Arun Nair | University of Calicut, Kerala, India (original) (raw)

Papers by Arun Nair

Frontiers in Microbiology, Jan 26, 2023

International Urology and Nephrology

Purpose COVID-19 frequently affects the kidneys with symptoms ranging from mild proteinuria to pr... more Purpose COVID-19 frequently affects the kidneys with symptoms ranging from mild proteinuria to progressive acute kidney injury. This prospective study aimed to assess the short- and long-term impact of asymptomatic and mild COVID-19 on the renal function of healthy young adults, and to determine the correlation between viral load and kidney function among these patients. Methods This was a prospective cohort study conducted over a period of 6 months. Patients were followed-up at baseline, and then after 3 and 6 months, respectively. Real-time PCR cycle threshold (CT) was used to determine the viral load and disease activity. Patients were classified into two groups with either asymptomatic COVID-19 or mild pneumonia. The assessment parameters were variables that could directly or indirectly relate to the renal function. Results A total of 48 patients were included and evaluated. The majority of patients (62.5%) had asymptomatic COVID-19 disease. Patients with mild pneumonia had sign...

Clinical Case Reports, 2022

Remdesivir was the first antiviral agent to receive FDA authorization for severe COVID‐19 managem... more Remdesivir was the first antiviral agent to receive FDA authorization for severe COVID‐19 management, which restricts its use with severe renal impairment due to concerns that active metabolites might accumulate, causing renal toxicities. With limited treatment options, available evidence on such patient groups is important to assess for future safety.

Open Access Macedonian Journal of Medical Sciences, 2021

BACKGROUND: Reports on coronavirus disease 2019 (COVID-19) associated with acute pancreatitis con... more BACKGROUND: Reports on coronavirus disease 2019 (COVID-19) associated with acute pancreatitis continue to emerge. In this series, we present three cases of acute pancreatitis associated with COVID-19 with no obvious etiology. CASE REPORTS: The first case was a 47-year-old man who presented with severe abdominal periumbilical pain, preceded by fever and dry cough. Based on a positive COVID-19 polymerase chain reaction (PCR) test and elevated serum amylase and lipase >3 times the upper normal limit, the diagnosis of COVID-19 and acute pancreatitis were established. The next case was a 57-year-old man with confirmed COVID-19 who developed severe epigastric pain radiating to the back and was associated with nausea and vomiting. His serum amylase and lipase were elevated >3 times the upper normal limit confirming the diagnosis of acute pancreatitis. The third case was a 31-year-old man who presented to the emergency department with a few hours of severe epigastric pain radiating to...

Acta Bio Medica : Atenei Parmensis, 2020

Background: Plain chest radiograph (CXR), although less sensitive than chest CT, is usually the f... more Background: Plain chest radiograph (CXR), although less sensitive than chest CT, is usually the first-line imaging modality used for patients with symptomatic SARS-CoV-2 infection. The relation between radiological changes in CXR and clinical severity of the disease in symptomatic patients with COVID 19 has not been fully studied and there is no scoring system for the severity of the lung involvement, using the plain CXR. Aim of the study: Current COVID-19 radiological literature is dominated by CT and a detailed description CXR appearances in relation to the disease time course is lacking. We propose an easy scoring system (CO X-RADS) to describe the severity of chest involvement in symptomatic COVID 19 patients using CXR and to correlate the radiological changes with the clinical severity of the disease. Patients and methods: The clinical manifestations and CXR findings were recorded in 500 symptomatic COVID-19 positive patients who were admitted to Hamad Medical Corporation (HMC)...

Acta Bio Medica : Atenei Parmensis, 2020

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...

BackgroundThe global pandemic of COVID-19 infections continues to grow worldwide, with rising num... more BackgroundThe global pandemic of COVID-19 infections continues to grow worldwide, with rising number of deaths day by day. The hyperinflammation state contributes to the multiorgan failure associated with COVID-19 infections. This study aims to explore the efficacy and safety of anakinra in COVID-19 patients with both respiratory distress and cytokine release syndromes.MethodsThis was an open-label, multicenter, randomized clinical trial. Patients were randomized in 1:1 ratio to receive standard of care (SOC) alone, or anakinra plus SOC. Adults with confirmed COVID-19 infection with evidence of both respiratory distress and cytokine release syndrome were included. The primary outcome was treatment success at day 14, defined as WHO clinical progression score of ≤3. The primary analysis was based on intention-to-treat population, with p-value of <0.05.ResultsA total of 80 patients were enrolled in the study. The mean age was 49.9 years (SD=11.7), with 82.5% (n=66) male patients. Th...

Dubai Medical Journal, 2021

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 Acute Medicine, 2020

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...

Journal of Microbiology and Infectious Diseases, 2019

Brain abscess is a collection of pus in the parenchyma of brain. Most common infecting organisms ... more Brain abscess is a collection of pus in the parenchyma of brain. Most common infecting organisms are streptococci, staphylococci and anaerobes, depending upon the source from which it originates. Clostridium cadaveris and Clostridium sporogenes are common organisms found in the gastrointestinal tract of humans, rarely producing disease. Few cases of bacteremia and abscesses are reported with these organisms. We hereby report the first case of brain abscess with C cadaveris and C. sporogenes in a young male with good outcome by surgical and medical management.

The American Journal of Tropical Medicine and Hygiene, 2021

ABSTRACTCOVID-19 has surfaced as a multi-organ disease predominantly affecting the respiratory sy... more ABSTRACTCOVID-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 u...

Qatar Medical Journal, 2016

Rabies is a zoonotic disease with the highest fatality rate of any infectious disease. The clinic... more Rabies is a zoonotic disease with the highest fatality rate of any infectious disease. The clinical features of rabies encephalopathy are highly nonspecific at the onset and clinicians from low endemic areas usually face difficulties in recognizing cases during the early stages. The need for establishing a rapid and accurate test to identify rabies during the ante-mortem period is important. However, in actual clinical practice, the latter may remain difficult for various reasons. In human rabies, positively identifying the antigen, antibody or genetic material by various diagnostic methods during the symptomatic period is affected by the unpredictable nature of viremia, levels of antibody immune response of the host, and the virulence of the infecting strain. Also, more advanced testing with greater sensitivity may not be readily available at all centers. Here we describe a case of a young male who was bitten by a rabid dog and developed progressive encephalopathy with a fatal outc...

Cureus

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 lowgrade 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 after TB polymerase chain reaction (PCR) from early morning urine was positive. She was started on anti-TB therapy. The sinus tract healed, and renal parameters improved after six months of therapy. Follow-up magnetic resonance imaging (MRI) showed resolution of the micro-abscesses as well as the surrounding fluid collection. Renal angiogram demonstrated well-perfused, normally functioning, non-obstructed renal transplant. Tuberculosis of renal allograft should be considered in a transplant recipient with pyrexia of unknown origin and persistent discharge from the surgical site, not responding to antimicrobials. Tuberculosis of transplant kidney can cause graft loss due to allograft rejection when there is a delayed diagnosis, or as anti-TB drugs reduce the efficacy of immunosuppressant medications. The index of suspicion should be high when donor status is unknown or if the donor is from an endemic tuberculosis area. Timely diagnosis and treatment helped to save the transplanted kidney of our patient without rejection.

Frontiers in Microbiology, Jan 26, 2023

International Urology and Nephrology

Purpose COVID-19 frequently affects the kidneys with symptoms ranging from mild proteinuria to pr... more Purpose COVID-19 frequently affects the kidneys with symptoms ranging from mild proteinuria to progressive acute kidney injury. This prospective study aimed to assess the short- and long-term impact of asymptomatic and mild COVID-19 on the renal function of healthy young adults, and to determine the correlation between viral load and kidney function among these patients. Methods This was a prospective cohort study conducted over a period of 6 months. Patients were followed-up at baseline, and then after 3 and 6 months, respectively. Real-time PCR cycle threshold (CT) was used to determine the viral load and disease activity. Patients were classified into two groups with either asymptomatic COVID-19 or mild pneumonia. The assessment parameters were variables that could directly or indirectly relate to the renal function. Results A total of 48 patients were included and evaluated. The majority of patients (62.5%) had asymptomatic COVID-19 disease. Patients with mild pneumonia had sign...

Clinical Case Reports, 2022

Remdesivir was the first antiviral agent to receive FDA authorization for severe COVID‐19 managem... more Remdesivir was the first antiviral agent to receive FDA authorization for severe COVID‐19 management, which restricts its use with severe renal impairment due to concerns that active metabolites might accumulate, causing renal toxicities. With limited treatment options, available evidence on such patient groups is important to assess for future safety.

Open Access Macedonian Journal of Medical Sciences, 2021

BACKGROUND: Reports on coronavirus disease 2019 (COVID-19) associated with acute pancreatitis con... more BACKGROUND: Reports on coronavirus disease 2019 (COVID-19) associated with acute pancreatitis continue to emerge. In this series, we present three cases of acute pancreatitis associated with COVID-19 with no obvious etiology. CASE REPORTS: The first case was a 47-year-old man who presented with severe abdominal periumbilical pain, preceded by fever and dry cough. Based on a positive COVID-19 polymerase chain reaction (PCR) test and elevated serum amylase and lipase >3 times the upper normal limit, the diagnosis of COVID-19 and acute pancreatitis were established. The next case was a 57-year-old man with confirmed COVID-19 who developed severe epigastric pain radiating to the back and was associated with nausea and vomiting. His serum amylase and lipase were elevated >3 times the upper normal limit confirming the diagnosis of acute pancreatitis. The third case was a 31-year-old man who presented to the emergency department with a few hours of severe epigastric pain radiating to...

Acta Bio Medica : Atenei Parmensis, 2020

Background: Plain chest radiograph (CXR), although less sensitive than chest CT, is usually the f... more Background: Plain chest radiograph (CXR), although less sensitive than chest CT, is usually the first-line imaging modality used for patients with symptomatic SARS-CoV-2 infection. The relation between radiological changes in CXR and clinical severity of the disease in symptomatic patients with COVID 19 has not been fully studied and there is no scoring system for the severity of the lung involvement, using the plain CXR. Aim of the study: Current COVID-19 radiological literature is dominated by CT and a detailed description CXR appearances in relation to the disease time course is lacking. We propose an easy scoring system (CO X-RADS) to describe the severity of chest involvement in symptomatic COVID 19 patients using CXR and to correlate the radiological changes with the clinical severity of the disease. Patients and methods: The clinical manifestations and CXR findings were recorded in 500 symptomatic COVID-19 positive patients who were admitted to Hamad Medical Corporation (HMC)...

Acta Bio Medica : Atenei Parmensis, 2020

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...

BackgroundThe global pandemic of COVID-19 infections continues to grow worldwide, with rising num... more BackgroundThe global pandemic of COVID-19 infections continues to grow worldwide, with rising number of deaths day by day. The hyperinflammation state contributes to the multiorgan failure associated with COVID-19 infections. This study aims to explore the efficacy and safety of anakinra in COVID-19 patients with both respiratory distress and cytokine release syndromes.MethodsThis was an open-label, multicenter, randomized clinical trial. Patients were randomized in 1:1 ratio to receive standard of care (SOC) alone, or anakinra plus SOC. Adults with confirmed COVID-19 infection with evidence of both respiratory distress and cytokine release syndrome were included. The primary outcome was treatment success at day 14, defined as WHO clinical progression score of ≤3. The primary analysis was based on intention-to-treat population, with p-value of <0.05.ResultsA total of 80 patients were enrolled in the study. The mean age was 49.9 years (SD=11.7), with 82.5% (n=66) male patients. Th...

Dubai Medical Journal, 2021

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 Acute Medicine, 2020

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...

Journal of Microbiology and Infectious Diseases, 2019

Brain abscess is a collection of pus in the parenchyma of brain. Most common infecting organisms ... more Brain abscess is a collection of pus in the parenchyma of brain. Most common infecting organisms are streptococci, staphylococci and anaerobes, depending upon the source from which it originates. Clostridium cadaveris and Clostridium sporogenes are common organisms found in the gastrointestinal tract of humans, rarely producing disease. Few cases of bacteremia and abscesses are reported with these organisms. We hereby report the first case of brain abscess with C cadaveris and C. sporogenes in a young male with good outcome by surgical and medical management.

The American Journal of Tropical Medicine and Hygiene, 2021

ABSTRACTCOVID-19 has surfaced as a multi-organ disease predominantly affecting the respiratory sy... more ABSTRACTCOVID-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 u...

Qatar Medical Journal, 2016

Rabies is a zoonotic disease with the highest fatality rate of any infectious disease. The clinic... more Rabies is a zoonotic disease with the highest fatality rate of any infectious disease. The clinical features of rabies encephalopathy are highly nonspecific at the onset and clinicians from low endemic areas usually face difficulties in recognizing cases during the early stages. The need for establishing a rapid and accurate test to identify rabies during the ante-mortem period is important. However, in actual clinical practice, the latter may remain difficult for various reasons. In human rabies, positively identifying the antigen, antibody or genetic material by various diagnostic methods during the symptomatic period is affected by the unpredictable nature of viremia, levels of antibody immune response of the host, and the virulence of the infecting strain. Also, more advanced testing with greater sensitivity may not be readily available at all centers. Here we describe a case of a young male who was bitten by a rabid dog and developed progressive encephalopathy with a fatal outc...

Cureus

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 lowgrade 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 after TB polymerase chain reaction (PCR) from early morning urine was positive. She was started on anti-TB therapy. The sinus tract healed, and renal parameters improved after six months of therapy. Follow-up magnetic resonance imaging (MRI) showed resolution of the micro-abscesses as well as the surrounding fluid collection. Renal angiogram demonstrated well-perfused, normally functioning, non-obstructed renal transplant. Tuberculosis of renal allograft should be considered in a transplant recipient with pyrexia of unknown origin and persistent discharge from the surgical site, not responding to antimicrobials. Tuberculosis of transplant kidney can cause graft loss due to allograft rejection when there is a delayed diagnosis, or as anti-TB drugs reduce the efficacy of immunosuppressant medications. The index of suspicion should be high when donor status is unknown or if the donor is from an endemic tuberculosis area. Timely diagnosis and treatment helped to save the transplanted kidney of our patient without rejection.