Sreethish Sasi - Academia.edu (original) (raw)

Papers by Sreethish Sasi

Acta Bio Medica : Atenei Parmensis, 2020

Background: Eosinophils can be considered as multifunctional leukocytes that contribute to variou... more Background: Eosinophils can be considered as multifunctional leukocytes that contribute to various physiological and pathological processes depending on their location and activation status. There are emerging eosinophil-related considerations concerning COVID-19. Variable eosinophil counts have been reported during COVID-19. Whether these changes are related to the primary disease process or due to immunomodulation induced by the treatment has not yet been elucidated. Aim of the study: To describe changes in the differential leukocyte counts including eosinophils, in a cohort of symptomatic patients with confirmed COVID-19 and to correlate these changes, if any, with the severity of the disease. Patients and methods: We recorded the clinical data, lab findings, including inflammatory markers and leukocyte and differential count, course of the disease and severity score in 314 confirmed symptomatic cases of COVID-19. Results: Laboratory tests revealed that 28.7 % (n =86) had mild eo...

1.7% of myeloproliferative neoplasms are associated with autoimmune conditions. Association of my... more 1.7% of myeloproliferative neoplasms are associated with autoimmune conditions. Association of myasthenia gravis (MG) with chronic myeloid leukemia is reported, but its association with polycythemia vera (PV) has never been reported. We report two patients who had MG and PV with JAK2V617F mutation. Both had splenomegaly but no thymoma.

Clinical Case Reports, 2021

The paper presents a case of bilateral facial nerve palsy and its unique presentation. It discuss... more The paper presents a case of bilateral facial nerve palsy and its unique presentation. It discusses the etiologies of bilateral facial nerve palsy. We aim to provide awareness to its presentation, diagnosis, and management.

The American Journal of Tropical Medicine and Hygiene, 2021

COVID-19 has surfaced as a multi-organ disease predominantly affecting the respiratory system. De... more COVID-19 has surfaced as a multi-organ disease predominantly affecting the respiratory system. Detection of the viral RNA through reverse transcriptase–PCR (RT-PCR) from a nasopharyngeal or throat sample is the preferred method of diagnosis. Recent evidence has suggested that COVID-19 patients can shed the SARS-CoV-2 for several weeks. Herein, we report six cases of COVID-19 who had persistently positive SARS-CoV-2 on repeat RT-PCR testing reaching up to 9 weeks. The spectrum of cases described ranges from asymptomatic infection to severe COVID-19 pneumonia. A full understanding of the virus’s transmission dynamics needs further research. Prolonged viral shedding currently has unclear implications on the management and isolation decisions—the role of the cycle threshold (Ct) value in guiding therapeutic decisions is yet to be clarified. More data on the relationship between Ct values and viral cultivation are needed, especially in patients with prolonged viral shedding, to understan...

Disseminated fungemia due to non-Candida yeasts is emerging as an opportunistic infection in hema... more Disseminated fungemia due to non-Candida yeasts is emerging as an opportunistic infection in hematological malignancies with prolonged neutropenia. Invasive infections by Geotrichum spp. are extremely rare and constitute only about 1% of all non-Candida yeasts. The mortality in such patients is high and is seldom reported in the literature. Here, we describe the case of a middle-aged male with treatment-resistant Hodgkin's lymphoma who developed invasive Geotrichum capitatum infection during his neutropenic phase, with poor response to combination therapy with voriconazole and amphotericin B. He was diagnosed from blood culture but succumbed to death on day 10 of admission in spite of treatment with multiple lines of antifungals. G. capitatum is responsible for fatal fungemia in patients with prolonged neutropenia complicating hematological malignancies. A high index of suspicion is required in this patient group to identify disseminated geotrichosis as delay in treatment worsen...

Clinical Case Reports, 2021

Screening for MG in patients with PV positive for JAK2V617F mutation can help in early diagnosis ... more Screening for MG in patients with PV positive for JAK2V617F mutation can help in early diagnosis and treatment, resulting in a significant reduction in morbidity and mortality.

Tuberculosis (TB) is a common post-transplant infection with high prevalence in developing countr... more Tuberculosis (TB) is a common post-transplant infection with high prevalence in developing countries due to reactivation. Post-transplant TB involves the respiratory system in 50% of patients, followed by disseminated involvement in 30%. The risk of tuberculosis of renal allograft post-transplantation is determined by disease endemicity in the donor population and the immunosuppressant regimen. TB can cause allograft rejection and graft loss due to delayed diagnosis or reduced immunosuppressant drug efficacy. A 23-year-old lady was seen 40 days after cadaveric unrelated renal transplantation from China. She was on immunosuppression with tacrolimus, mycophenolate, and prednisolone. Examination showed low-grade fever and infected surgical site in the right iliac fossa draining pus. Imaging showed fluid pockets, parenchymal micro-abscesses, and perinephric collections in the right iliac fossa communicating with skin. A diagnosis of renal allograft TB without dissemination was made afte...

BMJ Open Quality

Prescription of oxygen therapy has traditionally poor compliance across the globe and mostly give... more Prescription of oxygen therapy has traditionally poor compliance across the globe and mostly given to patients on verbal orders leading to under or overuse. The British Thoracic Society (BTS) guidelines (2017) recommend that oxygen therapy must be prescribed. Our study aimed to assess the prescription practice of oxygen therapy for patients admitted to acute medical assessment unit and general medical wards at Hamad General Hospital, Qatar and to achieve 80% compliance of valid oxygen therapy prescription implementing the quality improvement model against the BTS guidelines.The prescription practice of oxygen therapy was audited between April 2019 and August 2019. Using a Plan, Do, Study, Act (PDSA) model of improvement and multiple interventions was performed in the eight PDSA cycles, including (1) educational sessions for residents/fellows/nurses, (2) introduction of electronic prescription, (3) emails, posters/flyers, (4) nurse-led reminders and (5) re-enforced teaching for new r...

Dubai Medical Journal

Introduction: Aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH) are bone marrow ... more Introduction: Aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH) are bone marrow failure syndromes. A 20–40% of patients with AA have a PNH clone at diagnosis. To date, there are little data about the course of COVID-19 in patients with AA and PNH. Case Presentation: A 36-year-old gentleman, who was previously diagnosed as a case of AA with PNH clones off immune-suppressive therapy, presented with fever and cough and was diagnosed with mild pneumonia due to COVID-19 with positive nasopharyngeal swab polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2. His clinical course was benign except transient thrombocytopenia. He was asymptomatic after day 4, and viral PCR was negative on day 21. Discussion: Though studies have shown that COVID-19 is associated with lymphopenia, our patient had a normal to high lymphocyte count. The neutrophil to lymphocyte ratio (NLR) was <1 during COVID-19, which correlates with the mild course of the diseas...

Case Reports in Oncology

The commonest etiologies of new-onset pancytopenia are congenital bone marrow failure syndromes, ... more The commonest etiologies of new-onset pancytopenia are congenital bone marrow failure syndromes, marrow space-occupying lesions, infections, and peripheral destruction. Nutritional deficiencies, including folate and vitamin B12, can occasionally cause pancytopenia. We report a 48-year-old gentleman who presented with a 1-week history of dizziness and upper gastrointestinal bleeding. Laboratory evaluation revealed pancytopenia, macrocytosis, toxic neutrophils, hemolysis, suppressed reticulocyte count, positive direct anti-globulin test (DAT), severely reduced B12 levels, and positive anti-intrinsic factor and anti-parietal cell antibodies. He was started on weekly intramuscular B12 supplementation and showed improvement in blood cell counts during follow-up. Recognition of B12 deficiency as a cause of pancytopenia and DAT-positive autoimmune hemolytic anemia can help to avoid unwanted investigations and aid in early diagnosis and treatment.

Obesity Surgery

Purpose Bariatric surgeries are common procedures due to the high prevalence of obesity. This stu... more Purpose Bariatric surgeries are common procedures due to the high prevalence of obesity. This study aimed to investigate whether bariatric surgery increases fracture risk. Material and Methods It was a case-controlled study. Patients who underwent bariatric surgery during 2011 and 2012 were matched for age (± 5 years) and gender to patients on medical weight management during the same period with a ratio of 1:2. The index date was defined as the date of bariatric surgery for both groups. The subject’s electronic medical records were reviewed retrospectively to identify fractures documented by radiology during January 2020. Results Randomly selected 403 cases were matched to 806 controls with a median age of 36.0 years (IQR 14.0) and 37.0 years (IQR 14.0), respectively. Seventy per cent of the cohort were females. Eighty per cent received sleeve gastrectomy, and the remaining (17%) underwent gastric bypass. The mean duration of follow-up was 8.6 years. The fracture rate was higher in...

American Journal of Case Reports

Patient: Gender, 26-year-old Final Diagnosis: COVID-19 Symptoms: Cough • fever Medication:— Clini... more Patient: Gender, 26-year-old Final Diagnosis: COVID-19 Symptoms: Cough • fever Medication:— Clinical Procedure: — Specialty: Hematology Objective: Rare co-existance of disease or pathology Background: Beta-hemoglobinopathies and glucose-6-phosphate dehydrogenase (G6PD) deficiency are genetic disorders that cause hemolytic anemia when exposed to oxidative stress. Their co-existence is, however, not proven to enhance the severity of anemia. Case Report: We report the case of a young man with no known co-morbidities, who came with fever and cough and was diagnosed with COVID-19 pneumonia. He was found to have hemoglobin D thalassemia and G6PD deficiency during further evaluation. Hydroxychloroquine therapy started initially, was discontinued after 3 doses once the G6PD deficiency was diagnosed. His hospital course showed a mild drop in hemoglobin with evidence of hemolysis on peripheral smear. However, the hemoglobin improved without any need for transfusion. Conclusions: Hydroxychloroquine therapy can induce hemolytic crises in patients with underlying G6PD deficiency or hemoglobinopathies and should be avoided or closely monitored. Immediate intervention to stop hydroxychloroquine after 3 doses saved our patient from a major hemolytic crisis. The significance of this case report is that it is the first report that outlines the clinic course of COVID-19 pneumonia in a patient with underlying hemoglobin D disease and G6PD deficiency.

Transplant Infectious Disease

The emergence of hepatitis B surface antigen in a patient with previously negative hepatitis B vi... more The emergence of hepatitis B surface antigen in a patient with previously negative hepatitis B virus (HBV) serology post‐orthotropic liver transplant (OTLX) is known as de novo hepatitis B (DNHB). As there are no data on patients with DNHB available from Qatar, we aim to do a pioneer study indexing their clinical profile and epidemiology of patients with DNHB in Qatar.

Case Reports in Acute Medicine

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug r... more Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug reaction presenting with rash, fever, lymphadenopathy, and single or multiple organ involvement. It is most commonly associated with antiepileptics, NSAIDs, and sulfa drugs. We report a 40-year-old man who presented with a 1-week history of fever, sore throat, and a diffuse pruritic macular rash that started on the face and trunk before spreading to all extremities 4 weeks after the use of naproxen. He had lymphadenopathy, hepatosplenomegaly, transaminitis, and peripheral eosinophilia. A Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) score of 8 gave a diagnosis of definite DRESS syndrome. Significant resolution of symptoms and laboratory abnormalities were seen after 2 weeks of corticosteroid therapy. DRESS syndrome is a life-threatening condition, and the clinical status of patients can worsen rapidly. Given the high variability in clinical presentation, the diagnosis of DRESS...

Case Reports in Acute Medicine

Artery of Percheron (AOP) is an abnormal variant of the arterial supply of the thalamus. AOP occl... more Artery of Percheron (AOP) is an abnormal variant of the arterial supply of the thalamus. AOP occlusion can lead to bilateral thalamic and rostral midbrain infarct presenting as memory loss, fluctuating levels of consciousness, and altered mental status. A 43-year-old woman with a history of antiphospholipid syndrome (APS), managed on dabigatran, presented with acute confusion and drowsiness. She had slurred and slowed speech, disorientation in time and place, left-sided facial droop, decreased power of the left side (4/5), and was unable to walk due to generalized weakness. Labs showed a prolonged prothrombin time and activated partial thromboplastin time, positive lupus anticoagulant, anti-cardiolipin, beta-2 glycoprotein, anti-nuclear and anti-dsDNA antibodies. Contrast-enhanced CT perfusion showed ischemic changes in the bilateral thalami, suggesting infarct along the AOP territory. AOP infarcts are scarce and the presenting complaints are unusual of cerebrovascular accidents. It...

A systematic review of case reports was conducted by searching PubMed, Scopus, and Google scholar... more A systematic review of case reports was conducted by searching PubMed, Scopus, and Google scholar to identify case reports in which there is an association between Myasthenia Gravis (MG) and Myeloproliferative Neoplasms (MPNs) and know whether MG can be considered a possible neurological paraneoplastic syndrome in patients with MPNs.

Case Reports in Oncology

Acquired von Willebrand Disease (AVWD) is a rare disorder in which qualitative or quantitative de... more Acquired von Willebrand Disease (AVWD) is a rare disorder in which qualitative or quantitative defects in von Willebrand factor (VWF) occur secondary to other conditions. AVWD occurs in patients with myeloproliferative disorders due to formation of autoantibodies against VWF and development of excessive shear stress causing disruption of VWF multimers. AVWD is different from congenital VWD in its acute onset and absence of family history. We report a 42-year-old gentleman with essential thrombocythemia, who was on cytoreductive therapy with hydroxyurea, and presented with an acute history of gum bleeding with hemoptysis, without any antecedent trauma or infections. His platelet count was very high, and prothrombin time and activated partial thromboplastin time were prolonged. The VWF ristocetin cofactor assay (VWF: RCo) was low, but VWF antigen level (VWF: Ag) was normal. Their ratio (VWF: RCo/VWF: Ag) was much lower than the acceptable lower limit. Treatment in AVWD is focused on a...

Background: There is a scarcity of data regarding the effect of hypertension on the clinical pres... more Background: There is a scarcity of data regarding the effect of hypertension on the clinical presentation and outcome of symptomatic patients with COVID-19 infection in comparison with non-hypertensive patients. Aim of the study: To describe the clinical presentation, radiological and hematological data of a cohort of symptomatic COVID-19 positive hypertensive patients (n = 50) in comparison with another cohort of normotensive symptomatic COVID-19 positive patients (n = 250) diagnosed at the same time and managed in the same health facilities (from January 2020 to May 2020). Associated comorbidities were assessed, and the Charlson Comorbidity Index was calculated. The outcomes, including duration of hospitalization, length of intensive care unit (ICU) stay, duration of mechanical ventilation, and duration of O2 supplementation, were also assessed. Results: The prevalence of hypertension in symptomatic COVID-19 positive patients was 50/300 (16%; the prevalence of hypertension in Qata...