fever is one of the most commonly encountered mosquito-borne viral infections of humans worldwide with multiple reported outbreaks. Cardiac involvement is a known manifestation of the disease usually presenting as rhythm abnormalities, myocarditis, or pericardial effusion, which may be clinically asymptomatic. We describe a case of a 30-year-old woman who presented to us with high-grade fever, headache, retro-orbital pain, generalized maculopapular rash with bilateral pleural effusion, and hypotension. Dengue non-structural protein 1 (NS1) antigen and IgM antibodies were positive on admission, supporting a diagnosis of dengue hemorrhagic fever. Cardiac troponin-I was elevated on admission (65 ng/L) with diffuse convex ST segment elevations on electrocardiogram, suggestive of possible myopericarditis. Echocardiogram on admission revealed minimal pericardial effusion with preserved ejection fraction. Despite administration of fluids and inotrope use, the patient's hypotension progressively deteriorated over the next 6 hours, associated with decreased urine output and worsening sensorium. Clinical examination revealed muffled heart sounds and raised jugular venous pressure. A repeat echocardiogram confirmed an increase in the pericardial effusion manifesting as cardiac tamponade. Ultrasound-guided pigtail catheter insertion led to a prompt removal of the excessive pericardial fluid and correction of hypotension. Early identification of this uncommon but important complication of dengue hemorrhagic fever led to a good outcome in our case.
MeSH term(s)	Adult ; Cardiac Tamponade/virology ; Female ; Fever/virology ; Humans ; Immunoglobulin M/blood ; Myocarditis/diagnosis ; Myocarditis/virology ; Pericarditis/diagnosis ; Pericarditis/virology ; Severe Dengue/complications ; Troponin I/blood ; Viral Nonstructural Proteins/genetics
Chemical Substances	Immunoglobulin M ; NS1 protein, dengue-1 virus ; Troponin I ; Viral Nonstructural Proteins
Language	English
Publishing date	2019-06-04
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.19-0153
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Article ; Online: Efficacy of Rifaximin in Patients With Abdominal Bloating or Distension: A Systematic Review and Meta-analysis.

Arora, Umang / Sachdeva, Karan / Garg, Prerna / Baitha, Upendra / Kedia, Saurabh / Kalaivani, Mani / Ahuja, Vineet / Kumar, Arvind / Ranjan, Piyush / Vikram, Naval K / Sinha, Sanjeev / Biswas, Ashutosh / Wig, Naveet

Journal of clinical gastroenterology

2024 Volume 58, Issue 4, Page(s) 360–369

Abstract: Background: Abdominal bloating is a common complaint in patients with functional and organic bowel disease. Rifaximin, a nonabsorbable antibiotic, has been tried for the treatment of this disease. We performed a systematic review and meta-analysis to ... ...

Abstract	Background: Abdominal bloating is a common complaint in patients with functional and organic bowel disease. Rifaximin, a nonabsorbable antibiotic, has been tried for the treatment of this disease. We performed a systematic review and meta-analysis to study the efficacy of rifaximin in abdominal bloating and distension in patients with functional gastrointestinal disorders (FGID). Methods: We accessed 4 databases (MEDLINE, Embase, SCOPUS, and Web of Science) to identify randomized placebo-controlled trials that utilized rifaximin in FGID. We excluded observational studies, those including patients with organic bowel disorders such as inflammatory bowel diseases, or those in which rifaximin was given for other indications, such as hepatic encephalopathy. Results: A total of 1426 articles were available, of which 813 articles were screened after removing duplicates and 34 articles were selected for full-text review. Finally, 10 trials (3326 patients) were included. Rifaximin was administered in doses ranging from 400 to 1650 mg per day for 1 to 2 weeks. Rifaximin therapy led to a higher likelihood of improvement in symptoms of bloating (44.6% vs. 34.6%, RR 1.22, 95% CI 1.11, 1.35; n=2401 patients) without significant heterogeneity. However, daily doses less than 1200 mg/day were similar to placebo ( P =0.09). Bloating was quantified subjectively in 7 studies, and rifaximin led to a greater reduction in bloating scores compared with placebo (standardized mean difference -0.3, 95% CI -0.51, -0.1, P =0.04) but carried significant heterogeneity ( I2 =61.6%, P =0.01). Conclusions: Rifaximin therapy is associated with an increased likelihood of improvement in bloating and distension, as well as reduces the subjective severity of these symptoms in patients with FGID.
MeSH term(s)	Humans ; Rifaximin/therapeutic use ; Rifamycins/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Hepatic Encephalopathy ; Gastrointestinal Diseases/drug therapy ; Flatulence
Chemical Substances	Rifaximin (L36O5T016N) ; Rifamycins ; Anti-Bacterial Agents
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	448460-5
ISSN	1539-2031 ; 0192-0790
ISSN (online)	1539-2031
ISSN	0192-0790
DOI	10.1097/MCG.0000000000001872
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Article ; Online: Tuberculosis masquerading as metastasis in liver: a rare and an unusual presentation.

Keri, Vishakh C / Jorwal, Pankaj / Kodan, Parul / Biswas, Ashutosh

BMJ case reports

2020 Volume 13, Issue 2

Abstract: Hepatosplenic space occupying lesions are usually labelled as metastasis. This case highlights the importance of thinking beyond malignancy and the importance of adopting a systematic approach when dealing with such lesions that have a plethora of close ... ...

Abstract	Hepatosplenic space occupying lesions are usually labelled as metastasis. This case highlights the importance of thinking beyond malignancy and the importance of adopting a systematic approach when dealing with such lesions that have a plethora of close differentials. Hepatosplenic tuberculosis is a rare form of extra pulmonary tuberculosis. Timely diagnosis and treatment turned the table from a probable dismal prognosis to a completely curable cause. We report an unusual case, which was provisionally labelled as malignancy, due to isolated liver and spleen involvement but on evaluation turned out to be tuberculosis. The patient got cured with 6 months of anti-tubercular therapy. The report also brings to light the possible use of molecular methods like cartridge-based nucleic acid amplification test in diagnosing hepatobiliary tuberculosis, the literature about which is very scarce and limited.
MeSH term(s)	Biopsy ; Diagnosis, Differential ; Female ; Humans ; Liver/diagnostic imaging ; Liver/pathology ; Middle Aged ; Mycobacterium tuberculosis/isolation & purification ; Neoplasm Metastasis ; Nucleic Acid Amplification Techniques ; Spleen/diagnostic imaging ; Spleen/pathology ; Treatment Outcome ; Tuberculosis, Hepatic/diagnosis ; Tuberculosis, Splenic/diagnosis
Language	English
Publishing date	2020-02-19
Publishing country	England
Document type	Case Reports
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2019-233303
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Article ; Online: Risk factors of multidrug-resistant bacterial infections among patients admitted in a tertiary care hospital of north India.

Vaithiyam, Venkatesh / Ranjan, Piyush / Desai, Devashish / Mittal, Ankit / Kapil, Arti / Wig, Naveet / Biswas, Ashutosh

Journal of infection in developing countries

2021 Volume 15, Issue 4, Page(s) 544–551

Abstract: Introduction: Infections with drug-resistant organisms (DRO) have been associated with poor patient outcomes. To tackle this global problem, it is necessary to understand the risk factors that predispose to infections with DRO.: Methodology: This was ...

Abstract	Introduction: Infections with drug-resistant organisms (DRO) have been associated with poor patient outcomes. To tackle this global problem, it is necessary to understand the risk factors that predispose to infections with DRO. Methodology: This was a prospective observational study conducted over a three-year period at a tertiary-care hospital. Bacterial culture isolates from patients admitted in medicine wards with community or hospital-acquired infections were included. Logistic regression analysis was used to determine risk factors for drug-resistant infections. Results: Of the 295 patients with 323 isolates included, 40 (12.3%) had non-MDR (N-MDR) infections, 86 (26.6 %) had MDR infections and 197 (61%) had possible extensively drug-resistant (P-XDR) infections. History of previous admission in the preceding three months (Odds Ratio, OR = 4.53, 95% Confidence interval, CI = 1.8 - 11.42, p = -0.01), high SOFA score at admission (OR = 1.14, 95% CI = 1.0 - 1.290, p = -0.039) and prolonged duration of ventilation (OR = 1.25, 95% CI = 1.05 - 1.41, p = -0.012) were independently associated P-XDR infections when compared to patients with N-MDR. Conclusions: High rate of multidrug-resistant infections in the studied area is alarming. In this single-centre study, we elicited various risk factors for drug-resistant bacterial infections ranging from patient characteristics to iatrogenic risk factors during the hospital stay. Infections with P-XDR and MDR isolates independently increased hospital and ICU stay duration and were associated with increased mortality.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/epidemiology ; Community-Acquired Infections/microbiology ; Cross Infection/drug therapy ; Cross Infection/epidemiology ; Cross Infection/microbiology ; Drug Resistance, Multiple, Bacterial/drug effects ; Hospitalization/statistics & numerical data ; Humans ; India/epidemiology ; Prospective Studies ; Risk Factors ; Tertiary Care Centers/statistics & numerical data
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-04-30
Publishing country	Italy
Document type	Journal Article ; Observational Study
ZDB-ID	2394024-4
ISSN	1972-2680 ; 2036-6590
ISSN (online)	1972-2680
ISSN	2036-6590
DOI	10.3855/jidc.13963
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Article ; Online: Infective Endocarditis Following Chicken Pox: A Rare Association.

Bhatt, Manasvini / Gupta, Nitin / Soneja, Manish / DAS, Ujjwalkumar S / Thirumurthy, Velpandian / Biswas, Ashutosh

The Kurume medical journal

2021 Volume 66, Issue 2, Page(s) 127–133

Abstract: A 38-year old immunocompetent male presented to us with chicken pox complicated by development of Guillain-Barre syndrome (GBS) and left-sided native valve endocarditis due to methicillin resistant Staphylococcus aureus (MRSA). This was further ... ...

Abstract	A 38-year old immunocompetent male presented to us with chicken pox complicated by development of Guillain-Barre syndrome (GBS) and left-sided native valve endocarditis due to methicillin resistant Staphylococcus aureus (MRSA). This was further complicated by embolization to various vital organs including the brain. The patient was treated with vancomycin for four weeks but did not respond to the treatment. We present this case to highlight the rare complications associated with chicken pox and the challenges faced in management of such a case.
MeSH term(s)	Adult ; Anti-Bacterial Agents/therapeutic use ; Chickenpox/complications ; Endocarditis/diagnosis ; Endocarditis/drug therapy ; Endocarditis/microbiology ; Guillain-Barre Syndrome/diagnosis ; Guillain-Barre Syndrome/microbiology ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus/isolation & purification ; Staphylococcal Infections/diagnosis ; Vancomycin/therapeutic use
Chemical Substances	Anti-Bacterial Agents ; Vancomycin (6Q205EH1VU)
Language	English
Publishing date	2021-06-18
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	603905-4
ISSN	1881-2090 ; 0023-5679
ISSN (online)	1881-2090
ISSN	0023-5679
DOI	10.2739/kurumemedj.MS662004
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