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Papers by Prasanta Bhattacharya

Indian Journal of Medical Microbiology, 2011

Sr. No. Title Page No. 1. Abbreviations vii-viii 2. Distribution list (Controlled copies) ix 3. A... more Sr. No. Title Page No. 1. Abbreviations vii-viii 2. Distribution list (Controlled copies) ix 3. Amendment sheet x 4. Chapter 1: General guidelines 1-13 5. Chapter 2: Specimen collection, transport & processing Blood CSF Body fluids Ocular specimens Respiratory specimens Pus Urine Fecal specimen Tissue 15-47 6. Chapter 3: Identification of isolates Enterobacteriaceae Salmonella Stenotrophomonas maltophilia, Burkholderia cepacia complex Pseudomonas Acinetobacter Staphylococci Enterococci Fecal isolates Streptococcus sp (beta and alpha hemolytic) Streptococcus pneumoniae 49-77 7. Chapter 4: Antimicrobial Susceptibility Testing Definitions Disc diffusion testing ATCC control strains Preparing antibiotic discs in-house Minimum Inhibitory Concentration (MIC) testing Zone diameters and MIC breakpoints 79-103 8. Chapter 5: Special Tests (Phenotypic) Carba-NP test (For Enterobacteriaceae and Pseudomonas spp.) Modified carbapenem inactivation method (mCIM and eCIM); (For Enterobacteriaceae and Pseudomonas spp.) D-test for inducible clindamycin resistance Vancomycin screen agar for S. aureus and Enterococcus spp. MIC for vancomycin by broth micro dilution method Detection of heteroresistant vancomycin intermediate Staphylococcus aureus (hVISA) population analysis profile/area under curve (PAP/AUC) analysis Combination antimicrobial testing to evaluate the best combination of drugs for MRSA Detection of over-expression of efflux pumps MIC 105-113 9. Chapter 6: Quality control (QC) Reference strains for QC Storing and testing QC strains Frequency of testing Quality control of media

The Journal of the Association of Physicians of India, 2019

Introduction Eschar is one of the most important clinical sign which helps in early diagnosis, an... more Introduction Eschar is one of the most important clinical sign which helps in early diagnosis, and consequently initiation of specific treatment and prevention of complications in scrub typhus. Aims To study the prevalence and distribution of eschar in scrub typhus and comparison of clinical manifestations and complications among patients with or without eschar. Methodology A retrospective hospital based study in patients aged ≥ 18 years admitted to a tertiary care centre in north-eastern India. Scrub typhus was diagnosed based on clinical features supported by serological tests (Immunochromatographic card test, IgM ELISA and Weil Felix test). Chi square test was used for comparing variables. A 'p value' <0.05 was considered as statistically significant. Results A total of 129 patients of scrub typhus were included in the present study. Male to female ratio is 1.93:1 with the commonest age group being 18-30 years followed by 30-40 years. Eschar was found in 24.8% patients...

Cureus

Background Tuberculosis (TB) is one of the most common infectious diseases and is commonly associ... more Background Tuberculosis (TB) is one of the most common infectious diseases and is commonly associated with comorbidities. However, data regarding TB and comorbidities are lacking from northeast India. The aim of the study is to see the clinical spectrum of TB and the frequency of comorbidities. Methods This was a prospective observational study of all hospitalized TB patients between January 2016 and June 2017 who were selected by consecutive sampling. Data were analyzed using SPSS v. 17.0 (IBM Corp., Armonk, NY), and a p-value of <0.05 was considered significant. Results Of the 173 patients selected, the mean age was 41.05±17.04 years with a male:female ratio of 4.27:1. Pulmonary TB (PTB) was found in 43.94%, extra-pulmonary TB (EPTB) in 52.02%, and disseminated TB in 4.04%. Fever (61.27%) was the most common presentation, followed by cough (54.33%) and breathlessness (32.94%). Of the 76 patients with PTB and seven with disseminated TB, making a total of 83 patients, 56 (67.4%) were sputum positive. Out of 90 patients suffering from EPTB, pleural effusion (53.33%) was the commonest type of EPTB, followed by central nervous system (CNS) tuberculosis (26.66%) and abdominal tuberculosis (8.88%). Comorbidities were present in 53.17% of the patients, of which diabetes mellitus (DM) (26.58%) and hypertension (17.34%) were the most common. Comorbid conditions were significantly higher in PTB than EPTB (51 of 83 vs. 41 of 90, p<0.05). Mean glycated hemoglobin (HbA1c) was significantly higher in PTB as compared to EPTB (8.74±2.04 vs. 7.58±0.29, p<0.05). Conclusion Comorbidities, particularly DM, were present in half of the patients, mostly in PTB than EPTB, with glycemic control being significantly poorer in PTB patients.

Journal of Vector Borne Diseases

Background & objectives: Scrub typhus has a wide spectrum of clinical presentations from acut... more Background & objectives: Scrub typhus has a wide spectrum of clinical presentations from acute febrile illness to sepsis with multi-organ failure with poor prognosis. The aim was to study the clinical presentation of scrub typhus and application of SOFA and qSOFA scores of sepsis-3 criteria to determine sepsis and consequent in-hospital outcomes. Methods: A prospective study was carried out in adults (≥18 years), with scrub typhus diagnosed by IgM ELISA. Sepsis-3 criteria were used to identify patients with sepsis and plan subsequent management. Statistical analysis was done using software SPSS 16.0 and p value of less than 0.05 was taken as significant. Results: Of the 78 scrub typhus patients, 38 (48.71%) presented with sepsis. Mean age in the sepsis group was significantly lower than the non-sepsis group (35.41±11.14 versus 43.56±14.31 years, p<0.05). Mortality was 71.05% in the sepsis group compared to nil in the non-sepsis group. On regression analysis, the presence of eschar (OR=5.2, 95% CI=1.15-23.544, P= 0.032), Acute Respiratory Distress Syndrome (ARDS) (OR=5.33, 95% CI= 1.13-25.16, P = 0.034) and a GCS <10 (OR=9.29, 95% CI=1.04-82.96, P=0.046) were significant predictors of mortality in patients of scrub typhus with sepsis. Interpretation & conclusion: Scrub typhus is more common in young age, with significantly younger patients developing sepsis. Presence of eschar, ARDS and GCS<10 were risk factors for mortality in scrub typhus patients with sepsis.

The National medical journal of India

Non-communicable diseases (NCDs)-a term which includes diabetes, cardiovascular disease, cancers,... more Non-communicable diseases (NCDs)-a term which includes diabetes, cardiovascular disease, cancers, chronic respiratory diseases, and mental illness-are now the major cause of death in India and pose healthcare and economic challenges. There is an urgent need for enhanced clinical research training and capacity building for NCD prevention and control in India. We describe a multi-pronged approach funded in part by the US National Institutes of Health Fogarty International Center, which was initiated in 2001, to train Indian present and future scientists/doctors in NCD prevention and control. The approaches used were annual national seminars, intensive training courses, in-house workshops, short-term training sessions in the USA and monthly video conferences. During 2001-2016, a total of 3650 undergraduate, postgraduate and faculty from medical colleges and institutes from almost all states in India and several neighbouring countries participated in seminars and other capacity-building...

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Systemic Lupus Erythematosus (SLE) and Tuberculosis (TB) are intricately related with an increase... more Systemic Lupus Erythematosus (SLE) and Tuberculosis (TB) are intricately related with an increase in the risk of TB in SLE. Primary mechanisms pertaining to the increased susceptibility for TB are the inherent immunodeficient state of SLE and use of immunosuppressant agents in the treatment of SLE. We report a case series of five female patients of SLE with TB who presented between January 2015 and December 2015 in a tertiary care teaching hospital in North Eastern India. All the patients were young to middle aged females having SLE with or without lupus nephritis who were on immunosuppressive therapy with corticosteroids, mycophenolate mofetil or cyclophosphamide. Two of the cases had sputum positive pulmonary tuberculosis while rest had Extra-Pulmonary TB (EPTB). The response to anti-tubercular therapy led to clinical improvement in all the cases except one who had an adverse outcome. Our series further substantiates the increased risk of TB in SLE thus, prompting further research towards better management of these two disease entities in conjunction.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Pulmonary Lymphangitic Carcinomatosis (PLC) occurs in about 6-8% of patients with lung metastasis... more Pulmonary Lymphangitic Carcinomatosis (PLC) occurs in about 6-8% of patients with lung metastasis and may rarely develop in the course of gastric cancer representing a complication due to diffuse metastasis in the lymphatics of the lungs. A 29-year-old female, admitted with difficulty in breathing and productive cough for one week, was initially evaluated for respiratory tract infection. During evaluation of associated anaemia an upper gastrointestinal endoscopy showed large ulcerative growth in the lesser curvature of the stomach suggestive of carcinoma. A High Resolution Computed Tomographic (HRCT) scan of the lungs was done for evaluation of the pulmonary opacities on chest x-ray which showed nodular thickening of interlobular septa with peribronchial cuffing and fissural thickening. The biopsy of the gastric ulcer was suggestive of poorly differentiated malignancy. With the cumulative results of the investigations a diagnosis of poorly differentiated carcinoma of stomach with pulmonary metastasis as lymphangitic carcinomatosis was made. PLC is an extremely rare manifestation of metastatic gastric cancer. Though associated with an extremely poor prognosis, advanced gastric cancer in younger patients presenting with symptoms and signs of respiratory disease should alert the physician of a possible diagnosis of PLC.

Journal of clinical and diagnostic research : JCDR, 2016

Sepsis is the primary cause of death from infection worldwide. In resource-limited countries, inc... more Sepsis is the primary cause of death from infection worldwide. In resource-limited countries, increasing number of sepsis is managed in non-ICU settings, in Medical Wards (MW). To compare the burden, aetiology and short term outcome of sepsis treated in MW with ICU. Prospective, observational, analytical study in sepsis patients in general MW and medical ICU in a tertiary care hospital. Two hundred forty five sepsis patients (MW=150, ICU=95), ≥18 years, selected randomly, were studied to compare aetiology, co-morbidities, clinical & microbiological profile and short-term outcome between MW and ICU sepsis. Sepsis following surgery, trauma, those transferred to/from ICU, those with other life threatening diseases were excluded. Chi-square test/Fisher's-exact test was used for comparing ratios. A 'p-value' <0.05 was considered statistically significant. Sepsis was more common in elderly males, both in MW and ICU (median age: 56.7, 59.2 years; male: female ratios = 1.34:1...

International Journal of Medical Science and Public Health, 2016

Background: Sulfonylureas are mainstay of pharmacotherapy for type 2 diabetes mellitus (T2DM). In... more Background: Sulfonylureas are mainstay of pharmacotherapy for type 2 diabetes mellitus (T2DM). Individual variability exists in pharmacokinetic and pharmacodynamic responses adverse effects to sulfonylurea. Objective: To determine frequency of cytochrome P450 2C9 mutant allele CYP2C93*, in T2DM patients on sulfonylurea therapy, and to ascertain the frequency of adverse drug reactions (ADR) with respect to particular allelic distribution. Materials and Methods: A hospital-based prospective observational study was carried out in a tertiary-care teaching hospital. Study included 136 T2DM patients on sulfonylurea therapy (83 with ≥1 ADR and 53 without ADR). DNA was isolated from the blood samples taken from all 136 patients by DNA isolation. PCR-RFLP (restriction fragment length polymorphism) technique was used for detection of CYP2C93* (Ile359Leu) allele and the wild type allele CYP2C91* by digestion with restriction enzyme. Data were analyzed using Statistical Package for Social Survey (SPSS) for Windows, version 16.0 and Microsoft Excel to determine descriptive statistics. Result: Allele CYP2C93* was detected in 11 patients. All alleles negative for the nucleotide substitutions at position 42614 (*3) were presumed to be wild type CYP2C9*1. Among the patients with CYP2C93* allele 11 patients experienced hypoglycemia and one patient experienced acute visual disturbances. No CYP2C93* was detected in the subjects without ADR. Conclusion: In our study CYP2C93* was identified in 11 patients experiencing hypoglycaemia and in one patient experiencing acute visual disturbances. In view of the existence of such polymorphisms and its effects on sulfonylurea therapy further studies are required to assess the magnitude of such problems in T2DM.

International Journal of Biomedical and Advance Research, 2016

Background: Acute viral hepatitis is associated with significant hepatic dysfunction including li... more Background: Acute viral hepatitis is associated with significant hepatic dysfunction including lipid metabolism. Variations in the serum lipid fractions in acute viral hepatitis due to hepatic injury may serve as prognostic marker for severity of hepat ic injury. Methods: Hospital-based prospective study on acute viral hepatitis. Fifty cases of acute viral hepatitis and 50 age and sex matched controls, (>18 years) were studied. Routine biochemical investigation, hepatotropic viral serology and fasting serum lipid fractions were analysed for changes in patients with acute viral hepatitis. Chi-square test was used for comparing variables. A 'p value' <0.05 was considered statistically significant. Results: Baseline parameters were similar between cases and controls (p>0.05). Jaundice (100%) and high coloured urine (100%) were the commonest presentations. Hepatitis A virus (52%) and Hepatitis E virus (30%) were commonest aetiological agents. Serum cholesterol, triglycerides, low density lipoprotein (LDL) were significantly higher (p<0.01) while high density lipoprotein (HDL) was significantly lower (p<0.01) in acute viral hepatitis compared to controls. There was no statistically significant difference in the levels of very LDL between cases and controls (p>0.05). Complications were seen in 7 (14%) cases with hepatic encephalopathy being the commonest (6%). Serum cholesterol, triglycerides, LDL were significantly higher and HDL was significantly lower in hepatitis with complications compared to uncomplicated hepatitis (p<0.01). Conclusion Acute viral hepatitis leads to significant alterations of serum lipid fractions which may serve as an indicator of severity of liver damage and be helpful in assessing the prognosis of patients with acute viral hepatitis.

Monogram: Chronic Diarrhea, 2016

Indian Journal of Medical Specialities, 2015

ABSTRACT Abstract Introduction Alcohol and its relationship to ill health have been recognized as... more ABSTRACT Abstract Introduction Alcohol and its relationship to ill health have been recognized as an important public health challenge even though alcohol use has been part of the cultural tradition in different societies. It is known that alcohol contributes to more than 200 different health problems. We planned to study the burden of the diseases and clinical presentations of alcoholism. Methods and results Two thousand adult patients (one thousand male and one thousand female) were selected by systematic random sampling from all hospital admissions into the Department of General Medicine from February 2012 to August 2013 and screened for alcohol related admissions including different alcohol related diseases. Results The prevalence of alcohol related admissions were 13.3% and 2.3% respectively in male and female patients. Majority of patients belonged to age group 31–50 years. The most common presentation in both sexes was chronic liver disease and its complications. Alcohol dependence syndrome was more common in males as compared to females. Conclusion Since alcohol related hospitalization in this region was found quite high and affecting predominantly people in the prime age between 30 and 50 years of both sexes, this has a significant impact on the health and economic burden of the society. Keywords Alcoholism; Alcohol related diseases; North eastern India

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2016

Malaria is one of the most common protozoan diseases, especially in tropical countries. The clini... more Malaria is one of the most common protozoan diseases, especially in tropical countries. The clinical manifestation of malaria, especially falciparum malaria varies from mild acute febrile illness to life threatening severe systemic complications involving one or more organ systems. We would like to report a case of complicated falciparum malaria involving cerebral, renal, hepatic system along with acute pancreatitis. The patient was successfully treated with anti malarial and other supportive treatment. To the best of our knowledge there are very few reports of acute pancreatitis due to malaria. Falciparum malaria therefore should be added to the list of infectious agents causing acute pancreatitis especially in areas where malaria is endemic.

International Journal of Medical Science and Public Health, 2015

Background: Maintenance of physical fitness is a cornerstone of geriatric preventive care. Senior... more Background: Maintenance of physical fitness is a cornerstone of geriatric preventive care. Senior fitness test (SFT) is a simple test for assessing physical fitness of the geriatric population. However, its reliability in the Indian setting has not been well established. Objective: To determine the relative and absolute test-retest reliability of SFT as a physical fitness tool of the geriatric population in the community. Materials and Methods: A community-based prospective, nonexperimental study was carried out in an urban community of Guwahati, Assam, India. Thirty-one physically active, elderly individuals (aged ≥65 and <75 years) were asked to perform the SFT, at baseline and at a second session after 2-3 days, to assess the reliability of the test. Intra-rater variability and intraclass correlation coefficients (ICC) of the SFT were assessed. Reliability of the tests was measured using the standard error of measurement (SEM), minimal detectable change (MDC), and log-transferred limits of agreement of Bland-Altman plots. Result: The relative reliability of entire physical fitness test (SFT) was shown to be excellent. The ICC at the 95% confidence interval (CI) for all the tests ranged between 0.933 and 1.000. The F test values were significant for all the tests (0.00). The width of the CI of ICC ranged between 0.0 and 0.107 with body mass index having the smallest CI (0.0) and arm curl test (0.1.07) having the largest CI. The SEM and MDC values were small ranging from 0.43 to 0.0 and from 0.0 to 1.8 for all tests except for the 2-min step test. The SEM and MDC for the 2-min step test was 1.48 and 4.12, respectively. Bland-Altman plots for all the tests were positively skewed and heteroscedastic. Conclusion: Test-retest reliability of the physical fitness test was excellent and these tests were thus applicable for cross-sectional and controlled interventional studies for the elderly population.

Grudnaia i serdechno-sosudistaia khirurgiia / Ministerstvo zdravookhraneniia SSSR [i] Vsesoiuznoe nauchnoe obshchestvo khirurgov

Indian Journal of Medical Microbiology, 2011

Sr. No. Title Page No. 1. Abbreviations vii-viii 2. Distribution list (Controlled copies) ix 3. A... more Sr. No. Title Page No. 1. Abbreviations vii-viii 2. Distribution list (Controlled copies) ix 3. Amendment sheet x 4. Chapter 1: General guidelines 1-13 5. Chapter 2: Specimen collection, transport & processing Blood CSF Body fluids Ocular specimens Respiratory specimens Pus Urine Fecal specimen Tissue 15-47 6. Chapter 3: Identification of isolates Enterobacteriaceae Salmonella Stenotrophomonas maltophilia, Burkholderia cepacia complex Pseudomonas Acinetobacter Staphylococci Enterococci Fecal isolates Streptococcus sp (beta and alpha hemolytic) Streptococcus pneumoniae 49-77 7. Chapter 4: Antimicrobial Susceptibility Testing Definitions Disc diffusion testing ATCC control strains Preparing antibiotic discs in-house Minimum Inhibitory Concentration (MIC) testing Zone diameters and MIC breakpoints 79-103 8. Chapter 5: Special Tests (Phenotypic) Carba-NP test (For Enterobacteriaceae and Pseudomonas spp.) Modified carbapenem inactivation method (mCIM and eCIM); (For Enterobacteriaceae and Pseudomonas spp.) D-test for inducible clindamycin resistance Vancomycin screen agar for S. aureus and Enterococcus spp. MIC for vancomycin by broth micro dilution method Detection of heteroresistant vancomycin intermediate Staphylococcus aureus (hVISA) population analysis profile/area under curve (PAP/AUC) analysis Combination antimicrobial testing to evaluate the best combination of drugs for MRSA Detection of over-expression of efflux pumps MIC 105-113 9. Chapter 6: Quality control (QC) Reference strains for QC Storing and testing QC strains Frequency of testing Quality control of media

The Journal of the Association of Physicians of India, 2019

Introduction Eschar is one of the most important clinical sign which helps in early diagnosis, an... more Introduction Eschar is one of the most important clinical sign which helps in early diagnosis, and consequently initiation of specific treatment and prevention of complications in scrub typhus. Aims To study the prevalence and distribution of eschar in scrub typhus and comparison of clinical manifestations and complications among patients with or without eschar. Methodology A retrospective hospital based study in patients aged ≥ 18 years admitted to a tertiary care centre in north-eastern India. Scrub typhus was diagnosed based on clinical features supported by serological tests (Immunochromatographic card test, IgM ELISA and Weil Felix test). Chi square test was used for comparing variables. A 'p value' <0.05 was considered as statistically significant. Results A total of 129 patients of scrub typhus were included in the present study. Male to female ratio is 1.93:1 with the commonest age group being 18-30 years followed by 30-40 years. Eschar was found in 24.8% patients...

Cureus

Background Tuberculosis (TB) is one of the most common infectious diseases and is commonly associ... more Background Tuberculosis (TB) is one of the most common infectious diseases and is commonly associated with comorbidities. However, data regarding TB and comorbidities are lacking from northeast India. The aim of the study is to see the clinical spectrum of TB and the frequency of comorbidities. Methods This was a prospective observational study of all hospitalized TB patients between January 2016 and June 2017 who were selected by consecutive sampling. Data were analyzed using SPSS v. 17.0 (IBM Corp., Armonk, NY), and a p-value of <0.05 was considered significant. Results Of the 173 patients selected, the mean age was 41.05±17.04 years with a male:female ratio of 4.27:1. Pulmonary TB (PTB) was found in 43.94%, extra-pulmonary TB (EPTB) in 52.02%, and disseminated TB in 4.04%. Fever (61.27%) was the most common presentation, followed by cough (54.33%) and breathlessness (32.94%). Of the 76 patients with PTB and seven with disseminated TB, making a total of 83 patients, 56 (67.4%) were sputum positive. Out of 90 patients suffering from EPTB, pleural effusion (53.33%) was the commonest type of EPTB, followed by central nervous system (CNS) tuberculosis (26.66%) and abdominal tuberculosis (8.88%). Comorbidities were present in 53.17% of the patients, of which diabetes mellitus (DM) (26.58%) and hypertension (17.34%) were the most common. Comorbid conditions were significantly higher in PTB than EPTB (51 of 83 vs. 41 of 90, p<0.05). Mean glycated hemoglobin (HbA1c) was significantly higher in PTB as compared to EPTB (8.74±2.04 vs. 7.58±0.29, p<0.05). Conclusion Comorbidities, particularly DM, were present in half of the patients, mostly in PTB than EPTB, with glycemic control being significantly poorer in PTB patients.

Journal of Vector Borne Diseases

Background & objectives: Scrub typhus has a wide spectrum of clinical presentations from acut... more Background & objectives: Scrub typhus has a wide spectrum of clinical presentations from acute febrile illness to sepsis with multi-organ failure with poor prognosis. The aim was to study the clinical presentation of scrub typhus and application of SOFA and qSOFA scores of sepsis-3 criteria to determine sepsis and consequent in-hospital outcomes. Methods: A prospective study was carried out in adults (≥18 years), with scrub typhus diagnosed by IgM ELISA. Sepsis-3 criteria were used to identify patients with sepsis and plan subsequent management. Statistical analysis was done using software SPSS 16.0 and p value of less than 0.05 was taken as significant. Results: Of the 78 scrub typhus patients, 38 (48.71%) presented with sepsis. Mean age in the sepsis group was significantly lower than the non-sepsis group (35.41±11.14 versus 43.56±14.31 years, p<0.05). Mortality was 71.05% in the sepsis group compared to nil in the non-sepsis group. On regression analysis, the presence of eschar (OR=5.2, 95% CI=1.15-23.544, P= 0.032), Acute Respiratory Distress Syndrome (ARDS) (OR=5.33, 95% CI= 1.13-25.16, P = 0.034) and a GCS <10 (OR=9.29, 95% CI=1.04-82.96, P=0.046) were significant predictors of mortality in patients of scrub typhus with sepsis. Interpretation & conclusion: Scrub typhus is more common in young age, with significantly younger patients developing sepsis. Presence of eschar, ARDS and GCS<10 were risk factors for mortality in scrub typhus patients with sepsis.

The National medical journal of India

Non-communicable diseases (NCDs)-a term which includes diabetes, cardiovascular disease, cancers,... more Non-communicable diseases (NCDs)-a term which includes diabetes, cardiovascular disease, cancers, chronic respiratory diseases, and mental illness-are now the major cause of death in India and pose healthcare and economic challenges. There is an urgent need for enhanced clinical research training and capacity building for NCD prevention and control in India. We describe a multi-pronged approach funded in part by the US National Institutes of Health Fogarty International Center, which was initiated in 2001, to train Indian present and future scientists/doctors in NCD prevention and control. The approaches used were annual national seminars, intensive training courses, in-house workshops, short-term training sessions in the USA and monthly video conferences. During 2001-2016, a total of 3650 undergraduate, postgraduate and faculty from medical colleges and institutes from almost all states in India and several neighbouring countries participated in seminars and other capacity-building...

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Systemic Lupus Erythematosus (SLE) and Tuberculosis (TB) are intricately related with an increase... more Systemic Lupus Erythematosus (SLE) and Tuberculosis (TB) are intricately related with an increase in the risk of TB in SLE. Primary mechanisms pertaining to the increased susceptibility for TB are the inherent immunodeficient state of SLE and use of immunosuppressant agents in the treatment of SLE. We report a case series of five female patients of SLE with TB who presented between January 2015 and December 2015 in a tertiary care teaching hospital in North Eastern India. All the patients were young to middle aged females having SLE with or without lupus nephritis who were on immunosuppressive therapy with corticosteroids, mycophenolate mofetil or cyclophosphamide. Two of the cases had sputum positive pulmonary tuberculosis while rest had Extra-Pulmonary TB (EPTB). The response to anti-tubercular therapy led to clinical improvement in all the cases except one who had an adverse outcome. Our series further substantiates the increased risk of TB in SLE thus, prompting further research towards better management of these two disease entities in conjunction.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Pulmonary Lymphangitic Carcinomatosis (PLC) occurs in about 6-8% of patients with lung metastasis... more Pulmonary Lymphangitic Carcinomatosis (PLC) occurs in about 6-8% of patients with lung metastasis and may rarely develop in the course of gastric cancer representing a complication due to diffuse metastasis in the lymphatics of the lungs. A 29-year-old female, admitted with difficulty in breathing and productive cough for one week, was initially evaluated for respiratory tract infection. During evaluation of associated anaemia an upper gastrointestinal endoscopy showed large ulcerative growth in the lesser curvature of the stomach suggestive of carcinoma. A High Resolution Computed Tomographic (HRCT) scan of the lungs was done for evaluation of the pulmonary opacities on chest x-ray which showed nodular thickening of interlobular septa with peribronchial cuffing and fissural thickening. The biopsy of the gastric ulcer was suggestive of poorly differentiated malignancy. With the cumulative results of the investigations a diagnosis of poorly differentiated carcinoma of stomach with pulmonary metastasis as lymphangitic carcinomatosis was made. PLC is an extremely rare manifestation of metastatic gastric cancer. Though associated with an extremely poor prognosis, advanced gastric cancer in younger patients presenting with symptoms and signs of respiratory disease should alert the physician of a possible diagnosis of PLC.

Journal of clinical and diagnostic research : JCDR, 2016

Sepsis is the primary cause of death from infection worldwide. In resource-limited countries, inc... more Sepsis is the primary cause of death from infection worldwide. In resource-limited countries, increasing number of sepsis is managed in non-ICU settings, in Medical Wards (MW). To compare the burden, aetiology and short term outcome of sepsis treated in MW with ICU. Prospective, observational, analytical study in sepsis patients in general MW and medical ICU in a tertiary care hospital. Two hundred forty five sepsis patients (MW=150, ICU=95), ≥18 years, selected randomly, were studied to compare aetiology, co-morbidities, clinical & microbiological profile and short-term outcome between MW and ICU sepsis. Sepsis following surgery, trauma, those transferred to/from ICU, those with other life threatening diseases were excluded. Chi-square test/Fisher's-exact test was used for comparing ratios. A 'p-value' <0.05 was considered statistically significant. Sepsis was more common in elderly males, both in MW and ICU (median age: 56.7, 59.2 years; male: female ratios = 1.34:1...

International Journal of Medical Science and Public Health, 2016

Background: Sulfonylureas are mainstay of pharmacotherapy for type 2 diabetes mellitus (T2DM). In... more Background: Sulfonylureas are mainstay of pharmacotherapy for type 2 diabetes mellitus (T2DM). Individual variability exists in pharmacokinetic and pharmacodynamic responses adverse effects to sulfonylurea. Objective: To determine frequency of cytochrome P450 2C9 mutant allele CYP2C93*, in T2DM patients on sulfonylurea therapy, and to ascertain the frequency of adverse drug reactions (ADR) with respect to particular allelic distribution. Materials and Methods: A hospital-based prospective observational study was carried out in a tertiary-care teaching hospital. Study included 136 T2DM patients on sulfonylurea therapy (83 with ≥1 ADR and 53 without ADR). DNA was isolated from the blood samples taken from all 136 patients by DNA isolation. PCR-RFLP (restriction fragment length polymorphism) technique was used for detection of CYP2C93* (Ile359Leu) allele and the wild type allele CYP2C91* by digestion with restriction enzyme. Data were analyzed using Statistical Package for Social Survey (SPSS) for Windows, version 16.0 and Microsoft Excel to determine descriptive statistics. Result: Allele CYP2C93* was detected in 11 patients. All alleles negative for the nucleotide substitutions at position 42614 (*3) were presumed to be wild type CYP2C9*1. Among the patients with CYP2C93* allele 11 patients experienced hypoglycemia and one patient experienced acute visual disturbances. No CYP2C93* was detected in the subjects without ADR. Conclusion: In our study CYP2C93* was identified in 11 patients experiencing hypoglycaemia and in one patient experiencing acute visual disturbances. In view of the existence of such polymorphisms and its effects on sulfonylurea therapy further studies are required to assess the magnitude of such problems in T2DM.

International Journal of Biomedical and Advance Research, 2016

Background: Acute viral hepatitis is associated with significant hepatic dysfunction including li... more Background: Acute viral hepatitis is associated with significant hepatic dysfunction including lipid metabolism. Variations in the serum lipid fractions in acute viral hepatitis due to hepatic injury may serve as prognostic marker for severity of hepat ic injury. Methods: Hospital-based prospective study on acute viral hepatitis. Fifty cases of acute viral hepatitis and 50 age and sex matched controls, (>18 years) were studied. Routine biochemical investigation, hepatotropic viral serology and fasting serum lipid fractions were analysed for changes in patients with acute viral hepatitis. Chi-square test was used for comparing variables. A 'p value' <0.05 was considered statistically significant. Results: Baseline parameters were similar between cases and controls (p>0.05). Jaundice (100%) and high coloured urine (100%) were the commonest presentations. Hepatitis A virus (52%) and Hepatitis E virus (30%) were commonest aetiological agents. Serum cholesterol, triglycerides, low density lipoprotein (LDL) were significantly higher (p<0.01) while high density lipoprotein (HDL) was significantly lower (p<0.01) in acute viral hepatitis compared to controls. There was no statistically significant difference in the levels of very LDL between cases and controls (p>0.05). Complications were seen in 7 (14%) cases with hepatic encephalopathy being the commonest (6%). Serum cholesterol, triglycerides, LDL were significantly higher and HDL was significantly lower in hepatitis with complications compared to uncomplicated hepatitis (p<0.01). Conclusion Acute viral hepatitis leads to significant alterations of serum lipid fractions which may serve as an indicator of severity of liver damage and be helpful in assessing the prognosis of patients with acute viral hepatitis.

Monogram: Chronic Diarrhea, 2016

Indian Journal of Medical Specialities, 2015

ABSTRACT Abstract Introduction Alcohol and its relationship to ill health have been recognized as... more ABSTRACT Abstract Introduction Alcohol and its relationship to ill health have been recognized as an important public health challenge even though alcohol use has been part of the cultural tradition in different societies. It is known that alcohol contributes to more than 200 different health problems. We planned to study the burden of the diseases and clinical presentations of alcoholism. Methods and results Two thousand adult patients (one thousand male and one thousand female) were selected by systematic random sampling from all hospital admissions into the Department of General Medicine from February 2012 to August 2013 and screened for alcohol related admissions including different alcohol related diseases. Results The prevalence of alcohol related admissions were 13.3% and 2.3% respectively in male and female patients. Majority of patients belonged to age group 31–50 years. The most common presentation in both sexes was chronic liver disease and its complications. Alcohol dependence syndrome was more common in males as compared to females. Conclusion Since alcohol related hospitalization in this region was found quite high and affecting predominantly people in the prime age between 30 and 50 years of both sexes, this has a significant impact on the health and economic burden of the society. Keywords Alcoholism; Alcohol related diseases; North eastern India

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2016

Malaria is one of the most common protozoan diseases, especially in tropical countries. The clini... more Malaria is one of the most common protozoan diseases, especially in tropical countries. The clinical manifestation of malaria, especially falciparum malaria varies from mild acute febrile illness to life threatening severe systemic complications involving one or more organ systems. We would like to report a case of complicated falciparum malaria involving cerebral, renal, hepatic system along with acute pancreatitis. The patient was successfully treated with anti malarial and other supportive treatment. To the best of our knowledge there are very few reports of acute pancreatitis due to malaria. Falciparum malaria therefore should be added to the list of infectious agents causing acute pancreatitis especially in areas where malaria is endemic.

International Journal of Medical Science and Public Health, 2015

Background: Maintenance of physical fitness is a cornerstone of geriatric preventive care. Senior... more Background: Maintenance of physical fitness is a cornerstone of geriatric preventive care. Senior fitness test (SFT) is a simple test for assessing physical fitness of the geriatric population. However, its reliability in the Indian setting has not been well established. Objective: To determine the relative and absolute test-retest reliability of SFT as a physical fitness tool of the geriatric population in the community. Materials and Methods: A community-based prospective, nonexperimental study was carried out in an urban community of Guwahati, Assam, India. Thirty-one physically active, elderly individuals (aged ≥65 and <75 years) were asked to perform the SFT, at baseline and at a second session after 2-3 days, to assess the reliability of the test. Intra-rater variability and intraclass correlation coefficients (ICC) of the SFT were assessed. Reliability of the tests was measured using the standard error of measurement (SEM), minimal detectable change (MDC), and log-transferred limits of agreement of Bland-Altman plots. Result: The relative reliability of entire physical fitness test (SFT) was shown to be excellent. The ICC at the 95% confidence interval (CI) for all the tests ranged between 0.933 and 1.000. The F test values were significant for all the tests (0.00). The width of the CI of ICC ranged between 0.0 and 0.107 with body mass index having the smallest CI (0.0) and arm curl test (0.1.07) having the largest CI. The SEM and MDC values were small ranging from 0.43 to 0.0 and from 0.0 to 1.8 for all tests except for the 2-min step test. The SEM and MDC for the 2-min step test was 1.48 and 4.12, respectively. Bland-Altman plots for all the tests were positively skewed and heteroscedastic. Conclusion: Test-retest reliability of the physical fitness test was excellent and these tests were thus applicable for cross-sectional and controlled interventional studies for the elderly population.

Grudnaia i serdechno-sosudistaia khirurgiia / Ministerstvo zdravookhraneniia SSSR [i] Vsesoiuznoe nauchnoe obshchestvo khirurgov