Barney Isaac - Academia.edu (original) (raw)

Papers by Barney Isaac

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

Vaccine

Background COVID-19 vaccines were authorised for emergency use to mitigate the impact of the pand... more Background COVID-19 vaccines were authorised for emergency use to mitigate the impact of the pandemic. This study evaluated the effect of prior vaccination with either Oxford Astra Zeneca’s CovishieldTM or Bharath Biotech’s Covaxin® on mortality among symptomatic COVID-19 patients during the second wave of the pandemic in India. Methodology In this cohort study comprising of RT-PCR confirmed symptomatic COVID-19 patients presenting during April and May 2021, the effect of prior vaccination on mortality (primary outcome), need for hospitalization, oxygen therapy, non-invasive ventilation (NIV) and intensive care unit (ICU) admission were assessed and expressed as risk ratio (RR) with 95% confidence intervals (CI). Results The mean (SD) age of the cohort (n=4183) was 46.3 (15.5) years; 17.9% (748/4183) had received at least one dose of CovishieldTM and 4.8% (201/4183) had received Covaxin®. Mortality was 0.2% (95% CI: -0.2% - 0.7%), 3.5% (1.9% - 5.2%), 6.2% (0.3% - 12%) and 12.9% (11.8% - 14.1%) among fully vaccinated (>2 weeks after two doses), partially vaccinated (>2 weeks after one dose or <2 weeks after two doses), indeterminate (<2 weeks after one dose) and unvaccinated patients respectively. The difference in mortality among unvaccinated vs. fully vaccinated was 12.7% (95% CI: 11.4% - 13.9%), unvaccinated vs. partially vaccinated was 9.4% (7.4% - 11.4%) and unvaccinated vs. indeterminate vaccinated was 6.8% (0.8% - 12.7%). On adjusted analysis, as compared to unvaccinated patients, at least one dose of vaccine reduced the need for hospitalization (RR: 0.40; 95% CI: 0.35 - 0.47), oxygen (0.33; 0.27 - 0.40), NIV (0.23; 0.17 - 0.32), ICU admission (0.18; 0.12 - 0.27) and mortality (0.18; 0.11 - 0.29). Conclusion Among symptomatic COVID-19 patients, prior vaccination with Covishield TM or Covaxin® impacted the severity of illness and reduced mortality during a period of widespread delta variant circulation. Full vaccination conferred greater protection than partial vaccination.

Background: Nurses in developing countries are frequently exposed to infectious tuberculosis (TB)... more Background: Nurses in developing countries are frequently exposed to infectious tuberculosis (TB) patients, and have a high prevalence of TB infection. To estimate the incidence of new TB infection, we recruited a cohort of young nursing trainees at the Christian Medical College in Southern India. Annual tuberculin skin testing (TST) was conducted to assess the annual risk of TB infection (ARTI) in this cohort. Methodology/Principal Findings: 436 nursing students completed baseline two-step TST testing in 2007 and 217 were TSTnegative and therefore eligible for repeat testing in 2008. 181 subjects completed a detailed questionnaire on exposure to tuberculosis from workplace and social contacts. A physician verified the questionnaire and clinical log book and screened the subjects for symptoms of active TB. The majority of nursing students (96.7%) were females, almost 84 % were under 22 years of age, and 80 % had BCG scars. Among those students who underwent repeat testing in 2008, 1...

Respirology Case Reports

Patients with immunodeficiency are at an increased risk of recurrent COVID‐19 infection. They may... more Patients with immunodeficiency are at an increased risk of recurrent COVID‐19 infection. They may lack the natural immune response that usually confers long‐lasting immunity. Here, we present our experience managing one such patient, who had a COVID‐19 infection twice, 5 months apart. He had a positive SARS‐CoV‐2 real‐time reverse transcription polymerase chain reaction (RT‐PCR) and computed tomography (CT) thorax with classical findings of COVID‐19 on both occasions. He had multiple negative RT‐PCR tests and two CT scans without COVID‐19 features between these two infections. While the antibody response to the first infection was not detectable, the response to the second infection was robust. Live attenuated vaccines are contraindicated in patients with immunodeficiency, and other vaccines may not elicit an adequate immune response. A high index of suspicion for recurrent COVID‐19 is warranted in this group of patients.

Lung India : Official Organ of Indian Chest Society, 2021

had a greater prevalence of hypertension and cardiovascular diseases, raised serum ferritin and t... more had a greater prevalence of hypertension and cardiovascular diseases, raised serum ferritin and troponin levels, as well as a longer length of hospital stay. [15] Kaufman et al. matched the results of SARS-CoV-2 testing performed in a laboratory from mid-March through mid-June 2020, with 25(OH)D results from the preceding 12 months. They showed an association between lower SARS-CoV-2 positivity rates and higher circulating 25(OHD levels, which remained significant in a multivariable logistic model adjusting for all included demographic factors (adjusted odds ratio [OR], 0.984 per ng/mL increment; P < 0.001). [16] Davies et al. analyzed the global daily reports of fatalities and recoveries from 239 locations from January 22, 2020, to April 9, 2020, using a novel causal inference analysis and showed that vitamin D status plays a key role in COVID-19 outcomes.

European Respiratory Journal, 2020

Context: Home-based pulmonary rehabilitation (PR) can increase compliance in chronic obstructive ... more Context: Home-based pulmonary rehabilitation (PR) can increase compliance in chronic obstructive pulmonary disorder (COPD). There is paucity of data on this in India. Aims: To study the effectiveness of home-based PR on lung function, health-related quality of life, exercise tolerance and dyspnea among patients with COPD. Setting: The Department of Pulmonary Medicine, Christian Medical College, Vellore. Subjects and Methods: This was a quasi-experimental study which included COPD patients who found hospital-based PR impractical. Those willing for home-based PR constituted the intervention group and those unwilling, constituted the control group. Both groups received standard of care otherwise. At 6 weeks, forced expiratory volume in 1 sec (FEV1), St. George Respiratory Questionnaire (SGRQ), six-minute walk test distance (6MWD), COPD assessment test (CAT) score and modified Borg dyspnea scale were compared with their baseline values. Statistical Analysis: Student paired t-test. Resul...

Sleep and control of breathing

Sarcoidosis and other granulomatous ILD / DPLD

ABSTRACTHypervirulent K. pneumoniae (HvKp) is typically associated with ST23 clone; however, hvKp... more ABSTRACTHypervirulent K. pneumoniae (HvKp) is typically associated with ST23 clone; however, hvKp is also emerging from clones ST11, ST15 and ST147, which are also multi-drug resistant (MDR). Here, we aimed to characterise nine novel MDR hvKp isolates harbouring mosaic plasmids simultaneously carrying antimicrobial resistance (AMR) and virulence genes. Nine HvKp isolates obtained from hospitalised patients in southern India were characterized for antimicrobial susceptibility and hypervirulence phenotypes. All nine hvKp isolates were subjected to whole genome sequencing (WGS) using Ilumina HiSeq2500 and a subset of four were sequenced using Oxford Nanopore MinION. Among the nine isolates, seven were carbapenem-resistant, two of which carried blaNDM-5 on an IncFII plasmid and five carried blaOXA-232 on a ColKP3 plasmid. The virulence determinants were encoded in a mosaic plasmid (∼320 Kbp) that formed as a result of its insertion in a IncFIB-IncHI1B plasmid co-integrate. The mosaic pl...

Indian Journal of Tuberculosis

Abstract Background In the wake of the COVID-19 pandemic caused by a novel corona virus, health c... more Abstract Background In the wake of the COVID-19 pandemic caused by a novel corona virus, health care personnel are at increased risk of acquiring the infection. In preparation for the management of health care personnel that are likely to be infected, we looked in to the data collected during the Influenza pandemic in 2009, caused by a novel strain of H1N1 influenza called swine flu. The care of healthcare personnel in our institution, who had an acute febrile respiratory illness (AFRI) during that period was routed through a single channel using a uniform protocol. We retrospectively analysed the available data, during the initial four months of the pandemic, to draw lessons from it. Objective To study the prevalence, clinical profile and risk factors of swine flu among health care personnel during the pandemic of 2009 in a tertiary care hospital in South India. Methodology This retrospective study enrolled all the health care personnel including students of a tertiary care institution in South India, who presented with an acute febrile respiratory illness (AFRI) between June to August, the initial four months of the swine flu pandemic of 2009. The clinical profile and risk factors were extracted. The results of the RT PCR for swine flu was obtained. Prevalence in each demographic group was calculated and compared. Characteristics of those with swine flu were compared with those who turned negative for the swine flu. Results The prevalence of all AFRI and only swine flu among health care personnel during the study period was 18 per thousand and 8.7 per thousand respectively. Highest prevalence of swine flu was found among students and office staff. After adjusting for confounding factors, hyperthermia at presentation was significantly higher {OR=1.97; 95% CI (1.01-3.76)} among those who tested positive for swine flu as compared with those with other AFRI’s. Only 2.5% of the entire AFRI group required admission and there was no mortality. Conclusion Health care personnel are at increased risk of acquiring infection. Our study demonstrated that students and office staff were the most susceptible. Unprotected exposure to unknown infectious patients and relatives is likely to have been an important factor. Though the mode of transmission is similar, compared to H1N1, COVID-19 is associated with different comorbidities and has significantly higher mortality. Therefore, in preparation for the COVID-19 pandemic, the personal protective equipment of the healthcare personnel need to be escalated.

Journal of Global Health

The cost of procuring invasive mechanical ventilation is high and outcomes of ventilated COVID-19... more The cost of procuring invasive mechanical ventilation is high and outcomes of ventilated COVID-19 patients are poor and hence it may not be a cost effective investment and may deplete the scarce resources in resource limited settings.

Indian Journal of Medical Microbiology

Staphylococcus aureus is of significant clinical concern in both community- and hospital-onset in... more Staphylococcus aureus is of significant clinical concern in both community- and hospital-onset infections. The key to the success of S. aureus as a pathogen is its ability to swiftly develop antimicrobial resistance. Methicillin-resistant S. aureus (MRSA) is not only resistant to nearly all beta-lactams but also demonstrates resistance to several classes of antibiotics. A high prevalence of MRSA is seen across worldwide. For many decades, vancomycin remained as gold standard antibiotic for the treatment of MRSA infections. In the past decades, linezolid, daptomycin, ceftaroline and telavancin received regulatory approval for the treatment of infections caused by resistant Gram-positive pathogens. Although these drugs may offer some advantages over vancomycin, they also have significant limitations. These includes vancomycin's slow bactericidal activity, poor lung penetration and nephrotxicity;linezolid therapy induced myelosuppression and high cost of daptomycin greatly limits their clinical use. Moreover, daptomycin also gets inactivated by lung naturally occurring surfactants. Thus, currently available therapeutic options are unable to provide safe and efficacious treatment for those patients suffering from hospital-acquired pneumonia, bloodstream infections (BSIs), bone and joint infections and diabetic foot infections (DFI). An unmet need also exists for a safe and efficacious oral option for switch-over convenience and community treatment. Herein, the review is intended to describe the supporting role of anti-staphylococcal antibiotics used in the management of S. aureus infections with a special reference to levonadifloxacin. Levonadifloxacin and its prodrug alalevonadifloxacin are novel benzoquinolizine subclass of quinolone with broad-spectrum of anti-MRSA activity. It has been recently approved for the treatment of complicated skin and soft-tissue infection as well as concurrent bacteraemia and DFI in India.

Lung India

lessons have been learned from the measures adopted then, which include social distancing measure... more lessons have been learned from the measures adopted then, which include social distancing measures such as closing schools, churches, bars, and other social venues. Cities in which these interventions were implemented early in the epidemic were successful at reducing case numbers while the interventions remained in place and experienced lower mortality overall. [1] While our understanding of infectious diseases and their prevention is now very different compared to 1918, most of the countries across the world face the same challenge today with COVID-19, a virus with comparable lethality to H1N1 influenza in 1918. Two fundamental strategies have been deemed to be effective. [2] Suppression Here, the aim is to reduce the reproduction number (the average number of secondary cases each case generates), INTRODUCTION The COVID-19 pandemic is now a major global health of threat, the full impact of which is yet unknown. As of March 28, 2020, there have been 597,335 cases and 27,365 deaths confirmed worldwide. Global spread has been rapid, with 177 countries now having reported at least one case. Health-care workers (HCWs) who are at the frontlines in the fight against infectious disease are the most vulnerable. In this article, we look at the epidemiology of this epidemic, the likely impact on the nation and the preparation of the health-care settings to cope with the endemic. Most importantly, HCWs in this setting are the most valuable resources and so we cover the measures needed to protect HCWs and optimize their output.

Interventional Pulmonology

In cases of hard rubbery lymph nodes like in Sarcoidosis and Lymphoma, it is sometimes difficult ... more In cases of hard rubbery lymph nodes like in Sarcoidosis and Lymphoma, it is sometimes difficult to obtain optimum cytology samples during EBUS TBNA (Transbronchial needle aspiration cytology) and thus the diagnostic yield of EBUS TBNA samples drops down to 60%. An EBUS TBNB sample from such lymph nodes can help to increase the diagnostic yield. Methods: We did a Pilot study in patients presenting with hard rubbery lymph nodes during EBUS TBNA, EBUS guided Transbronchial biopsy of the subcarinal lymph node was done with small size biopsy forceps. Diagnostic yield of biopsy samples was compared with EBUS TBNA cytology results. Results: Over a period of 6 months, 11 patients underwent EBUS guided transbronchial biopsy of Subcarinal lymph node. 9 patients were male and the average age was 46 years (Range 19 to 65 years). EBUS guided TBNB sample could be successfully obtained in 9 patients. In 2 patients (final diagnosis was Sarcoidosis and Lung cancer respectively), biopsy needle failed to pierce the subcarinal lymph node. TBNB samples provided the diagnosis in all 9 patients (Sarcoidosis in 3 patients, Tuberculosis in 4 patients, Lung cancer in 1 patients and Acute myeloid leukaemia in one patient). But in all these 9 patient EBUS TBNA samples were also diagnostic of the same pathology. EBUS TBNB did not increase the diagnostic yield of EBUS guided procedure in this pilot study with only 11 patients. However, the study proves that it is feasible to do EBUS TBNB. It is a promising new technique and may help in increasing the diagnostic yield in a prospective trial with a large number of patients, especially when Pulmonologist finds it hard to obtain an adequate cytology sample with EBUS TBNA.

Respirology (Carlton, Vic.), Jul 27, 2018

Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion ... more Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion is the second most common site of EPTB. The diagnosis of pleural TB is challenging due to the pauci-bacillary nature of the disease. Histopathology of thoracoscopically obtained pleural biopsy provides the highest diagnostic yield. The Xpert MTB/RIF assay (Xpert) is a PCR test that can identify both Mycobacterium tuberculosis (MTB) and rifampicin resistance. Currently, there is a lack of clarity regarding the value of Xpert on pleural tissue. We report our experience of using Xpert on thoracoscopic pleural biopsy samples. We retrospectively reviewed the records of patients who underwent thoracoscopy in our institution over a 1-year period. Relevant clinical details; indications; and results of tests on pleural tissue and fluid, including histopathology, mycobacterial cultures and Xpert, were extracted. Of the 156 patients who underwent thoracoscopy, 73 (47%) had TB, 66 (42%) malignancy a...